Looking for Answers

[workbooboo]

I've been on a long road as most of you have. I was injured over a year ago and my case manager talked my doctor into referring me to one of their doctors. I know it was their doctor since I wasn't examined and the doctor talked to her more than me. Their doctor says I don't need to see a doctor anymore and I should just live with my disability. My doctor (which they won't pay for) says I will need to see a doctor for this for the rest of my life.
I am wondering if this has happened to anyone else in Indiana and any advice would be appreciated. I have a lawyer but with the laws, I feel I am screwed because if I go to court to make them pay for my medical, I will have to go to their doctors and I have already tried that and no thank you.

[BvIA]

This happens to everyone all over the country...Indiana is not unique.

Medical treatment in comp is goal oriented. That is to functional restoration, and a return to gainful employment. Whether that is your pre injury job, or elsewhere doesn't matter. Nor is the goal to a pre injury physical condition.

The ER/employer is permitted in most cases to control the medical treatment you receive, through the treatment guidelines if the state has adopted those, and the medical UR/Utilization Review process. If your treating physican can't show the medical necessity, on an industrial basis, the treatment is not likely to be authorized.

I have a lawyer but with the laws, I feel I am screwed because if I go to court to make them pay for my medical, I will have to go to their doctors and I have already tried that and no thank you.

Those comp laws are there because the ER is liable for your injury. They buy comp ins to cover that liability and reduce the financial exposure in work injury/illness claims. Everyone is subject to those laws.
WC/medical is not like your own health ins coverage... treatment is limited, and the ER/IC is not going to provide any more than the law demands. If you were paying the bills you could of course have access to any treatment you and your IC were willing to pay for. Not so in WC.

Their doctor says I don't need to see a doctor anymore and I should just live with my disability. My doctor (which they won't pay for) says I will need to see a doctor for this for the rest of my life.

As the IC has a doctor saying you are stable, and have reached MMI/max med improvement, your condition will be rated to PD/impairment and the claim move toward some type of resolution/settlement.
You should talk to your atty about the options you have in settleing your claim.

You can read more about PPI/MMI and those benefits here http://www.in.gov/wcb/handbook/HANDB...onforLostWages

IX. COMPENSATION FOR PERMANENT PARTIAL IMPAIRMENT (PPI)
Definition

Impairment, or Permanent Partial Impairment as it is referred to under the Act, means the partial or total loss of the function of a member or members of the body or the body as a whole. In Indiana, compensation for impairment is paid according to a statutory schedule. Ind. Code §22-3-3-10. For injuries occurring on and after July 1, 1991, the calculation of impairment compensation is not based on the employee’s wages. Rather, impairment awards are designed strictly to compensate the employee for the loss or loss of use of body parts or functions.

“Maximum Medical Improvement”An award of PPI can only be made after it is determined that the employee has reached “maximum medical improvement” (MMI). MMI may also be referred to as “quiescence” or “permanence and quiescence.” Each of these phrases means that the injury has healed to the fullest extent possible and no further treatment would improve the employee’s condition. Another way of saying this is that the employee is “as good as he is going to get” after treatment for the work-related accidental injury. At that time, disability compensation (TTD) will be terminated and a PPI rating may be assessed by the treating physician or another doctor.