Medically stationary — Claim closure
My doctor said that my accepted
conditions are medically stationary. What does medically stationary mean?
The term “medically stationary” means
that your condition or injury is not expected to get better with further
treatment or the passage of time. When your doctor determines that you are
medically stationary, the insurer will close your claim. The insurer may continue
to pay for some prescriptions and limited medical services.
What does “claim closure” mean?
Disabling claims are “open” while you are
recovering from your injury and must be “closed” when you are medically
stationary. If your claim is classified as a disabling injury the insurer will
issue a Notice of Closure.
• Notice of Closure - This is the legal
document that closes your claim. It lists the periods for which time-loss was
authorized and tells you how much permanent disability you may have.
• Updated Notice of Acceptance at closure –
This letter tells you what medical conditions have been accepted and what
conditions have been denied. Only accepted conditions will be rated to
determine permanent disability. If the updated notice is incomplete or
incorrect, notify the insurer in writing.
If your claim is classified as nondisabling, the
insurer will send you a letter advising of their responsibility to cover the
costs of compensable medical services such as prescription drugs, diagnostic
care, life-preserving care, and some other services related to your accepted
What if I disagree with the insurer’s
decision to close my claim?
If you disagree with the Notice of Closure, you
have the right to appeal the closure by asking the Workers' Compensation
Division for “Reconsideration” within 60 days from the mailing date printed in
box 1 on the front of the form. If you do not appeal within 60 days, you will
lose all rights to appeal your claim closure. Your appeal rights and the
address where to send your appeal are printed on the back of the Notice of
What is “Reconsideration”?
is a review of the Notice of Closure conducted by the Workers’ Compensation
Division (WCD). WCD will review the claim documents the insurer used to close
your claim and may schedule an arbiter examination to obtain an additional
medical opinion regarding your accepted conditions. Additionally, you may
submit a written statement explaining your condition and your disagreement with
the claim closure. You may also submit statements from others to support your
position. This will be your last opportunity to provide new information about
the closure of your claim. We encourage
legal representation when requesting a Reconsideration.
See Need an attorney.
An Order on Reconsideration will be issued by the
Workers’ Compensation Division following their review of the Notice of Closure.
The Notice of Closure awarded permanent
partial disability (PPD). When will I receive payment of the PPD?
The insurer must begin making PPD payments no later than the 30th
day after the Notice of Closure (NOC) was issued.
· If the PPD award is less than $6,000,
the insurer must pay the entire award to you in a lump sum no later than the
30th day after the NOC was issued.
· If the PPD award exceeds $6,000, the
insurer may pay the award in monthly installments. The monthly installments
should be equal to 4.35 times your current time-loss rate, but no less than
$108.75 per month. Additional payments should be made monthly until the entire
PPD award has been paid.
You may request a lump-sum payment of any PPD award greater than
$6,000. To request a lump-sum payment you must complete and submit Application
for Approval of Lump-sum Payment of Award (Form 1174) to your insurer. By
applying for and accepting a lump-sum payment, you will give up your right to
appeal the adequacy of the award.
Form 1174 - "Application
for Approval of Lump-sum Payment of Award"