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  1. #1
    Join Date
    Jul 2010

    Default Light Duty/MMI 0% - Now What

    Thanks to everyone who posts information here. I have learned so much by reading this formum.

    Injury in Florida in 2009.

    I was injured with knee, neck and shoulder injuries from a fall at work 9 months ago. I was restricted to light duty while they looked for what was wrong. I worked on light duty for 2 months and then my employer said my job required full active duty (I drive to customer sites, etc daily) and could no longer accommadate my restrictions so I was given TPD benefits by workers comp.

    I was sent to an orthopedic after 2 months and 1 MRI later. The ortho said I needed knee surgery but did not state what was wrong with me. While waiting on approvals, I was given narcotics for the pain, I went to PT, and to the dr every 3 weeks. Each visit I complained about my shoulder/neck and numbness in my fingers. He finally order an MRI of my neck 3 months later. He said I had slight disc buldges, nothing to worry about and it would not prohibit sugery. Still waiting I got a 2nd opinion on my own.

    I paid for on my own a 2nd option and another knee MRI. My knee problem diagnosed as torn cartiledge, needing arthoscopy surgery. This dr referred me to a spine dr for my neck/shoulder. Spine dr looked at the original MRI films of my neck and said you have a herniated disc that is why you are in so much pain. He told me he didnt know why the report did not state it as it is clear on the film and showed it to me. He said I also have a frozen shoulder from overcompensating for neck injury. He said I need disc fusion surgery. He ordered an additional MRI to confirm (I will be going this week and paying on my own for it). We have designated the knee dr that gave the 2nd opinion as my IME.

    A week ago I went to my workers comp dr who said I would be scheduled for knee surgery in 3 weeks, set a pre op visit for me to return, gave me continued light duty restrictions and more narcotics. I asked about the spine/shoulder pain and he said he dosent know what is wrong but it isnt dangerous.

    I received a letter from workers comp stating my dr has rated me at MMI with a 0% impairment rating without restrictions and released me from his care. The letter stated that they are searching for a new dr. for my ongoing treatment and I am to pay a $10.00 co-pay for medical and indemnity benefits are terminated.

    What do I do? I cant do my job because it requires driving, walking long distances, etc. My employer knows I am on restricted duty as they have the same paperwork I received from the dr. They said I can not return to work unless I am off all pain medications, can drive, use stairs, walk long distances, etc. Additionally they require a dr's certification stating I have no restrictions and am not on any mediciation. So basically I am not going to get paid by workers comp and I cant go back to work. I have wanted to work all this time and offered to do any job within my restrictions and due to the nature of my employer there was nothing they go give me to do. This is not a case where I dont want to work because I do however want to work and have offered to work many times. I can not drive on company insurance (driving is a primary part of my job) when I am on meds (painkillers, muscle relaxers and sleeping meds) and can not turn to look over my shoulder while driving.

    I have an attorney and am waiting for his response but not sure what the options are. Workers comp dr obviously says I am fine. I still have this neck/shoulder issue that the workers comp never addressed. Now no payment and no job. What can I do? What are my options? Please help.
    Last edited by FLkneeneck; 07-31-2010 at 12:17 PM.

  2. #2
    Join Date
    Feb 2007

    Default Re: Light Duty/MMI 0% Now What

    You wanna pare that down to a specific question or two...?
    You have an attorney hadling the claim...that is where legal advice should come from... second guessing your attorney isn't going to happen on a message board...

  3. #3
    Join Date
    Jul 2010

    Default Re: Light Duty/MMI 0% Now What

    Thanks but I am not questioning my attorney. I am waiting for his response which may not be for several days as he is in court next week. Sorry if the questions were not clear, I was trying to give all the information.

    I was looking for advice. Now since my dr gave me light duty due to not being able to drive, walk long distances, stairs, etc and my employer will not accommadate I am not able to work. The same day as he gave me light duty IN WRITTING and made an appointment for my pre op surgical visit and subsequent knee sugery the IC is stating that Dr put me at MMI with 0% impairment and no restrictions ON THE SAME DAY. Specific questions are how can he give me light duty with restrictions, give me the paperwork, schedule me for surgery but tell the IC that I am at MMI with 0% and no impairment at the same time? Is that within the workers comp statute? Also since I can not work, have no treating dr according to the letter I received (they are searching for one) and have an IME that says I have medical issues requiring surgery what are my options? How do I get treatment? How do I get paid if I can not work and IC cut off my indemnity? I know attorney can and most likley will file a PFB but that can take 130 days until mediation and 210 day MINIMAL for trial. What do I do in the meantime for treatment, medication and money?

    Thank you.

  4. #4
    Join Date
    Feb 2007

    Default Re: Light Duty/MMI 0% - Now What

    The other option is to settle, then go through your private insurance and get the real help you need. (Advice from my attorney, who probably just wants to get paid quickly.)
    If you settle the comp claim, take money for future medical care, then knowlingly permit another carrier to pay for treatment to your injury, you are committing a fraud against an insurance company. You cannot be paid benefits twice for the same loss... money from WC for medical care, benefits from your own health coverage for the same medical care. Double dipping.

    While your comp claim is open, the ER/IC is responsible for medical care costs. When you take the cash, you are agreeing to be the responsible party with the money you are paid... you use that money as 'out of pocket' to pay for further treatment to the work injury.

  5. #5
    Join Date
    Jul 2010

    Default UPDATE - Light Duty/MMI 0% - Now What

    Thank you for the advice. This is what has happened.

    Dr 1 - stated I needed surgery, gave me light duty paperwork with restrictions that employer would not accommadate thus I would continue receiving TPD. 2-3 days after carrier sends me a letter stating dr put me at MMI 0% rating and no restrictions.

    Carrier stops paying TPD

    My own IME Dr. - states restricted duty and need surgery.

    Dr 1 released me from his care. Carrier assigns a new dr - Dr 2 (takes a month)

    Dr 2 - Stated NOT at MMI. He stated I am to be on light duty with restrictions and I need surgery. Writes prescription for meds and for pre op testing that carrier is to provide. Asks for documentation from my personal dr clearing me for surgery.

    Pharmacy - through EHeathySystem states claim is closed and would not approve prescriptions. 5 days later and countless calls carrier approves prescriptions.

    Carrier still NOT paying TPD

    Dr 2 - told them I had the information they requested for me to obtain and that I would like an appointment so we can get the surgery done. Dr 2 will not schedule a follow up appointment as carrier will not respond to their requests for surgery or pre op testing.

    Carrier still NOT paying TPD, not authorizing surgery or pre op testing. Carrier not responding to attorney.

    Filed PFB. I am told I may have to wait until Mediation (January) or Trial (likely March) and have the court decide about the surgery and TPD.

    Called ombudsman. What a joke - they said now that it is in litigation carrier has the right to challange any of the doctor's opinions and they are suppossed to respond to the PFB within 14 days but they do not have to.

    Meanwhile I have NO income and am in pain with no relief in sight. Called ombudsman

    Attorney's stance is to wait until mediation and trial.

    So what can I do? How does one pay for their bills and function? Any suggestions

  6. #6
    Join Date
    Feb 2007

    Default Re: Light Duty/MMI 0% - Now What

    You need to tell your attorney to get of his butt and call the carrier. If needed file for an emergency hearing. If the authorized doctor has indicated you are light duty then they should be paying you tpd. Waiting for the mediation is not appropriate. He works for you so tell him to earn his paycheck.

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