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 conditions.

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 Closure.

What is “Reconsideration”?

“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"