An injured worker's "Medical End Result”, “end medical result” or “maximum medical improvement, are all terms that refer to an important milestone in a workers' compensation claim. The term Medical End Result is somewhat of a misnomer in that it does not indicate that medical treatment is at an end. We will address here how Medical End Result is defined and what information and factors the Department reviews in determinations of Medical End Result. We will also address the benefit implications an injured worker may face upon reaching Medical End Result.
"Medical End Result" defined
Vermont workers' compensation rule 2.1200 defines Medical End Result or End Medical Result as:
The point at which the person has reached a substantial plateau in the medical recovery process, such that significant further improvement is not expected, regardless of treatment.
By definition, the injured worker has recovered about as much as is expected such that their condition is stable. Their condition may still wax and wane, but no significant further improvement in is likely. Moreover, additional medical treatment is not expected to improve the workers’ condition. If further medical treatment is expected to improve an injured workers' condition, then the individual is not at medical end result.
Some physicians or care providers use other terms interchangeably with medical end result. Maximum Medical Improvement is just one term sharing the same meaning.
Objective Evidence is necessary in determining Medical End Result
The Department requires a medical provider’s opinion, supported by objective evidence that an injured worker is at Medical End. Medical providers are frequently asked when and whether an injured worker has reached Medical End. Medical providers do not always possess a complete understanding of what the term means. A physician’s mere statement of “Medical End’ or Not at Medical End” alone is not sufficient for workers’ compensation actions and decisions. The opinion must be supported by objective medical evidence.Medical End Result Milestone
Medical End Result is the point of focus in many claims because it presents an opportunity for the insurance carrier to stop paying specific benefits. It also marks the point at which other benefits may start.
Lost Time Benefits and Medical End Result
In the Vermont workers' compensation system, once an injured worker reaches Medical End Result, the insurance adjuster may stop payment of lost time benefits (Temporary Total or Temporary Partial Disability benefits) by filing a Notice of Intention to Discontinue Benefits (Form 27) properly supported with medical evidence establishing Medical End Result.
“Disability” is different from Medical End Result
With some injuries an individual may remain disabled, that is unable to work, even after their medical condition has improved and they are stable. Under Vermont law, lost time benefits may cease at Medical End Result, despite continuing disability. This is because Medical End Result and disability are two different considerations. An injured worker who is disabled, but whose medical condition has stabilized and no significant further improvement is expected may be found at Medical End Result and may cease to receive lost wage benefits.
Permanent Impairment Benefits and Medical End Result
An injured worker may be entitled to Permanent Impairment Benefits after reaching Medical End Result. The insurance adjuster handling the claim frequently writes to the treating physician or schedules an Independent Medical Evaluation (IME) to ask such questions as; 1)whether medical end has occurred; 2) whether there is a permanent impairment and, if so; 3) permanent impairment rating. Not all injuries result in permanent impairment. If a medical provider determines that the injured worker has suffered a permanent impairment, then benefits for that impairment may commence.
Disputes about Medical End Result
The Vermont workers' compensation system allows opinions from all parties to a workers' compensation claim. The injured worker may be treating with a physician who has an opinion concerning Medical End Result. The insurance carrier may obtain the treating physician's opinion concerning Medical End Result. If the injured worker has selected their own physician, the carrier may request the worker attend an Independent Medical Examination (IME) and may ask the IME physician for their opinion concerning medical end.
Doctors may disagree about whether or not medical end has occurred. Because each doctor may not have a full understanding of what the term means, and because each doctor’s opinion must be weighed and considered, it is important for each opinion to be reviewed in conjunction with the medical records and evidence relevant to the opinion.
Legal Determination of Medical End Result
Medical End Result is a legal determination in workers’ compensation, although it does require consideration of medical opinion and evidence. Vermont case law provides helpful guidelines in understanding the type of information and factors that are considered in deciding whether medical end has occurred. In Coburn v. Frank Dodge and Sons, 165 Vt 529 (1996), the Supreme Court noted that in determining medical end the focus should be on the workers’ “underlying condition”. The justices noted that treatment for pain and “symptomatic relief” was not proof that such treatment would improve the underlying condition. Further, the Court stated, “the test is whether treatment contemplated at the time it was given was reasonably expected to bring about significant medical improvement.”
Medical Care may continue after Medical End Result
Medical End Result, if properly supported, may allow insurance carriers to stop paying lost time benefits. Medical end does not mean, nor even imply that medical care may be stopped. Medical care that is reasonable and necessary to treat the work injury must be covered by the insurance carrier. Oftentimes a medical provider may address medical end and the reasonableness or necessity of medical treatment in the same note. These represent two separate issues, however, and must be considered based upon differing factors.
Medical End Result represents a significant milestone in any workers’ compensation claim. Injured workers, doctors and other interests in the workers’ compensation system may benefit by better understanding this complex legal term.