When you get hurt at work or your doctor diagnoses you with a condition caused by your employment, workers’ compensation benefits will cover the cost of your treatment. Workers’ compensation will cover all of your expenses, from surgery to physical therapy.
Provided that the doctor overseeing your care agrees that certain treatment is necessary, you won’t have any patient responsibility to help pay for those expenses. However, at some point, the state may limit your treatment options. If the doctor overseeing your care determines that you have achieved maximum medical improvement, that determination will limit your future medical benefits.
When does a worker achieve maximum medical improvement?
When treatment won’t likely help them get better
Typically, a doctor can state that you have achieved maximum medical improvement when the medical condition is stable and is unlikely to continue improving over the next year. Even if you still have limitations or symptoms, treatment may not have much impact.
Both your overall prognosis and your response to treatment will influence when a doctor declares that there will be diminishing returns on any future medical interventions. While achieving maximum medical improvement bodes well for your health, it may mean that you no longer have as much medical coverage and may have to accept different job responsibilities because you will not fully recover.
It is important to note that maximum medical improvement does not completely end all medical coverage, as you could continue receiving certain benefits for necessary maintenance care, like pain management prescriptions. Learning more about the rules that govern workers’ compensation claims in California will help you get the support you need as you recover from your condition.