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  1. #1
    Join Date
    Sep 2010
    Posts
    10

    Default Workmans Comp Denying SCS

    I have fallen at work almost a year ago. I was diagnosed with CRPS. Since all this has happened the CRPS has spead to 3/4 of my body. The insurance company sent me to Boston cause Vermont said it was to severe for them to do anything. I went to Boston over a month ago and they set me up for a Spinal Cord Stimulator trial. Now the insurance company wants me to wait until I get an IME. Well they have had over a month to set up the IME and still say I have over another month to wait. Boston has told me I do not have that long cause they fear it will spread to my one good arm. Boston wont do the surgery without prior approval cause it is so expensive. I have a lawyer and he has been working on this but he says his hands are tied. Does anyone know what else I can do? I can not suffer like this anymore.

  2. #2
    Join Date
    Mar 2008
    Posts
    71

    Default Re: Workmans Comp Denying Scs

    Not sure who 'Boston ' is but they seem to be misinformed about CRPS spread ("Boston has told me I do not have that long cause they fear it will spread to my one good arm."). The SCS implant will probably not prevent spread. I had an SCS implant for CRPS of my left lower extremity done a year ago and I have since had spread to my right lower extremity.

    Due to the high cost involved with treating CRPS you should not be surprised if the WC IME opines that you either do not have CRPS or that (as in my case) there is no such thing as CRPS.

    I am truly sorry about your diagnosis and truly hope that they eventually approve you for the SCS trial but please keep in mind that the SCS may or may not work and even if it should, do not expect 100% pain relief. During my trial I had nearly 100% relief and went ahead with the permanent implant which is a godsend but only provides about 60 to 70% reduction in daily pain levels and I still have frequent breakthrough pain. I also continue on a regimen of daily pain meds to keep me 'managed'.

    You will probably just have to wait for this to play out. In my case it took approx. 8 months form the time the SCS trial was requested till the surgery. Best of luck, I know what you are going through and "it ain't easy". BTW, my DOI was 3 1/2 yrs ago.
    "Broke down, busted up and outta gas"
    Gramps

  3. #3
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    17,943

    Default Re: Workmans Comp Denying Scs

    Boston has told me I do not have that long cause they fear it will spread to my one good arm. Boston wont do the surgery without prior approval cause it is so expensive.
    SCS is for pain management.... not cure for the CRPS/RSD. This condition may or may not spread... there is nothing you could do to stop the progression anyway.

    The IME is to verify the opinion of the "Boston" Dr...Boston is evidently a pain management clinic... what those Dr have told you is an "opinion" the same as any other Dr, IME or otherwise is going to offer.
    In this case, you've heard something that sounds like what you want to hear... right/wrong/indifferent, it's still an opinion. Every Dr you see is likely to offer an opposing opinion... doesn't make one more viable than the next.

    You should discuss this with your treating physician, and atty, and...expect the IME to deny the SCS trial. There are also other diagnositcs you would undergo prior to the SCS trial...but your Atty should probably file for a hearing now...just to get on calendar.

    There is also info here you may find helpful...www.rsds.org

  4. #4
    Join Date
    Sep 2010
    Posts
    10

    Default Re: Workmans Comp Denying Scs

    What I mean by Boston Dr is its a Dr in Boston who is specialized with CRPS. I have already been through many many test as well as had nerve blocks and all confirm CRPS. I have had 5 Dr's confirm the diagnosis for CRPS. The insurance company is the one who sent me to Boston Ma in the first place for treatment. Now the Dr they sent me to say's at this point all I have left to try is the Scs and they dont want me to do it. They want me to do the IME. I am more than willing to do the IME but to leave me suffering for months is horrible. The CRPS is already in both of my legs and my left arm. I have horrible color changes to the point where I am embarrassed for anyone to see it. My lawyer has told me the IME Dr is always for the insurance company. I just did not know if there was anything else I could do or if anyone else has been through this.

  5. #5
    Join Date
    Jan 2010
    Location
    Pennsylvania
    Posts
    606

    Default Re: Workmans Comp Denying Scs

    Heh you are even lucky to have a Dr. to diagnose your condition. I have my PTP, my personal primary physician, and my PM Dr. all pointing to one another to diagnose me as I have "something." I ask the PTP what the swelling (not circulatory as all of those tests have been exhausted and negative), the pain, the mottling, the discoloration and my incontinence is all about and I get..."go see your personal dr. about that because I don't know." I go to the personal dr. and she says it's CRPS but all she can do is write it down, doesn't mean that WC will listen to her. The PM doesn't believe in the syndrome (believe it or not). I can't get another MRI through my private insurance nor can I pay for it. WC says "no need" or course they will say that, because they don't want to find out. I do have an appointment with a Neuro in oct that deals with CRPS and is supposed to have worked with Dr. Schwartzman (one of THE experts in CRPS and RDS fields), so hopefully it might be fruitful. I just believe that my PTP does not want to be the first to diagnose it.

  6. #6
    Join Date
    Sep 2010
    Posts
    10

    Default Re: Workmans Comp Denying Scs

    I am sorry that they are putting you through that crap. I have a lot of Drs on my side who say its CRPS so that is a good thing! I spoke with my Dr who by the way was hired by the insurance company to treat me in the beginning and he told me the Dr they hired to do the IME does not believe in CRPS, so I was going to have a fight on my hands. I just dont understand how some of these people can live with themselves knowing how crooked they are. If it was someone in there family who is in constant pain and cant move it would be a different story!

  7. #7
    Join Date
    Feb 2007
    Location
    Calif
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    Default Re: Workmans Comp Denying Scs

    I just dont understand how some of these people can live with themselves knowing how crooked they are. If it was someone in there family who is in constant pain and cant move it would be a different story!
    It depends on who is paying the bills.. Not necessarily the Dr IME... the medical costs.

    RSD/CRPS at this point in time is extremely costly to treat, there is no 'cure'... in fact even with all the medical evidence out there on this condition, you will still find Dr's who may be resistant to the initial diagnosis.
    Medicine is a science...science is not necessarily facts all practioners agree on. That is why Dr ''practice'' what they have learned in medical school, and experience in the workplace.

    All Dr's, as all people are going to have differing opinions...you are suffering pain... you're going to accept a Dr opinion that coincides with that of your own...or at least sounds good...or reasonable. A opinion that differs from yours/your Dr...is going to be worth... well... crap to nothing.

  8. #8
    Join Date
    Jan 2010
    Location
    Pennsylvania
    Posts
    606

    Default Re: Workmans Comp Denying Scs

    I have to plead guilty here myself.... well not entirely. I am a nurse and at one point I used to work in assisted living. We had a woman there who injured her arm and constantly complained of pain in that arm. Her injury was a year old at that point and she was remained on heavy narcotics. She would come in crying stating her pain was intractable. Most of the nurses (and Dr.s I might add) felt that she was a drug seeker who would just want more and more narcotics. She was insistant that she would not get full relief of the pain. She admitted that the medication would give her about 2 hours of some relief. She did finally go to pain management and did have a treatment plan that stated that her pain was indeed real and her diagnosis was RSD. Not one of us nurses (or Dr.s ?) bothered to find out what this was and went on complaining that she was a drug seeker until she died. I did feel sorry for her, so working the night shift, I was able to sit and chat with her a lot. I was able to uuuhh get her, her meds before her alloted time. If it was every 4 hours I would get them to her every 3- 31/2 hours. But I am still guilty of not really looking into it further. I am a pretty good advocate for patients when I want to be and if I would have known that I would be in this position myself, I would have gone online and got every scrap of information and made my cohorts aware of this. It may have helped her by convincing the other nurses to be more empathetic and the Dr.s to be more lienient in their drug scheduling.

  9. #9
    Join Date
    Feb 2007
    Location
    Calif
    Posts
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    Default Re: Workmans Comp Denying Scs

    There a stories like yours every single day... years ago, my grandmother was accused of being a ''drunk''... she'd hide Vodka in boiled out perfume bottles with atmoziers on them... 'squit' in the mouth would do the trick... wash out a Scope bottle, a little blue/green food dye would hide that... a smoke colored water glass, filled to the rim on the top shelf in the kitchen would hide another stash of the 'juice' nicely...
    That went on for several years... after she lost all of her children visiting...no reason to hide the stuff... a few years later, she'd lived alone... one of her daughters found her in a coma...head stuck to the pillowcase in her own vomit... she'd had a brain tumor the size of a orange... for YEARS.... she complained of ''headaches''.... the Dr gave aspirin ok... no x rays... MRI or CT scan wasn't developed yet.... she died after about 6 weeks/coma in a nursing home... no one had to bother with getting pain meds early...or at all.

    At the end of the day... or better yet, the beginning of every day....anyone with the responsibility for ANY person should be listening... and listening again... and again if necessary... when someone says "I hurt...."... LISTEN and DO something. Or GET someone to do something...

    More on RSD is here www.rsds.org

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