Claimant cannot avoid MMI finding, reduction in benefits by refusing surgery

Where a doctor opines that surgery could improve a claimant's condition and that the condition will not improve without surgery, the claimant's refusal to undergo the procedure could result in a finding that he has reached MMI.

Case name: City of Pawtucket v. Pimental, No. 2007-106-M.P. (R.I. 12/15/08).

Ruling: The Rhode Island Supreme Court upheld a lower court's decision, which reduced the employee's workers' compensation benefits based upon his attaining maximum medical improvement. The employee could not delay an MMI finding by refusing to undergo surgery that had a reasonable likelihood of improving his condition.

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What it means: Where a doctor opines that surgery could improve a claimant's condition and that the condition will not improve without surgery, the claimant's refusal to undergo the procedure could result in a finding that he has reached MMI. Additionally, a pretrial order reducing compensation benefits does not violate the employee's due process rights, even if the employee has not yet litigated the MMI issue.

Summary: The claimant, a city sanitation engineer, sustained a herniated disk at work and began receiving workers' compensation benefits for partial incapacity. He underwent surgery and received total disability until the court determined his condition had improved and his benefits were reduced to partial disability.The first surgery was unsuccessful due to recurrent disk herniation, and the claimant declined to undergo a recommended second surgery.

After contending that the claimant had reached MMI, the employer petitioned for the mandatory 30 percent reduction in his workers' compensation benefits. The trial court reduced the benefits to 70 percent but delayed the effective date of the order for five months. In the meantime, the claimant argued that the city's request to reduce his benefits was premature, as his maximum medical improvement date had not yet been determined.

The Supreme Court upheld the reduction in benefits, reasoning that reaching the opposite conclusion would allow an employee to circumvent an MMI determination by simply refusing surgery. The court further explained that the 30 percent reduction in benefits was not intended as a punitive measure but simply adjusted the workers' compensation benefits once the recovery period ended.

January 26, 2009

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