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  1. #1
    Join Date
    Dec 2009
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    6

    Default What If You Get Worse After P&S Determination

    My workers compensation claim was made in the State of: CALIFORNIA


    my QME dr declared me permanent and stationary what if my back problem progresses? is there a statue of limitation on the time i have for further examinations for further ratings i have 5% thoracic and 5% lumbar 2% for pain and suffering, which i am not sure that is fair consdering how much pain i am in... am i ever allowed another rating if i feel the problem worsens over the years since i am at the same job, and if so is there a name for that process? also i believe i my adjuster might contest the QMES report because he said he was going to.... if he does that will i have more time to put together more medical information and reports? to turn into the QME? also what is the maximum disability rating one can recieve before being forced to have to complete vocational rehabilitation? is it 25% WPI.... another question i have is due to my back injury, i filed for FMLA june 2009 since that is the only way to protect my job that i know of on days when i have inflamation and flare ups..... the paper work was filled out by my family practice doctor for my serious injury aka my back and i have missed over 400 hours of work, is workers comp responsible for paying me back for works missed? as well as chirpractic visits that i have paid for out of pocket?


    LAST QUESTION- if my work has a MPN is there any possible way i can make my chiropractor i have been seeing my primary doctor or my pain management doctor my primary or my family practice doctor my PRIMARY TREATING PHYSICIAN FOR MY CLAIM I TRUST THESE THREE the doctor they sent me to are disgusting degenerate insurance puppets thats wont make it in this world if i get my way thats for sure....... and they work for kaiser..... they make me sick
    Last edited by Lifter12; 12-04-2009 at 11:05 PM.

  2. #2
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,045

    Default Re: Couple Questions

    my QME dr declared me permanent and stationary what if my back problem progresses? is there a statue of limitation on the time i have for further examinations for further ratings
    There is a SOL of 5 years from the org DOI/date of injury to petition the court to re-open your claim for new and further PD/WPI...IF you settle the claim by a Stipulation w/Request for Award, or F&A/O...Finding w/Award & Order by a judge at trial.
    If you settle by C&R, you cannot come back later for additional treatment or PD.
    i have 5% thoracic and 5% lumbar 2% for pain and suffering, which i am not sure that is fair consdering how much pain i am in...
    Unless you are rated under the 'old' PDRS, that is not a valid rating. You should be rated to 'WPI' Whole Person Impairment, not seperate body parts. The spine/back would not be rated to Thoracic/Lumbar, but again, to WPI. The max addon for 'pain' is 3%. (no ''suffering'' in WC)
    also i believe i my adjuster might contest the QMES report because he said he was going to.... if he does that will i have more time to put together more medical information and reports? to turn into the QME?
    Your PQME report goes to the DEU/Disability Evaluation Unit for review and confirmation of the PQME rating... if there is a dispute by the CA, it would go to a hearing/judge...if you have a 12% PD/WPI rating, I don't see why there would be a dispute...that's not significant dollar wise.
    also what is the maximum disability rating one can recieve before being forced to have to complete vocational rehabilitation? is it 25% WPI....
    There is no VR any more. You can't be 'forced' to re-train. And IF there were a need for rehab, it's not dependant upon a rating. But whether or not your PTP/PQME determines you cannot continue your pre injury job duties, and/or your ER abilty to bring you back to work with your restrictions, or request for reasonable accommodation. In that case, you would be elibible for a SJDV/voucher for help in returning to work or gainful employment.
    another question i have is due to my back injury, i filed for FMLA june 2009 since that is the only way to protect my job that i know of on days when i have inflamation and flare ups..... the paper work was filled out by my family practice doctor for my serious injury aka my back and i have missed over 400 hours of work, is workers comp responsible for paying me back for works missed? as well as chirpractic visits that i have paid for out of pocket?
    While WC and FMLA may have overlaps, they are not connected benefits. FMLA provides job protection for up to 12 weeks/annum, unpaid. If you return to work, you can replenish those weeks by the formula as defined in the rules.
    TTD is paid when you cannot work due to your injury, and your PTP must certify those wage loss days.
    There is some info on the overlaps of FMLA/EEOC/ADA here http://www.ppspublishers.com/articles/fmla.htm
    Your family Dr doesn't have that ability. Your PTP also must submit the request for treatment/chiro with supporting rational for the treatment requested, The IC can use MTUS/ACOEM treatment guides, and the UR process to determine medical necessity. Self procured treatment is also subject to prior authorization... and there is a cap of 24 PT/OT/Chiro for the life of your claim. You may or may not be reimbursed for chiro you self procure.
    LAST QUESTION- if my work has a MPN is there any possible way i can make my chiropractor i have been seeing my primary doctor or my pain management doctor my primary or my family practice doctor my PRIMARY TREATING PHYSICIAN FOR MY CLAIM
    In a word...No. There are VERY limited circumstances where you can treat outside the MPN... what you provide here does not meet those exceptions.
    the doctor they sent me to are disgusting degenerate insurance puppets thats wont make it in this world if i get my way thats for sure....... and they work for kaiser..... they make me sick
    Well, you can stop thinking about 'doing' anything to stop the Kaiser Dr's in the way they treat industrial injury. There are adopted treatment guidelines MPN Dr's, or any Dr who treats industrial injury/illness must comply to. That doesn't mean they are not ''good doctors'', more often than not it means their hands are tied in what treatment they are able to provide. You aren't going to change that.
    You are however permitted up to 3 PTP's, if you disagree with the diagnosis or treatment plan you go to IME. If there are disputed medical issuesl, you go to PQME and/or hearing at WCAB and let a judge decide and resolve the issue.

    It would probably help if you were to make yourself familiar with what WC benefits are available, what is not, and how you access the benefits you are eligible for. The fact sheets for IW's at the DWC site http://www.dir.ca.gov/dwc/InjuredWorker.htm will help answer many of your questions.
    If you are experiencing denials to your benefits, you should talk to an I&A officer at the WCAB, or an atty specializing in WC.

  3. #3
    Join Date
    Dec 2009
    Posts
    6

    Default Re: Couple Questions

    well the adjuster wants to contest it because the hipaa forms were never filled out so they can get all my medical records..... and this injury happend over a year ago and they realized they didnt have the hipaa forms and sent me the hipaa forms right when i requested the QME and realized they did not have them...

  4. #4
    Join Date
    Jan 2010
    Posts
    1

    Default Re: What If You Get Worse After P&S Determination

    Thanks you for the post.
    Hi guys, Im a newbie. Nice to join this forum.

  5. #5
    Join Date
    Feb 2007
    Location
    Calif
    Posts
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    Default Re: Couple Questions

    Quote Quoting Lifter12 View Post
    well the adjuster wants to contest it because the hipaa forms were never filled out so they can get all my medical records..... and this injury happend over a year ago and they realized they didnt have the hipaa forms and sent me the hipaa forms right when i requested the QME and realized they did not have them...
    WC is expressly exempt from HIPAA laws... Don't know what the problem is with getting prior medical records, either you sign a release, or the WCAB can compel you to produce them.

    The ER/IC is entitled to your medical records because the PTPPQME must address the issue of apportionment to cause of your PD.
    They are only liable for the PD/Impaiement due to THIS injury. So if you have prior/pre exsisting condition or injury that contribut to your PD, that will reduce your final rating, and money award to the claim.

  6. #6
    Join Date
    Nov 2009
    Location
    going no where
    Posts
    27

    Default Re: Couple Questions

    [QUOTE=BvIA;130661]
    Well, you can stop thinking about 'doing' anything to stop the Kaiser Dr's in the way they treat industrial injury. There are adopted treatment guidelines MPN Dr's, or any Dr who treats industrial injury/illness must comply to. That doesn't mean they are not ''good doctors'', more often than not it means their hands are tied in what treatment they are able to provide. You aren't going to change that.
    QUOTE]

    Sorry but they are not good doctors or decent people. I am sure that if they were good doctor they could make a decent living without being OWNED by the ic. They are only doing whats best for their wallet.


    (rant off)
    "P"

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