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Thread: MMI

  1. #1
    Join Date
    May 2011
    Posts
    25

    Default MMI

    What does a 10% whole. Body rating mean for a brain injury headaches. 5% congnitive whole body rating for same injury?i Any help appreciated!

  2. #2
    Join Date
    Feb 2007
    Location
    Charlotte, NC
    Posts
    3,038

    Default Re: MMI

    IN NC, it means nothing. "Whole body" ratings do not comply with the NC Rating Guidelines.
    The North Carolina Court of Appeals has held that "In contested Workers' Compensation cases today, access to competent legal counsel is a virtual necessity." Church v. Baxter Travenol Labs, Inc., and American Motorists Insurance Company, 104 N.C. App. 411, 416 (1991).

    Bob Bollinger, Attorney at Law

  3. #3
    Join Date
    May 2011
    Posts
    25

    Default Re: MMI

    That was in Dr's notes and I am no longer with that Dr. Never gave an official MMI. Thanks for the response.

  4. #4
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,011

    Default Re: MMI

    As you know, WC is state specific. Mandated by the State Constitution.
    States vary on how PD/impairment is determined, not by IC standards or rule, but state law
    You say you are in a neighboring state to NC... if you'd provide your state, maybe someone could provide the 'law' regarding MMI/PPD/UR etc you are seeking.
    If they believe they must terminate services when they don't have to acting under the Law, perhaps patients needing doctor-ordered services will continue to receive them and providers of medical services will be paid by insurance as is their responsibility under the Law.
    The 'law' says medical care must be provided, IF the injury meets the AOE/COE stanard... that too is subject to litigation in the WC courts.

    WC is not insurance covering the EE/IC... but the ER liability for qualifying work injury.

  5. #5
    Join Date
    Feb 2007
    Location
    Charlotte, NC
    Posts
    3,038

    Default Re: MMI

    I think the "whole body" ratings are in the AMA guidelines, which many states use. NC does not use the AMA guidelines. The rating is pretty subjective. Most state WC laws provide a framework for determining what a specific rating is worth in dollar terms. Here in NC, we have the "scheduled benefits" in NCGS 97-31 that provide the framework.
    The North Carolina Court of Appeals has held that "In contested Workers' Compensation cases today, access to competent legal counsel is a virtual necessity." Church v. Baxter Travenol Labs, Inc., and American Motorists Insurance Company, 104 N.C. App. 411, 416 (1991).

    Bob Bollinger, Attorney at Law

  6. #6
    Join Date
    Apr 2012
    Location
    Oregon
    Posts
    350

    Default Re: MMI

    I don't think it is efficient to " stack the deck" with biased medical views. I believe it to be an example of what is deemed waste. The reviews are price inflated, biased and a tool to deny medical care to IWs in many many instances. When it easily defended by a competent wc lawyer with contrary evidence how has it prooved to be an efficient practice? I think I'm correct in believing that there is more deception being enacted by ICs and ERs then by IWs and those stories, these sad stories, right here on this board are what should be making the news.

  7. #7
    Join Date
    Feb 2007
    Location
    Charlotte, NC
    Posts
    3,038

    Default Re: MMI

    UR or Utilization Review, from what I have seen of it, is nothing more than an insurance industry creation that exists for the sole purpose of denying medical care whenever possible. The cost savings come only from the denial of medical care.

    Leslie, those defense doctor opinions are a lot harder to debunk than you may think. Saying that "a competent wc lawyer with contrary evidence" can debunk it is really a bit naive. How does that lawyer obtain that contrary evidence, for starters? That is a significant challenge. It is difficult to discredit a doctor in a deposition. Sometimes they will say something that can be used to discredit them, but most of them are pretty careful about what they say and don't put themselves in that position. And the judges do not allow "personal attacks" on doctors or opposing counsel. So you really do need some pretty strong medical evidence or testimony to beat back the opinions of those docs who are in the carrier's pocket.
    The North Carolina Court of Appeals has held that "In contested Workers' Compensation cases today, access to competent legal counsel is a virtual necessity." Church v. Baxter Travenol Labs, Inc., and American Motorists Insurance Company, 104 N.C. App. 411, 416 (1991).

    Bob Bollinger, Attorney at Law

  8. #8
    Join Date
    Apr 2012
    Location
    Oregon
    Posts
    350

    Default Re: MMI

    You are right, the system is not always fair and equitable. The treating physicians, as opposed to the IME/AME non-treating physicians, should ultimately realize that treating IWs is their function and denying care would be limiting their own incomes. Economics teaches that supply and demand serve each other and if you apply the theory to doctors and IWs the doctors who actually treat IWs should provide the evidence needed in hearings just to ensure themselves a job.

  9. #9
    Join Date
    Feb 2007
    Location
    Charlotte, NC
    Posts
    3,038

    Default Re: MMI

    Leslie, in a perfect workers' comp world, you would certainly be correct about the doctors.
    The North Carolina Court of Appeals has held that "In contested Workers' Compensation cases today, access to competent legal counsel is a virtual necessity." Church v. Baxter Travenol Labs, Inc., and American Motorists Insurance Company, 104 N.C. App. 411, 416 (1991).

    Bob Bollinger, Attorney at Law

  10. #10
    Join Date
    May 2011
    Posts
    25

    Default Re: MMI

    What stinks is the games played with people's lives. I am probably never gonna recover totally, but I am trying to keep working despite constant pain. I will more than likely get less because I am trying to be productive and work through pain many wouldn't attempt to work through. Guess I am stupid.

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