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  1. #1
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    Aug 2007
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    374

    Default Difference Between Evaluation and Exam

    When the IW receives a netter from the IC saying they have set up an appointment for a neurological "evaluation," in the terms of WC, how is this different from an "Exam?" Is this going to be like the FCE?

  2. #2
    Join Date
    Dec 2006
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    2,165

    Default Re: Is There A Difference?

    Lue, the Neurological evaluation will mean that the Neurologist will not only perform a physical examination of you, but the Neurologist SHOULD review ALL your medical records so that he can determine :
    (1). What your diagnosis is,

    (2). IF it is "linked" (causally related to having hit your head when you fell), and is therefore a compensable injury that the IC is LIABLE FOR,

    (3). recommenations regarding any further diagnostic testing that is reasonably medically necessary,

    (4), any reasonably necessary medical treatment,

    (5). Your current work status (off work and on TTD, light duty with restrictions, etc).

    IF this cyst is determined to be "causally related" to your fall at work, and the IC disputes the Neuro's opinion, then you can expect that the IC will probably have you re-evaluated..I amnot sure what the process is in Tennessee, but perhaps an IME. Your attorney will be able to explain this to you.

    Even IF the Neuro determines your Neuro problems are NOT a result of your fallat work, he STILL has to arrive at a diagnosis and treatment recommendations.

    HOWEVER, IF the Neuro says that the blow to your head "lit up" or exacerbated a "pre-existing condition" (like perhaps you DID have that cyst, but it was ASYMPTOMATIC prior to the fall, and the fall at work made it WORSE, hence your NEW SYMPTOMS), then, depending on the WC Laws in Tennesse, it might STILL be considered a compensable injury under WC.
    Any "residual PD" that you might have from the cyst will then be "apportioned", meaning what percent of PD is due to pre-existing factors, and what percent of PD is due to the injury from work, which usually is a "SWAG" (Scientifically Wild-Assed GUESS)...

    IF this IS determined to be a totally non-industrial injury, then you should NOT have a problem getting your private health insurance to cover whatever is necessary for treatment for this.

  3. #3
    Join Date
    Aug 2007
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    374

    Default Re: Is There A Difference?

    Seems the WC IC doctor has nothing to lose if he says it didn't happen at work. What difference does it make how it happened to him, other than he tries to get it changed over to personal insurance. He might say, "Yes, I see a cyst, and it was already there." Even though the with contrast MRI is never run when the radiologist says it is needed to diagnose this cyst.
    Can he just rule this without further MRI's? Or does he just have the right to accomodate the IC, but who makes the final call? A judge?
    Seems all they have to do is deny, and then they are off the hook.
    Lue

  4. #4
    Join Date
    Feb 2007
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    550

    Default Re: Is There A Difference?

    You know Lue, my Ex Husband is a Board Certified Internal Medicine Specialist.
    What a Dr has to lose would be their integrity, and then some. They have taken an oath to their patients. I know you have heard of the Hippocratic Oath, right? I want you to Google it, Lue, and read it, please.

    Most Dr's are very conscientious, and are honest about their opinions. Just like there are IW's that are full of shit, you may find a Dr that is full of shit. However, if you had spent 200,000 on your education, do you really think you would risk flushing that down the toilet, to tell an IC what they wanted to hear? I didn't think so, Lue.


    SO, keep the faith.

    LA

  5. #5
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    Aug 2007
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    374

    Default Re: Is There A Difference?

    princessLA,
    I hope this doctor takes that oath the same. It scares me that the NCM says he is one of her favorites, so that sends out a flare of distress to me.
    I'll give you a report after the big evaluation.

    Charles,
    Looks like anything goes here.
    I dread this.
    When an MRI, CT, etc is taken, is a radiologist the one that reads it and tells the doctor what is going on, or does the doctor have the ability to read it 100%?

  6. #6
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    Feb 2007
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    Calif
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    Default Re: Is There A Difference?

    Lue,
    In a X-ray lab there is always a Radiologist, MD...who reviews Every X-ray, MRI, CT scan...whatever test is performed the Doctor reviews and makes a diagnosis...the report goes to your PTP. IF the PTP has additional questions, they converse and come to a determination of what the Radiologist has found. Your PTP/Dr. through experience CAN read the films...but relies heavily on the Radiologists report. There MUST be a written report issued, or the CA won't pay the Radiologist or for the exams.

  7. #7
    Join Date
    Aug 2007
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    374

    Default Re: Is There A Difference?

    BvIA,
    The reason I ask, it seems so convienent that the NCM will throw in my face that a doctor has only one specialty. If it is an ortho doc, then if you tell him your head hurts each time you go to see him after hitting your head, he will not refer you to a neuro, because he doesn't know about heads. The NCM says the Ortho cannot order a test that a neuro only can order,that are in his line of specialty and cannot oder an MRI of the brain. But when the NCM wants the brain scan, she has the Ortho order it

    I am wondering in the line of "WC" specialites, where is the line drawn here. If the neuro says he see's no problem iwth the MRI, then does the IC and the neuro get to fall back on the fact that he isn' a radiologist?
    I am having a terrible time with games like this.
    No documenting any of my complaints, etc.....
    Do you ask the doctor while he is looking at the films if he is a radiologist? Did he ask a radiologist about the films?
    Seems I always leave an open for them to stick this "specialty crap" in my face to get out of things. Grrrrrrrrrrrrr!

  8. #8
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    Aug 2007
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    374

    Default Re: Is There A Difference?

    Charles,
    Yes I will behave at the doctor's office but I am steaming off my anxieties before I go.
    Lue

  9. #9
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    Feb 2007
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    Calif
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    Default Re: Is There A Difference?

    I am wondering in the line of "WC" specialites, where is the line drawn here. If the neuro says he see's no problem iwth the MRI, then does the IC and the neuro get to fall back on the fact that he isn' a radiologist?
    I am having a terrible time with games like this.
    No documenting any of my complaints, etc.....
    Do you ask the doctor while he is looking at the films if he is a radiologist? Did he ask a radiologist about the films?
    Seems I always leave an open for them to stick this "specialty crap" in my face to get out of things. Grrrrrrrrrrrrr!


    Lue,
    This isn't an issue of "WC specialties", over the years most all medical pro's have concentrated on a 'specialty', you'll find the same in "regular' medicine. It's just that in WC there are limitations to the treatment as to "medical necessity', and many states use the ACOEM guides or other EBM to provide a test as to what treatment is necessary, based on peer reviewed criteria, for your specific injury.

    So a radiologist will give a diagnosis based on the tests your PTP ordered, but doesn't treat..the PTP/Ortho/Neuro as the case may be, relies on the Radiologist to provide/concur with the diagnosis and then treats.

    Whether it's an ortho, neuro, radiologist etc, all the 'specialties' work together to provide you with the diagnosis/treatment/care you are entitled to.

    The NCM says the Ortho cannot order a test that a neuro only can order,that are in his line of specialty and cannot oder an MRI of the brain. But when the NCM wants the brain scan, she has the Ortho order it


    I don't know how true that is...a lot of times we find NCM's telling us what they want us to hear...
    If you're dealing with a spine injury, there could be an ortho OR a neuro involved OR both at times...depends on the injury, muscle/soft tissue, or nerve, that is causing the problem. Lots of time you hear about orthos and neuros arguing about what the treatment should be...usually because they can't agree on what the specific injury is.

    I am having a terrible time with games like this.

    I don't know that it's really ''games''...vs. confusion in the system...medicine has changed drastically, along with the costs, over the years...when you're not 'ill', you don't see a doctor, maybe for a long period of time, then when you do go, everything is different.
    Remember when there were "GP's", the doctor you went to that took care of everything/anything that ailed you...? All gone....

  10. #10
    Join Date
    Aug 2007
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    374

    Default Re: Is There A Difference?

    Boils down to: "It doesn't make a difference." In the meantime, I am going to try to find help to get the double vision turned around. Doctor said that the damage may have gone too far, and I might have to live with it. I am not happy with that. I am not happy at all. My vision has gone down to 20/200. I found that 20/20 for pilots, 20/40 for drivers license, 20/80 may be used for special educational assistance and 20/200 for tax benefits in the USA. I am not confused about it at all.

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