There are some valid cases for which there can be no effective resolution. There are patients that have reached MMI, have residual limitations and for which there is no acceptable (to the patient) ending.
This exists in several types of cases:
a. Where the residual limitations far out-shadow the patient_s residual education and skills
b. Where the patient is at MMI, yet subjective complaints are increasing as in the case of valid RSD
c. Where the patient_s residual pain is so great there is no true quality of life, and/or
d. Where the patient cannot financially compensate for the ind ebtedness that has accumulated during the course of care.
For some patients, their pre-injury income was so low that receiving workers_ compensation is not as significant of a financial loss as it is for someone with an executive_s salary attempting to exist on that same workers_ compensation amount. Debt rapidly mounts, credit is ruined, arguments with spouse over finances ensue, children_s emotional and financial needs are not met, and the problem rapidly escalates.
The simple fact is that we attempt to manage cases by obtaining medical and administrative closure based upon PPD ratings. In reality, these ratings are almost totally unrelated to the socioeconomic impact of the injury.
What we feel is obstructionistic, when a patient does not wish to settle, may, indeed, be their own sense of futility and fear of their future.