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  1. #1
    Join Date
    Sep 2011
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    68

    Default Permanent Disability Rating Issued After AME

    Long story short.. I got injured in 2009, filed a comp claim in June 2011 for the injuries. I've had 3 injections and my WC doc wants to do a 4th, which hasn't happened yet and may not happen or be approved. Had an AME on Nov 8th and my attorney called today saying he got the report from the AME and I've been given a perm disablity rating and will be looking at a stipulation soon. Said he will bring me in to go over the paperwork.

    I'm really confused by what all this is meaning. He said I'll continue to get medical treatment.. but why am I getting what sounds like something so final when the WC doctor hasn't really done anything yet beyond given me painkillers and physical therapy.

    And what happens if 5 years from now things are severely worse? Is the rating something that can be reevaluated? Or am I stuck with it for life?

    Any advice on what all this means? I know I will be meeting with the attorney soon but having this dropped on my lap late afternoon on a Friday has left me with a million questions and no where to go for answers.

    Thanks everyone!

  2. #2
    Join Date
    Oct 2006
    Posts
    9,108

    Default Re: Had Ame, Lawyer Called Told Me Got a Perm Disability Rating. I'm Confused

    you and the carrier agreed to abide by the opinion of the AME. the doctor determined that your condition is at maximum recovery or permanent and stationary.
    further treatment will not likely significantly change your impairment.
    the treating doctor's opinion is overruled by the AME-that's the whole purpose.
    now your permanent impairment can be determined and therefore the duration of permanent disability payments.
    you have 5 years from the date of injury to file for a change of disability.
    Last edited by .SH; 11-18-2011 at 06:28 PM.

  3. #3
    Join Date
    Feb 2007
    Location
    Calif
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    18,011

    Default Re: Had Ame, Lawyer Called Told Me Got a Perm Disability Rating. I'm Confused

    I'm really confused by what all this is meaning. He said I'll continue to get medical treatment.. but why am I getting what sounds like something so final when the WC doctor hasn't really done anything yet beyond given me painkillers and physical therapy.
    You didn't say what the nature of your injury is... but what do you want you PTP to do...? Do you believe you are a surgical candidate...?

    You are likely to be paid weekly cash indemnity benefits, based on the PD/WPI rating... vs a cash lump sum payment. That is actually the carriers option. Medical care will continue. That's a Stipulation w/Award in resolving a claim. If you don't agree with this...your claim will be set for trial and a WCAB judge will issue a finding.

  4. #4
    Join Date
    Sep 2011
    Posts
    68

    Default Re: Had Ame, Lawyer Called Told Me Got a Perm Disability Rating. I'm Confused

    I have mild changes to 5 discs in my cervical spine that cause headaches, pain through my neck, shoulder, down my arm into my hand. I also have a crushed disc is my lumbar spine that causes pain through my low back down into my leg. Cause of injury was repeated moving of heavy furniture without proper training, equipment or safety measures.

    I don't know if I'm a surgical candidate. The physical therapist says so. The WC doc wanted me to see a surgeon (which is scheduled on 12/15 and was approved by the insurance company).

    Before I had filed the claim I had saw my regular doc and went through different docs (spinal surgeon, rhuemy). They are the ones who had me get injections that failed. The only thing I've gotten from the WC doc is PT and drugs. Both of which have not been helpful. I've told every single doc that I've met that I just want to be fixed! I don't want the drugs or this battle just fix it. Unfortunatly my age (I'm 31) and my outdated films (2010, early 2011 although the pain has increased to where my medication has had to be doubled twice) have been the decided factor. I didn't even know what this AME was for!

    The AME doctor told me with my age there wasn't anything more that they could do. Things would have to get worse, way worse, before they decided to do a surgery. I will admit I had a weak point and broke down, which was incredibly uncomfortable for me and for him.

    I just feel... that the least they could do is take up to date films and try to find a way.. instead of basing everything on the past. If the films show the same.. then so be it, I guess. But I don't care about an award or anything. I just.. I can't imagine having to wake up everyday for the rest of my life like this. The past 2 years have been hard enough. I can't deal with the loss of hope that the 'answer', 'the fix', is at the next dr. visit.

    Sorry.. kind of vented there.

  5. #5
    Join Date
    Feb 2007
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    Calif
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    Default Re: Had Ame, Lawyer Called Told Me Got a Perm Disability Rating. I'm Confused

    Cause of injury was repeated moving of heavy furniture without proper training, equipment or safety measures.
    CT/Cumulative Trauma can be a compensable claim...this has nothing to do however with training issues... or safety measures. Did you file a complaint with Cal-OSHA ?
    I've told every single doc that I've met that I just want to be fixed! I don't want the drugs or this battle just fix it. Unfortunatly my age (I'm 31) and my outdated films (2010, early 2011 although the pain has increased to where my medication has had to be doubled twice) have been the decided factor.
    OK... you want to be "fixed"... if you are not a candidate for surgery, and you should not be wishing for this...what do you suppose a "fix" might be...? The meds aren't working...the PT is going to be capped at 24 visits
    How old are your films...?

  6. #6
    Join Date
    Sep 2011
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    68

    Default Re: Had Ame, Lawyer Called Told Me Got a Perm Disability Rating. I'm Confused

    No. I believe the attorney will be filing something regarding OSHA. He mentioned this during my consult with him.

    Why shouldn't I wish for surgery if it could correct things? I know there is no magic wand that can be waved and restore me to my previous physical state but shouldn't there be something that can be done? Maybe it's wishful thinking. I'm just not ready to give up hope that they CAN find a way to fix things so I can do the things I used to be able to do and miss doing.

    My PT has been approved for over 24 visits. My films are from July, 2010 and March 2011. The reason I say I believe updated films are need is at the time those films were taken the pain was manageable with Tramadol. And at this time the pain isn't manageable with Norco. Wouldn't the increase in pain be a sign of something worse or more?

  7. #7
    Join Date
    Aug 2011
    Location
    Georgia
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    800

    Default Re: Had Ame, Lawyer Called Told Me Got a Perm Disability Rating. I'm Confused

    Quote Quoting PainandSmiles View Post
    Why shouldn't I wish for surgery if it could correct things?
    Probably because the initial finding concerning the cervical spine is "mild changes", which doesn't dictate surgical intervention. Also, because most patients who have ONE spinal surgery end up having many more. My wife will tell anyone, after her sixth such surgery, if you can avoid it, do so at any cost.

    The single, isolated "crushed disc" (by the way, there really is no such thing) may also not be significant enough for surgical intervention either. “Crushed Disc” is not a correct term but in general usage means the same thing as “deteriorated or degenerated” disc. A deteriorated or degenerated disc is typically a normal process that begins usually in the person's mid-20's. If there is a specific injury (herniation, for example), then the deterioration and degeneration would be accelerated.

    In short, the "crushed disc" - which is actually a natural occurrence of deterioration or degeneration is not a contributory factor to the injury. The injury, if any, would be contributory to the deterioration/degeneration progressing faster.

    If the Dr. has not specifically indicated a herniated disc, annular tear, etc, then the condition might possibly be considered a non-injury condition, and not advanced enough for surgical intervention.

    Wouldn't the increase in pain be a sign of something worse or more?
    Yes and No. An increase in pain could also be attributable to an increased tolerance to the pain medication (type or dosage).

    I know there is no magic wand that can be waved and restore me to my previous physical state but shouldn't there be something that can be done?
    Physical Therapy and strengthening exercises are often beneficial for pathological illnesses (deterioration/degeneration) in the spine.

  8. #8
    Join Date
    Sep 2011
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    68

    Default Re: Had Ame, Lawyer Called Told Me Got a Perm Disability Rating. I'm Confused

    I didn't use medical terms. )

    There is dorsal annular tearing and disc protrusion of L5-S1 and mild changes in L4-L5. There are remarks on C3-4, C4-5, C5-6, C6-7, C7-T1 ranging from mild to moderate changes regarding facet joints, uncovertebral hypertrophy (not sure what that means), neural foraminal narrowing, and effacement ventral thecal sac. These reports are from 2010.

    Physical therapy has not consisted of any exercises per doctors orders. Physical therapy has been simulators and light massage.

    Does it not make sense to have up to date films? my 2009 film vs my 2010 films show change.. wouldn't it make sense that there would be changes from then to now?

    I've emailed my attorney and have an appointment upcoming with the WC doc. I guess I'll be able to voice all this to them and either have them ease my mind and tell me I'm wrong or agree and do something.

    I just feel like I've been rushed. This was my first appointment outside of my WC doc and all of a sudden I'm being 'discharged' (in my eyes). I thought there would be more than this.

  9. #9
    Join Date
    Aug 2011
    Location
    Georgia
    Posts
    800

    Default Re: Had Ame, Lawyer Called Told Me Got a Perm Disability Rating. I'm Confused

    Quote Quoting PainandSmiles View Post
    There is dorsal annular tearing and disc protrusion of L5-S1 and mild changes in L4-L5. There are remarks on C3-4, C4-5, C5-6, C6-7, C7-T1 ranging from mild to moderate changes regarding facet joints, uncovertebral hypertrophy (not sure what that means), neural foraminal narrowing, and effacement ventral thecal sac. These reports are from 2010.
    Seems a bit more significant than what you originally posted. I'm unsure as to why you would not be a surgical candidate - then again, I'm not a Dr.

    Hopefully, your attorney can help you get this sorted out.

  10. #10
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,011

    Default Re: Had Ame, Lawyer Called Told Me Got a Perm Disability Rating. I'm Confused

    There are remarks on C3-4, C4-5, C5-6, C6-7, C7-T1 ranging from mild to moderate changes regarding facet joints, uncovertebral hypertrophy (not sure what that means), neural foraminal narrowing, and effacement ventral thecal sac. These reports are from 2010.
    Have you 'googled" any of the terms used here...?
    You have to be a willling participant... have you discussed your options with your PTP...?

    I can tell you...from experince... you have DDD/Degenerative Disk Disease...not uncommon in about 80%, or more of the general public, it's simply part of the ageing process and working doesn't help to supress it. The neural forminal narrowing, or stenosis, causes nerve impingement... that's the souce of your neck pain. The cervical spine nerves control everything from the head to about mid chest...including upper extremities...arms, hands etc, and the upper colon. IF one of those nerves is severly damaged, it can cause paralysis... so, you are likely a surgical candidate... it happened to me...and I am now solid bone from C-3 to T-1. Talk to your PTP...
    I just feel like I've been rushed. This was my first appointment outside of my WC doc and all of a sudden I'm being 'discharged' (in my eyes). I thought there would be more than this.
    What do you mean "outside WC Dr" ?
    It doesn't do any good to treat outside the MPN system... those medical reports are not admissable in your claim.

    If your PTP or AME finds you are stable "as is"... MMI, you'll be rated for PD/WPI and your claim move to some type of resolution... that does not mean you won't be entitled to on going medical based on necessity. You'll have 5 years from the org DOI to reopen the claim for new and further PD.
    You're being 'rushed'... you are being offered treatment reasonable expected to 'cure or relieve from the effects of your injury"... that's all there is in WC. You are not expected to recover to pre injury condition...only stability/MMI.

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