War Stories: When the Insurance Company’s Own Doctor Helped Us Win
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War Stories: When the Insurance Company’s Own Doctor Helped Us Win
Some victories are satisfying.
Some are strategic.
And some — like this one — are poetic.
This is the story of how we used the insurance company’s own required medical examination (RME) doctor to overturn the designated doctor, defeat the carrier’s MMI/IR position, and secure justice for an injured worker who simply wasn’t done healing.
The Injury Everyone Agreed On
The compensable injury wasn’t in dispute. The parties stipulated that the claimant sustained:
- Right knee sprain
- Right knee strain
- Right lateral meniscus tear
She underwent knee surgery, completed post‑surgical therapy, and continued to recover.
The only dispute was whether she had reached maximum medical improvement — and whether the designated doctor’s 8% impairment rating could stand.
The Designated Doctor’s Mistake
The designated doctor placed the claimant at maximum medical improvement on December 9, 2024. He said this was the date she:
- last saw her orthopedic surgeon,
- was released to return to work, and
- was released to as‑needed follow‑up.
But there was a problem — a big one.
The judge noted:
“It appears Dr. Lawrence was basing those comments on his discussion with the claimant because it does not appear he was able to obtain the record from the December 9, 2024 office visit… It is not listed in his list of reviewed medical records.”
And when we looked at the surgeon’s actual note from that date, it said something very different.
The surgeon documented that the claimant:
- was still weak,
- would benefit from continuing her home exercise program, and
- should not return to work until January 6, 2025.
In other words:
She was still recovering. She was not at MMI.
The Attempt to Return to Work — and the Setback
The claimant followed her surgeon’s plan. She attempted to return to work in January 2025.
But her job was physically demanding. The judge summarized it clearly:
“Due to the strenuous nature of her work, the claimant began to experience increased pain and swelling… Her pain was so intense that the claimant was not able to return to work at that time.”
Her treating doctor recommended work hardening — a structured program designed to safely rebuild strength and function so she could return to full duty.
That alone is evidence of an expectation of further material recovery, which is the opposite of MMI.
But the best evidence came next.
The Carrier Sends Her to an RME — and It Backfires
The insurance company sent the claimant to their RME doctor on July 22, 2025.
They expected him to support the designated doctor’s MMI date and 8% IR.
He did — but he also made a critical mistake.
He performed his own range‑of‑motion testing and found:
- The claimant’s knee ROM had improved by 50% since the designated doctor’s exam.
- Her current ROM supported only a 4% impairment rating, not 8%.
Yet he still agreed with the designated doctor’s MMI date — a date six months in the past — and still agreed with the 8% IR, even though his own measurements contradicted it.
The judge saw the contradiction immediately:
“His own range of motion testing showed the claimant had only a 4% impairment rating and her range of motion had significantly increased in the six months since being examined by Dr. Lawrence.”
And then the judge delivered the key line:
“the RME doctor opined there would be no further lasting improvement… but his own report shows a significant improvement.”
That’s the definition of further material recovery — the exact legal standard for determining whether someone has reached MMI.
The carrier’s own doctor proved she hadn’t.
Improvement = further material recovery = NOT at MMI.
Our Argument: Use Their Evidence Against Them
We highlighted the contradiction:
- If the claimant’s ROM improved by 50% between December and July,
- And if her IR dropped from 8% to 4% based on that improvement,
- Then she was still improving,
- Which means she was not at MMI.
We also emphasized that Dr. Vu — the treating doctor referral — certified she was not at MMI because she needed to complete work hardening.
The judge agreed:
“That the claimant has not reached maximum medical improvement as determined by Dr. Vu… is supported by the preponderance of the evidence.”
The Result: Designated Doctor Overturned. RME Neutralized. Justice Served.
The ALJ ruled:
- The claimant has NOT reached MMI.
- No impairment rating can be assigned.
- The designated doctor’s certification is contrary to the evidence.
- The treating doctor referral’s certification is adopted.
And the best part?
We won using the insurance company’s own RME doctor — the very expert they hired to support their position.
His measurements proved our case.
His contradictions destroyed theirs.
Why This War Story Matters
This case is a perfect example of why MLF Legal wins tough medical disputes:
- We read every line of every medical record.
- We compare every measurement, every date, every inconsistency.
- We hold designated doctors and RME doctors to the legal standard.
- And when the carrier’s own evidence helps our client — we use it.
Because justice isn’t about who the insurance company hires.
It’s about what the evidence actually shows.
And in this case, the evidence showed one thing clearly:
She was still healing — and we made sure the judge saw it.
Why This Matters for Injured Workers
Insurance companies often try to close claims early by relying on designated doctors or RME doctors who say an injured worker is “fine.”
But at MLF Legal, we dig deeper.
We read every medical record. Compare every measurement. We hold every doctor — even the insurance company’s own experts — to the legal standard.
And when the evidence shows you’re still healing, we make sure the judge sees it.
If You’re Being Told You’re at MMI Too Soon, Call Us
You don’t have to accept an unfair MMI date or an incorrect impairment rating.
In this case, we protected our client’s right to:
- continued medical treatment,
- continued income benefits, and
- a fair impairment rating once she truly reaches MMI.
If you want to take your shot at overturning an unfair impairment rating, give us a call for a free case evaluation.
📞 Call the Texas workers’ comp lawyers at MLF Legal at 214‑357‑1782. We fight for injured workers — and we know how to win these disputes.
The Takeaway
Insurance carriers will always try to reframe injuries as pre‑existing conditions. But when the evidence is developed correctly, and when medical opinions are held to the standard the law requires, those defenses collapse.
This case wasn’t about sympathy. It wasn’t about credibility.
It was about evidence—and evidence won.
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.
FAQs About Overturning an Incorrect MMI or Impairment Rating
1. What does it mean when the insurance company says I’m at “MMI”?
Maximum Medical Improvement (MMI) means the insurance company believes you’ve healed as much as you’re going to — even if you’re still in pain or still need treatment.
If you’re placed at MMI too early, your medical care and income benefits can stop. That’s why it’s critical to challenge an incorrect MMI date.
2. Can the insurance company’s own doctor actually help my case?
Yes — and it happens more often than you’d think.
In this case, the insurance company’s RME doctor documented that the claimant’s knee range of motion had improved by 50%, proving she was still healing. That evidence helped us overturn the designated doctor’s MMI date and impairment rating.
3. What if the designated doctor says I’m at MMI but my surgeon or treating doctor disagrees?
You are not stuck with the designated doctor’s opinion.
If your treating doctor or surgeon documents ongoing weakness, pain, or the need for additional therapy — like work hardening — that is strong evidence you are not at MMI. Judges can and do overturn designated doctors when the evidence supports continued recovery.
4. How does improvement affect my impairment rating?
Improvement is the key.
If your range of motion, strength, or function continues to get better, then you are still experiencing further material recovery — the legal standard for determining whether you’ve reached MMI.
In this case, our client’s improvement meant her impairment rating should have been lower, which proved she wasn’t done healing.
5. What if the insurance company tries to use the RME doctor against me?
Improvement is the key.
If your range of motion, strength, or function continues to get better, then you are still experiencing further material recovery — the legal standard for determining whether you’ve reached MMI.
In this case, our client’s improvement meant her impairment rating should have been lower, which proved she wasn’t done healing.
6. What happens if the judge decides I’m not at MMI?
If the judge rules you are not at MMI:
- Your medical treatment continues
- Your income benefits continue
- No impairment rating can be assigned yet
- You keep your right to a fair IR once you truly reach MMI
This is exactly what happened in this case.
7. How do I know if my MMI date is wrong?
Your MMI date may be incorrect if:
- You still have pain or swelling
- You still need therapy or work hardening
- You can’t perform your regular job duties
- Your surgeon or treating doctor says you’re not done healing
- Your condition has improved since the designated doctor’s exam
If any of these apply, you should get a legal review immediately.
8. Can MLF Legal help me fight an incorrect MMI or impairment rating?
Absolutely.
We specialize in challenging early MMI dates, incorrect impairment ratings, and flawed designated doctor reports. And when the insurance company’s own doctor helps prove your case — like in this case — we make sure the judge sees it.
📞 Call MLF Legal at 214‑357‑1782
We fight for injured workers — and we know how to win these disputes.
Call MLF Legal today
214-357-1782
Fill out our online form
for a free consultation.
We only get paid if we win your case.