Is Future Medical Covered Under the Indiana Workers’ Compensation Act?

Many injured workers are eligible for future medical coverage if a work-related injury requires future medical coverage. Under the Indiana Workers Compensation Act, once an injured worker completes his or her medical treatment and reaches the point of maximum medical improvement, the insurance company will offer a settlement. That settlement is typically based upon a degree of impairment called a Permanent Partial Impairment (PPI).

A PPI rating is assigned by a doctor when the injured worker reaches a point where his or her injury will not significantly improve with further medical treatment, also known as maximum medical improvement  MMI). In short, a PPI rating is a medical doctor’s determination of some permanent loss of function of a body part (or parts) as a result of an employee’s work accident. The rating does not take into account your ability to do your old job again.

Considerations regarding settlements for future medical needs

1. Doctors selected by insurance companies will often assign PPI ratings that are lower than independent doctors may assign. This will save the insurance company money.
2. If an injured worker, at the time of maximum medical improvement, can prove to a judge that he or she will have future medical needs causally related to the work accident claim, the worker has the right to pursue a claim for future medical coverage.
3. The injured worker, at the time of settlement, must be careful when considering a PPI rating from the insurance carrier’s physician. If he or she accepts a PPI rating, the worker may be precluded from obtaining future medical coverage.

The wise worker will not accept the PPI settlement and will instead negotiate a settlement signed off on by the judge. This requires the insurance company to pay future medical coverage. It is your right as an injured worker to negotiate a higher settlement if you think the injury is serious enough that a second opinion from another specialist could result in a higher PPI rating.

Here are some things to consider when deciding if you should negotiate:

• Did my injury require surgery?
• Is my injury an aggravation of a pre-existing injury?
• Does the pain from the injury affect other areas of my body?

Not all workers compensation claims result in future medical coverage, and in fact only a small portion of them do. To receive an award of future medical coverage, the injured worker must prove to a judge that he or she will have “future medical needs casually related to the work accident claim and medically necessary to limit or reduce the impairment.” A doctor who has treated the injured worker will need to state very specifically the type of treatment required, period of time treatment will be needed and cost of future treatment. Then the Board will consider these things in light of their effect on the injured workers impairment.

If the injured worker is awarded future treatment, it will be for the sole purpose of limiting or reducing his or her extent of impairment. This does not mean, however, that an injured worker who is left with any degree of impairment from his or her work injury will automatically be awarded future medical treatment by the Board.

If you have any questions on this topic, please feel free to contact an attorney at Klezmer Maudlin, PC. Call our office at (800) 809-3776.