Opinion ID: 1562586
Heading Depth: 2
Heading Rank: 1

Heading: The Maximum Medical Improvement Determination

Text: The central issue in this case is whether a partially injured employee may be found to have attained maximum medical improvement when he refuses to undergo surgery that has been recommended to improve his condition. Maximum medical improvement as defined by statute is a point in time when any medically determinable physical or mental impairment as a result of injury has become stable and when no further treatment is reasonably expected to materially improve the condition. G.L. 1956 § 28-29-2(8). Mr. Pimental contends that by omitting the word surgery from this definition, the Legislature must have intended that injured [e]mployee's [ sic ] who are surgical candidates cannot be found to be at a point of maximum medical improvement. Because surgery can reasonably be expected to improve one's condition, he argues, surgical candidates are shielded from a finding of MMI. He further contends that such a construction remains faithful to the remedial and benevolent purpose of the Workers' Compensation Act. The city argues in opposition that the plain and ordinary meaning of the statutory language does not preclude a finding of MMI for injured employees who decline to undergo recommended surgery. This Court reviews de novo questions of statutory interpretation. Rison, 707 A.2d at 678. In so doing we strive to establish and to give effect to the intent of the Legislature. Howard Union of Teachers v. State, 478 A.2d 563, 565 (R.I.1984). This is accomplished from an examination of the language, nature, and object of the statute.    Additionally, we must give to the words in a statute their plain and ordinary meaning, unless a contrary interpretation is apparent. Id. The Appellate Division has twice had occasion to consider the statutory language at issue in this case. In Robin Rug v. Manteiga, W.C.C. No. 93-4363 (App.Div. Aug. 16, 1994), medical evidence indicated that the employee's condition had reached a plateau and that there would be no improvement absent surgery, which the employee refused. Id. at -3. The Appellate Division upheld a finding of MMI by the trial judge and rejected the employee's argument that the possibility of surgery prevented an MMI determination. Id. at . If that view were accepted, the Appellate Division reasoned, any employee by refusing surgery notwithstanding his or her condition could prevent the ultimate finding of maximum medical improvement. Id. One member of the three-judge panel dissented however. Id. at -4. He argued that a finding of MMI was inappropriate in light of medical evidence that surgery would improve the employee's condition, stating that the majority's decision would chill the employee's right to refuse intrusive major surgery. Id. at . In 1995, the Appellate Division reviewed a trial judge's determination that an injured employee had not reached MMI because medical experts indicated that the employee would benefit from knee replacement surgery. Providence College v. Gemma, W.C.C. No. 95-1493, at -3 (App.Div. Aug. 19, 1996). The evidence indicated that the employee's condition had reached a plateau and that he had refused to undergo the recommended procedure. Id. at . The Appellate Division overturned the trial judge's decision, however, reasoning that an employee could circumvent a finding of maximum medical improvement by simply refusing surgery. Id. at . It is our opinion that the Appellate Division's well-established construction of § 28-29-2(8) maximum medical improvement is correct and consistent with the purpose of the Workers' Compensation Act. Maximum medical improvement is not a determination that the employee's condition will never improve or decline, nor does it preclude the possibility of future medical interventions entitling the employee to review his MMI status when his condition has substantially deteriorated or improved. Section 28-29-2(8). Rather, the designation merely identifies the point at which an employee's physical or mental impairment has stabilized and further treatment is not reasonably expected to materially improve his condition. The mere possibility that surgery might improve Mr. Pimental's condition does not preclude a finding that he has reached MMI when his refusal to undergo the sole treatment that each of his examining physicians recommended ensures that his condition has, in all reasonable likelihood, become stable. Mr. Pimental has determined the limits of his own recovery and must, therefore, accept the determination that he has attained maximum medical improvement. We concur with the Appellate Division that by refusing the surgery his impairment had become stable and no further treatment was reasonably expected to improve his condition. Furthermore, we are not persuaded by Mr. Pimental's argument that such a construction places him in the position of having to choose between his physical well-being, versus his, and his family's, financial well-being. Mr. Pimental is free to choose whether to have surgery and, given his poor prognosis and relatively minor impairment, we have no reason to doubt the reasonableness or sincerity of his decision. The mandatory 30 percent reduction of benefits upon attainment of MMI, however, is not a punitive measure; rather it seeks to adjust the worker's benefits once the recovery period has come to an end. [5] The General Assembly clearly has expressed its desire that partially injured workers be encouraged to return to the work force when they have reached maximum recovery. It is not our place to question the wisdom of that judgment. Mr. Pimental continued to receive workers' compensation benefits but, as his active recovery period had come to an end, he was entitled to only the reduced benefits specified in § 28-33-18(b). We do not believe Mr. Pimental was ensnared in the catch-22 [6] situation that he implies. We also share the Appellate Division's concern that adopting Mr. Pimental's reasoning would allow an employee [to] circumvent a finding of maximum medical improvement by simply refusing surgery. Providence College, W.C.C. No. 95-1493 at . We do not believe that the General Assembly could have intended such a result. [I]t is this [C]ourt's responsibility in interpreting a legislative enactment to determine and effectuate the Legislature's intent and to attribute to the enactment the meaning most consistent with its policies or obvious purposes. Brennan v. Kirby, 529 A.2d 633, 637 (R.I.1987). We previously have recognized, in Lombardo v. Atkinson-Kiewit, 746 A.2d 679, 682 (R.I.2000), that the General Assembly enacted sweeping reforms in 1992 to the Workers' Compensation Act to eliminate waste and unnecessary costs and to swiftly and fairly make appropriate adjustments for employees who are capable of employment. P.L. 1992, ch. 31, § 1. Prior to 1992, § 28-33-18(b) provided that if the employee proves that he or she has attempted in good faith to obtain employment suitable to his or her limitations and has been unsuccessful, then partial incapacity shall not be reduced. P.L. 1990, ch. 332, art. IV, § 28. The post-1992 revision now requires a 30 percent reduction of benefits upon a determination of maximum medical improvement and reduces the trial judge's discretion to the timing of that reduction. This constriction of the court's discretionary authority is consistent with the General Assembly's goal to swiftly and fairly make appropriate adjustments for employees who are capable of employment and to motivate return to gainful employment in the work force. Section 28-29-1.2(a)(7). Given the General Assembly's clear mandate to deter waste and abuse, we believe allowing an employee to delay a finding of MMI by refusing to undergo a recommended treatment would frustrate the purpose of the Workers' Compensation Act.