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Workers comp wants me to settle. Im still in pain.

2

Comments

  • L4L5, it seems like it’s nationwide that the insurance company chooses and pays for the IME in W/C cases unless the patient schedules and pays for it out of pocket. ( sometimes the best alternative). Remember the IME isn’t going to cut off his own foot because they know who is paying for it!

    DavidG

    Veritas-Health Forum Moderator

  • L4_L5LL4_L5 Posts: 1,481
    edited 02/06/2018 - 3:50 PM

    This is very concerning from fesstuss’ older post. It’s too bad he can’t get a new attorney.

    I went back to the neurosurgeon monday and my case manager was late. They were talking about me needing another surgery until my case worker showed up with A IME report. Then the doc does a 360 saying that he puts alot of faith and heart in what the WC doctor said. Said he is best friends with the WC doctors son whom is also a doctor.
    You probably don’t want a neurosurgeon who’s “best friends” with the WC doc’s son. :# Too much nepotism.
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  • MMI will be set by the treating physician. A IME can be requested by the Employers HR or insurance company. 

    DavidG

    Veritas-Health Forum Moderator

  • I'm not sure how they calculate MMI if you haven't had surgery.  I can tell you that if you don't require surgery or refuse surgery if there is something that can be done, your case will be hotly contested.  I have a friend who hurt his back at work, refused surgery and had to fight in court for five years before he was granted any $$$. 

    You are allowed a second opinion in KY, but its also a little complicated because they (WC) will say your changing your physician of record when you do that when in fact, it's only a second opinion.  Then, what WC will do is hire an out of state doctor who relies on the Official Disability Guidelines (ODG) to shoot holes all over what your doctor found.  The ODG is written by a for profit company who researches "best practices" for getting a worker back to work.  Mind you, I didn't say get you healthy, only to get you back to work.  Many of the doctors whey hire simply read your charts and make a decision.  There is no exam.  Judges in KY lean heavily towards these reports.  I found bold face lies in mine, proved that it was a lie and the Judge still refused to strike it from the record.  Listen, the WC system is rigged HEAVILY against the injured worker.  They count on the injured person to not fight them because of how difficult they make the system.  I'm not a huge lawyer fan, but after what I've been through representing myself for the last 11 years, I really should have hired an attorney early on.  In KY, after your initial settlement is closed, you cannot hire an attorney legally to represent you on a re-opening of your case.  Typically, the lawyer who represented you on your first settlement will handle the re-opening at no charge to you.  I could write a book about everything I've had to learn and have been through with WC in KY.

     

    Several Epidurals, L4-S1 360 ALIF, Numerous Facet Joint Injections, RFA x2
  • I have to agree with EMS guy completely. As a past first responder who was injured during a extrication, you think your employer will be looking for what’s best for you. In reality, their looking at what will cost them less financially! W/C cases depending on the injury and severity need to be handled by a experienced W/C lawyer. The laws in this area seem to change daily. I applaud EMS guy for taking it solo and he’s fortunate to have a company that supports him! Yes, laws vary State to State but there are similarities between all of them. Here in Fl, you have a 1 time option of a second opinion and he WILL be your MD and your not allowed to go back to your 1st MD. The 2 nd MD is also contracted through the company you work for. So don’t expect much of a difference. As far as settlements go, several factors are considered such as loss of future income, Are you young enough to be retrained in a different field, Is their gainfull employment available. This is also factored into Social Security Disability. Most importantly, educate yourself on Workman’s Comp for your State! I can’t stress that enough! You’ll see after educating yourself why it’s important to get a good attorney early on. When I was injured, my attorney found out that the case manager was going into the exam room. That was stopped immediately! Your case manager is ALSO taking notes such as watching you get up and off the exam table, your mental health status such as depression, as well as giving instructions to the MD such as certain work restrictions including what medications NOT to prescribe to keep you on light duty. The Case Manager works FOR the insurance company. They are NOT your friend! They are usually older RNs but are also trained on asking leading questions such as How was your weekend? Sounds innocent I know but when you tell them you spent the week end at the park with your kids....guess what? You just told her you can maintain some form of a family life! Note pad comes back out! Guys and Gals educate yourselves. This isn’t for the get rich scheme which irritates all of us and makes it harder on the true injured worker. This is to keep a roof over your head!

    DavidG

    Veritas-Health Forum Moderator

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  • EMS guy, just a FYI, MMI is calculated by using a score sheet for each body part. Surgery doesn’t matter. Severe hearing loss 1 ear is like 6%. It’s a worksheet that adds all body parts and functions. If someone refuses surgery, another percentage is added

    DavidG

    Veritas-Health Forum Moderator

  • L4_L5LL4_L5 Posts: 1,481
    edited 02/07/2018 - 9:45 AM

    Thanks for that information. Amazingly complex.

    What if the doctor who gives you a second opinion on what your impairment rating should be is not your WC physician of record but says on his business card that he’s certified by worker’s comp to provide impairment ratings?

    Can his opinion be considered in KY?

  • L4L5, I can only speak from Fl laws. Workman’s Comp is very complicated . Unfortunately there are those that have taken advantage of the system which in turn makes it hard on the rest of us. Regardless, if you have a work related injury which stops you from working ( especially spinal issues) it’s best to get a qualified attorney to represent you. Not the Attorney’s who run TV commercials! Good Attorney’s do not need them. Old saying is you will NOT get rich on disability is a true saying. Another false saying is they can’t fire me while I’m on W/C. Oh yes they can but it’s hard. Normally both MDs will be close to the same in impairment ratings since their both being paid by the same Insurance company and both have all the records. Insurance companies as well are downright mean when it comes down to it especially when it’s a career ending injury. Insurance companies are well known to hire investigators to follow you around such as in the grocery store reaching for a item on the top shelf and taking pictures. Most companies will first try to accommodate you! They might give you a job sitting at a desk staring at a clock ( ask me how I know that one, ) They can make it so unbearable you’ll just want to quit! This is especially true after your MD has set you at MMI. Then your company can put you under a microscope waiting for you to make a mistake or be 1 minute late and then start a paper trail. But getting back on the initial question, First step is mediation ( where the majority of cases are closed due to agreement by both parties) If no agreement is made, then you go in front of a judge. If not satisfied, you file a appeal..regardless, every step is a challenge and the settlement will either rise or lower, so it’s a game of chance at every level. That’s why a good attorney is for your benefit! Again I can’t stress that enough! Regardless of what State your in.

    DavidG

    Veritas-Health Forum Moderator

  • L4L5, After having a unsuccessful C-5 through C-7 with left sided radiculapthy and chronic pain syndrome, and everything that goes along with it was the easy part! Dealing with W/ C as well as the unnamed company I was working for broke me mentally, emotionally and they did it systematically. I really wish I could tell the whole story but I’m bound by a settlement agreement! 

    DavidG

    Veritas-Health Forum Moderator

  • L4-5, I can't say for sure, but I would think since all doctors use the same book (I believe AMA Guidebook, 5th edition), the PPD rating should be the same regardless of doctor UNLESS one of the doctors rates your residual pain higher than the other doctor.  I can't stress enough that each state does something different from the others.  If you feel your case could get complicated, I would highly suggest you hire an attorney.  Yes, they will get part of your settlement, but its worth it in the end given how much they can mess with you down the road!

    Several Epidurals, L4-S1 360 ALIF, Numerous Facet Joint Injections, RFA x2
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