Opinion ID: 1344051
Heading Depth: 1
Heading Rank: 2

Heading: conflict between maximum degree of improvement and ability to work

Text: Petitioners assert that a claimant's treating physician often informs the Commissioner by medical report (WC-219) that the claimant has reached his maximum degree of improvement but is not yet authorized to return to work. This leads the Commissioner to terminate temporary total disability benefits. Thus, the claimant is unable to work but receives no compensation to offset his loss of income. In her answer, the Commissioner maintains that when such conflicting information is provided on form WC-219 her staff makes an independent evaluation of the entire case to determine whether the claimant should continue to receive temporary disability benefits. We do not disapprove of the Commissioner's making an independent investigation to resolve the apparent conflict in the physician's answers on form WC-219. In fact, W.Va.Code 23-4-7a [1979] explicitly states that the Legislature believed it was necessary for the Commissioner to operate a systematic program for the monitoring of injury claims where the disability continues longer than might ordinarily be expected. We do have reservations, however, about the Commissioner's approach to such cases. Petitioners allege, and the respondent does not deny, that the commissioner often allows findings of maximum recovery and continued inability to return to work to be held compatible. This court noted in Mitchell v. State Workmens Compensation Commissioner, W.Va., 256 S.E.2d 1 (1979) that there was no statutory definition of the term temporary total disability. Id. at 5. We went on to observe that historically the commissioner had notified parties that temporary total disability benefits would continue until he [the worker] had been certified for employment or until further proper order of the Commissioner .... Id. at 6. In an explanatory note, the court took notice of the commissioner's occasional use of the phrase until he has returned to work or has been certified by his attending physician for employment. Id. at n. 1. Thus, the commissioner's own language suggests that the relevant medical opinion focuses on ability to work rather than abstract notions about maximum recovery. In fleshing out the meaning of temporary total disability the court also looked to precedent from other jurisdictions. We observed that the term reaching maximum degree of improvement and being certified for employment were often used interchangeably by other state courts. Id. See, e.g. Douglass v. Gresen Manufacturing Co., 300 Minn. 82, 217 N.W.2d 846 (1974); McAlear v. Arthur G. McKee and Co., 171 Mont. 462, 558 P.2d 1134 (1976); Inserra v. Village Inn Pancake House, 197 Neb. 168, 247 N.W.2d 625 (1976). Thus, in view of both the common practice in this state and legal precedent from other jurisdictions it appears unlikely to this court that circumstances would arise often in which a claimant could be found to have reached maximum degree of improvement without being certified for employment. [3] There are cases in which these seemingly contradictory findings are reconcilable. The claimant may in fact have a permanent disability that prevents his return to his regular employment. ( See Section III). Alternatively, he may be unable to return to work for reasons unrelated to a compensable injury. In the absence of a specific finding on these matters, however, it confounds simple reason to find that workers' compensation does not compensate a disabled worker. We hold, therefore, that when a physician indicates that a claimant has reached his maximum degree of improvement but cannot yet return to work, the Commissioner shall continue temporary total disability benefits until either the claimant is released to return to work or it conclusively appears that the claimant's inability to return to work is the result of a permanent disability or of medical problems that are unrelated to the compensable injury.