Maximum Medical Improvement: Now You See It, Now You Don't


As you may know, under the New Jersey Workers’ Compensation Statute (Section 15) and case law, the respondent/employer is responsible for providing medical treatment to cure and relieve the effects of a workers’ compensation injury. The obligation to provide this treatment is for the life of the claim. 

What is key to this concept is that once the injured worker reaches maximum medical improvement, the respondent is entitled to cease making payments of temporary total disability benefits assuming the injured worker has been unable to work.  This is regardless of whether or not the employee is working or capable of working. In other words, once the petitioner is discharged from care, wage loss benefits cease, and the employee’s work status is irrelevant. There are a few synonyms for the concept of maximum medical improvement including a plateau of recovery, discharge from care, and released “PRN.” 

What we see frequently is clients mistake ongoing treatment with a plateau in terms of recovery.  While the employer may be responsible for relieving the effects of the injury, wage loss benefits cease when the medical treatment ceases to cure the injury. When the injured worker has reached that plateau of recovery and is not getting any better or any worse, then the plateau or maximum medical improvement has been reached.  Temporary total disability benefits can cease at that point.  That does not mean that medical treatment ceases. Again, the statute requires medical treatment that “relieves” the effects of the injury. The New Jersey Appellate Division has concluded that treatment that cures OR relieves the effects of the injury should be provided.[1] In chronic pain cases or significant injuries where the authorized physicians believe that ongoing treatment is necessary to avoid a decline in the employee’s health, that treatment is equally compensable and should be provided. However, treatment that is only relieving the effects of the injury is not curative and does not require ongoing temporary total disability benefits. 

Respondents must pay attention to the medical records from the authorized physicians, as well as any physical therapy notes to determine whether the treatment is curative or palliative (relieving the effects of the injury). This may require a direct conversation between the respondent and the medical provider to confirm, in writing, that the treatment, while necessary, is no longer curative.  Sometimes a second opinion or an IME will be necessary to address that situation. 

If the injured worker has been unable to return to work, but still needs palliative care in a chronic pain type of claim, the respondent can consider making a voluntary offer of permanency in order to provide a flow of income while the injured work either seeks alternative employment or while their workers’ compensation claim is pending for a resolution of an award of permanency. 

One further thing to keep in mind, if the injured worker injured more than one part of the body and is receiving treatment to more than one part of the body, then ALL parts of the body must reach that plateau of recovery before temporary total disability benefits can cease. 

[1] Hanrahan vs. Twp of Sparta, 284 N.J. Super 327 (App. Div. 1995), certif. denied, 143 N.J. 326 (1996).


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