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  1. #1
    Join Date
    Mar 2015
    Location
    Arizona
    Posts
    2

    Default When to File for Permanent Partial Disability

    Hi all,

    I'm a 20 year old with a likely case of either systemic lupus or juvenile arthritis (we'll know after I have bloodwork monday). I injured my back at work, specifically the facet joints in my lower back, causing inflammation and essentially perpetual muscle spasm in my spinal erector muscles. The injury doesn't sound severe, but it has completely destroyed my day to day life and I have not been able to work since December 2014. I am unable to lift anything over 5 pounds without extreme discomfort, and cannot push the shopping cart at the grocery store without severe pain and muscle spasms. My ortho specialist sent a request for cortisone injections to my employer's insurance company (The Hartford, if anyone is curious) and it was denied on the grounds of being "not medically necessary." However it is the only treatment available for my injury and I will only repeatedly re-injure the area if left untreated, meaning I can no longer work. They went into Peer to Peer with the insurance company and the insurance company's doctor said they would not consider approving the treatment unless they were told the levels in my back where the treatment would be administered. The way the procedure is done, however, means that is impossible to know as my doctor has to inspect joint by joint while administering the treatment. So the company refuses to approve the treatment. They are now dodging a request to resume physical therapy as well. In addition to the medical approval issues, they are frequently late with my payments and have claimed to have "lost" or "misfiled" my paperwork twice. I have to wait about 6 weeks between payments, minimum. We have tried to get my personal insurance carrier (Cigna) to approve the treatment as well, but there is a conflict there because The Hartford is the company the accident was reported to.
    I am becoming increasingly frustrated as this is the prime of my youth and I had so many plans going forward that are seeming to fall apart. I used to be highly active and had planned on really focusing on weight lifting this year and now it's becoming clear that I may never work a typical 9-5 job again as nobody is picking up the treatment request. Am I going to need to talk to my ortho and apply for Permanent Partial Disability? How does that even work? Can I if the insurance company acknowledges the injury and treatment and just says it's "not medically necessary" despite being the only treatment available?

    Thanks...

  2. #2
    Join Date
    Oct 1971
    Posts
    5,089

    Default Re: Should I File for Permanent Partial Disability and How Would That Work in Az

    Am I going to need to talk to my ortho and apply for Permanent Partial Disability? How does that even work?
    You don't apply for Permanent Partial Disability, you reach it after going through the first stage.
    Here's an explanation of the stages of a claim.
    Different Disability Stages in Arizona Workers’ Compensation Claims
    http://www.avvo.com/legal-guides/ugc...nsation-claims

    If you don't have a lawyer, now's the time to get one.

    Tony
    Moderator Responses are based on my personal bias, experience and research - They do not represent the views of the admin nor may be accepted in the legal community, always consult an attorney.

  3. #3
    Join Date
    Mar 2015
    Location
    Arizona
    Posts
    2

    Default Re: Should I File for Permanent Partial Disability and How Would That Work in Az

    I can't afford a lawyer. I'm 20 years old and my worker's comp "monthly" payments are $750. What do I do in this case?

    Also, the reason I'm asking about talking to my doctor about moving me to PPD is because I'm not sure what happens in my specific case. The article states the following definition for PPD:
    This means that a doctor believes that the injured worker has received maximum benefit from medical treatment and that additional treatment will not provide additional improvement to the permanent injury.
    I have currently received maximum benefit from medical treatment based on what has been approved, but not from what could be done. However, I cannot receive the treatment that would provide maximum benefit because no insurance company will approve it. Does this qualify for moving to PPD? Why/why not? If I cannot receive the only medical treatment that will improve my condition, haven't I technically received maximum benefit?

  4. #4
    Join Date
    Oct 1971
    Posts
    5,089

    Default Re: Should I File for Permanent Partial Disability and How Would That Work in Az

    aj1994
    I can't afford a lawyer. I'm 20 years old and my worker's comp "monthly" payments are $750. What do I do in this case?
    Hire a lawyer.
    A lawyer works on a contingency, it'll cost you nothing up front.
    It's not to your advantage to rush a perm rating, it's best to stay on TTD for as long as possible.
    Let your case progress at it's own pace, don't rush it.

    You are clueless as to how the system works, without a lawyer, they'll chew you up and spit you out.
    For the price of a lawyer, you'll be money ahead, protect your rights and save your sanity.
    Consult and retain a lawyer immediately.

    Tony
    Moderator Responses are based on my personal bias, experience and research - They do not represent the views of the admin nor may be accepted in the legal community, always consult an attorney.

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