Court ruling brings ‘sea change’ to work comp

A recent Missouri Supreme Court ruling reinterpreted a venerable tenet of the workers’ compensation system and could help some injured workers with lingering pain from their injuries get additional benefits.

The Supreme Court ruled Dec. 8 that an injured worker could gain additional temporary total disability payments for treatment he sought long after doctors said he achieved “maximum medical improvement” — a term that for decades has served as the cut-off for such payments. The court said that, while maximum medical improvement is a useful concept, it’s not a statutory requirement.

“This Court is not eliminating the concept of maximum medical improvement from the workers’ compensation lexicon,” Judge George W. Draper III wrote for the unanimous court, saying the date of maximum medical improvement could aid the Labor and Industrial Relations Commission in determining the time when a disability becomes permanent.

“However,” he added, “this Court holds the commission is not required to accept maximum medical improvement as a bright-line date to terminate TTD benefits when there is substantial and competent evidence presented that a claimant continues to be engaged in the rehabilitative process beyond a date initially believed to be the end of the rehabilitative process. Cases that hold to contrary should no longer be followed.”

Robert S. Merlin, an attorney with Ray B. Marglous PC in St. Louis who for years has represented the injured worker, Carl Greer, said the blow to maximum medical improvement — or MMI, as it is informally abbreviated — is a big deal in the worker’ compensation legal world.

“MMI doesn’t necessarily mean MMI,” Merlin said. “It’s now left to the court’s discretion.”

The Missouri Chamber of Commerce and Industry, which had watched the case carefully, quickly vowed to take the issue to lawmakers in the upcoming session.

“This ruling should send shivers down the spines of Missouri employers,” Chamber President Daniel P. Mehan said in a statement shortly after the ruling.

The case began in February 2006, when Greer, a former employee of Sysco Food Services, had his foot crushed between two forklifts. His foot healed enough that he could still walk, and a doctor declared that he had reached the point of MMI in April 23, 2007.

Nonetheless, Greer continued to complain of pain from the injury. After quitting Sysco in November 2007, Greer consulted with multiple doctors on his own. In 2010 he underwent tarsal tunnel release surgery, though it failed to relieve the pain or to permanently fix a deformity in his foot.

Greer filed an amendment to his original work comp claim in 2013. An administrative law judge denied Greer’s claim that he was totally disabled, but found him to be permanently partially disabled. The judge denied Greer’s request for TTD benefits beyond the April 2007 maximum medical improvement date.

On review, however, the Labor and Industrial Relations Commission partially reversed the judge. Although it agreed that Greer had reached maximum improvement in 2007, it found that barring him from getting additional TTD benefits after that date worked an “absurd result” under the circumstances.

According to the opinion, the concept of maximum medical improvement stems from a 1991 case in the Court of Appeals Eastern District, Vinson v. Curators of the University of Missouri. The labor commission in that case had awarded TTD benefits for the period leading up to the date of “maximum treatment potential.” Under the standard of review in effect at the time, the Eastern District found the agency’s approach “reasonable” and upheld it. Since then, appellate courts have “routinely, repeatedly and consistently” used that standard, as lawyers for Sysco put it in their brief to the Supreme Court.

However, nothing like the phrase “maximum medical improvement” appears in statute. Instead, the workers’ compensation law merely says temporary benefits “shall be paid throughout the rehabilitative process” — a period that can last more than seven and a half years under the statute. In his opinion, Draper wrote that in many cases, the date of MMI will coincide with the end of the rehabilitative process.

“However, when the commission is presented with evidence, as here, that a claimant has reached maximum medical improvement yet seeks additional treatment beyond that date for the work-related injury in an attempt to restore himself or herself to a condition of health or normal activity by a process of medical rehabilitation, the commission must make a factual determination as to whether the additional treatment was part of the rehabilitative process,” Draper wrote.

It’s not clear how many cases could be affected by the new understanding of MMI. It appears most likely to affect cases where a worker suffers an injury that continues to cause pain after healing yet doesn’t leave him or her totally disabled.

Jonathan Sternberg, an appellate lawyer in Kansas City who argued the case in the Supreme Court, said the ruling represents a “sea change” in the law — though one that he said makes sense.

“What this enables is case-by-case award-making and fact-finding. Isn’t that what we want from courts?” said Sternberg, adding that the appeal was his first-ever work comp case. “We want courts not to be constrained by grand, vast legal doctrines, especially quasi-legal ones some court thought up 25 years ago that aren’t in the statute.”

John M. Allen of RestovichAllen, who represented Sysco, didn’t return a call seeking comment.

The chamber, however, argued that injured workers now have an incentive to continue to seek treatment after they have healed.

“Temporary disability payments are capped at 400 weeks for extreme cases and the Supreme Court has given a roadmap for claimants and trial attorneys to maximize those awards — even after a worker has recovered the best he or she can,” Mehan said.

The case is Greer v. Sysco Food Services, SC94724.