Maximum Medical Improvement in Texas Workers' Compensation: What Appeals Panel Decision 110670 Teaches Injured Workers
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Maximum Medical Improvement in Texas Workers’ Compensation: What APD 110670 Teaches Injured Workers
When you’ve been hurt on the job, one of the most important milestones in your Texas workers’ compensation case is the determination of maximum medical improvement (MMI). MMI marks the point where doctors believe your condition has improved as much as it reasonably can with medical treatment. The date of MMI affects your income benefits, your impairment rating (IR), and ultimately the value of your case. It has become increasingly clear that preathorized treatment affects MMI more than any other variable.
A recent decision from the Texas Division of Workers’ Compensation Appeals Panel—APD 110670—shows how MMI is closely tied to the expectation of further recovery, preauthorized medical care, and programs like chronic pain management.
The Case: A Knee Injury and Disputed MMI
The injured worker in this case was a drywall installer who suffered a serious right knee injury after falling from stilts. He underwent surgery, physical therapy, and later a preauthorized chronic pain management program.
- One doctor certified MMI in April 2009.
- The designated doctor certified MMI in July 2009 with a 7% IR.
- But another physician, after reviewing the worker’s progress in pain management, certified MMI on February 9, 2010, with a 10% IR.
The Appeals Panel ultimately ruled that the earlier MMI dates were premature because the worker continued to make substantial improvements after July 2009. The Panel adopted the later February 2010 MMI date. The reasoning was that preauthorized treatment affects MMI whether it helps with recovery or not.
FAQs About Texas Non-Subscriber Employers
Yes. If your employer is a non-subscriber and their negligence caused your injury, you may file a lawsuit.
Medical bills, lost wages, pain and suffering, and in some cases punitive damages.
Generally two years from the date of injury.
Yes. These cases are complex, and employers often fight aggressively to avoid liability.
Injured at work in Texas and your employer doesn’t have workers’ comp?
You may have the right to sue and recover full compensation.
Contact MLF Legal today for a free consultation. You pay nothing unless we win your case.
Why Preauthorization Matters
A key factor was that the insurance carrier preauthorized additional treatment—including physical therapy and two rounds of chronic pain management. Preauthorization means the carrier agreed the treatment was medically necessary and reasonably expected to help. That directly undercuts any claim that the worker had already reached MMI.
In other words, if the insurer is authorizing treatment designed to improve your condition, then by definition, further recovery is still anticipated. That is why it is important to understand how preauthorized treatment affects MMI.
Chronic Pain Management and Functional Gains
The worker’s participation in a chronic pain management program produced measurable results: reduced reliance on narcotics, improved function, and better psychological coping. These improvements were documented in medical records and functional capacity evaluations. The Appeals Panel emphasized that MMI is not about whether treatment ultimately cures the injury—it’s about whether further recovery can reasonably be expected. Here, the evidence showed it could.
What This Means for Injured Workers
This case highlights several important lessons for Texas employees dealing with workplace injuries:
- MMI is not always final at the first certification. If you are still improving with treatment, you may not have reached MMI.
- Preauthorized treatment is powerful evidence. If your insurance company approves therapy or pain management, that supports the argument that you can still recover.
- Chronic pain programs can extend recovery. These programs often provide both physical and psychological benefits that delay MMI and may increase your impairment rating.
Protecting Your Rights
If you’ve been told you are at MMI but you are still receiving treatment—or if you believe your condition is improving—you should speak with an experienced Texas workers’ compensation lawyer. The timing of MMI and the accuracy of your impairment rating can significantly affect your benefits and your future. Preauthorized treatment affects maximum medical improvement more than anything else. A Texas workers’ compensation lawyer can help you get that preauthorized care that you need to assist in your recovery and to keep your benefits coming.
At MLF Legal, we help injured workers challenge premature MMI certifications, ensure their treatment is fully considered, and fight for the benefits they deserve.
Call us today for a free consultation if you’ve been injured at work and need guidance on MMI, impairment ratings, or your workers’ compensation benefits.