Workers compensation??"???

by admin on August 28, 2010

Hopefully someone can assist me with what I could do to get better medical care. I have a workers comp claim that has been open come this August which will be 2 yrs. I have been to numerous doctors who has given me numerous diagnosis from fibromyalgia, sprain/strain back, neuropathy, pinched nerves, thoracic outlet sydrome and it keeps going. My injury are to my upper back, neck and right arms. I worked a job for 7 years doing repetitive computer work in an unergonomic situation. I haven’t been able to get any real treatment other than a pain management dr. who every 2 weeks want to prescribe drugs with all kind of side effects.

So far none of the meds i have tried for pain and muscle spasm has worked. I can not sit for periods of time without being in escutiating pain. I did get some sort of relief thur chiropractice service but workers comp will not approve any other. I have not been consider strationary/permanent yet by the QME provider. Workers comp has never paid for an mri they went off an mri i paid for a week prior to be filing a claim and because that was normal i guess they feel they need not pay for one.

Is there any way or having medical care paid under my private insurance when i have a workers comp case open when the injuries are related?

Any advice that would steer me in the right direction of getting some sort of medical care and to have someone to find out exactly what is wrong with me to someone alleviate some of my pain so that i can be more active?
To: A decent Answer

I have been seen by a Qme doctor who requested that I see another provide of specialty which was an otthopedic surgeon for the numbness and tingling in my wrist and hand to determine whether i also had carpal tunnel. She examine me and found other things wrong and requested extensive therapy to assist me with that issue. My claim adjusted never did follow thru and allow me to have the therapy she requested per her report yet they chose to send me back to the Qme provider. I assume they are doing this to same money and to try to go ahead and close my case since it has been open for so long.

Since they did not follow the request per the specialist once i go back in to see the Qme this month what effect will that have on my claim? Will he request more medical care per the request or will he try to go ahead and just specify my permanent/stationary? My pain has gotten worsen instead of better. How do they determine what percentage disability you ?

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A decent answer August 28, 2010 at 2:11 pm

Well depends on the the claim itself and where your at. So I’m assuming that you claim has already been accepted. Has there been an IME or any consultants that helped out in this case? Sometimes a IME with two doctors, one in orthopedic and the other being a neurologist can benefit at the same time and find a way of treatment, these are called panel IME’s.

If you want your medical care to go under your private insurance there really is only one way of doing this and that’s is to settle the claim on a full basis, meaning you’ll take a certain amount of money in exchange you can never reopen your file again. Your claim is obviously stalled at this point, your still in pain and there really is no clear diagnosis, neuropathy injuries are very difficult at times. You may have to consider the fact that you might be in pain for the rest of your life.

So how do you figure your settlement amount? From my point of view I’m going to look at whether your able to return back to work, if your able to treat with your doctors and how much is your injury worth. So lets say your 50% permanent partial disability (PPD) you claim could be worth over $100,000. If you can’t return to work than you might qualify for vocational rehab. Some states have laws in which if your off work for an x amount of days you could self enroll to vocational rehab, which means school work within your light duty restrictions. How much is that? I wouldn’t know since I don’t know how much your paid but generally it’s $25,000, close out medicals…how much will this cost you over the next few years? Could be $50,000 so when you add it up your claim could be well worth over $200,000 at the end. Will you get that money? Don’t know, again it’s based on how much you think the claim is worth.
But the thing is do you really want to close all this out when your in pain? If the answer is yes and your prepared to move on, than settle the claim. If you decide to keep going with this and you don’t have an attorney perhaps you should seek advice to an attorney.

Check out whether acupuncture would work. Some state laws would cover that. If you try it and it feels great you might be able to keep that open for the rest of your life and treat with that. I would try alternative medicine first to see how your body feels, and sorry most states will not cover weed.

Good luck


Well you should contact your adjuster and ask them why they are not approving the therapy that was recommended by the consultation doctor. It’s not fair for you to be held out on the cold for a simple consultation. If your doctor believes it’s related to your work injury than they should be able to provide you the benefits required under state law. If they continue to ignore the request for therapy from your doctor they are acting in bad faith, and that’s the last thing an adjuster wants to be involved in. Contact both your provider and the adjuster. If the adjuster doesn’t return your call request the supervisor to help out. Your file shouldn’t close w/o your doctor releasing you back to full duty w/o any restrictions.

When you go back to see your doctor nothing will be affected on your claim, your basically at the same spot you started with. The doctor will ask you about the consultation with the specialist and you’ll say "WC adjuster never approved the therapy that the specialist recommended."

I can’t say what the doctor will do, I doubt he’ll release you back to work at your condition. I can only see your doctor releasing you stating "There is nothing else I can do for this patient" than your technically done with treatment. But if the consultation came with some other problems the doctor will do whatever it takes to get treatment to resolve the issues.

PPD is based on a number of things, age, range of motion (ROM), strength, pressure and so on. Each body part is rated different, each state is different. Some states us formulas, while other states have assigned weeks per body part based on the American Medical Association (AMA) guidelines. Normally your doctor will do this, however if your doctor doesn’t do this than the adjuster will schedule a IME to have you reviewed for PPD. I don’t think your quite there yet with all those problems you have. Best to see what therapy will do to resolve your ongoing problems.

FYI, pain is not a ratable thing. There is no pain and suffering, so there is no dollar value. You can say pain is worth $500,000 but I can say it’s worth $0. No way to but a dollar figure on pain.

mbrcatz August 28, 2010 at 2:11 pm

SOME of those diagnosis are clearly NOT workers comp related. Autoimmune disorders are NOT NOT NOT workers comp.

You need to work on finding out what is wrong with you – but keep in mind, phantom pain, sometimes that NEVER gets diagnosed. Also keep in mind, pain medications, over time, can give you permanent nerve damage that manifests as phantom pain.

cindy m August 28, 2010 at 2:11 pm

You cannot use your private insurance. If you do, workman’s comp can stop paying them. I would ask for a nurse to be assigned to your case, via workman’s comp. You are entitled to that. She/he will work with you thu this. They are usually mid ground, not on anybody’s side so to speak. You should have received a booklet from w/c if not ask for one and find out your rights.

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