maximum medical improvement with a 6% disability.

[butterfly300]

COPY OF EMIL FROM ADJUSTER

The O/A is Rita and she is awesome. She has been with us for many years.
I assigned her to have a face to face metting with you to discuss settlement of your
claim. You have reached 104 weeks and I have sent to our Medical Director who
based on your medical records places you at maximum medical improvement with
a 6% disability. This does not mean you can no longer treat with authorized provider.

This disabiltiy rating allows you 12 weeks of benefits.

I am your adjuster, it's just that Rita is an outside adjuster who meets with injured worker's
face to face.

If we settle the claim then I will assign an attorney to draw up the paperwork, you may have to
appear by phone with Judge to confirm settlement. That's it. If you need some time to think
of settling your claim that is fine.

I am always here to answer any questions you have.

[jayne]

IME is Independant Medical Exam....sounds like your friend the adjuster is offering only 12 weeks of benifits as a settlement sucks big time....

[butterfly300]

Yes it does suck Jayne. Im more worried about the long term effect from this rating & how it could be done by their medical director & not my doctors. I dont see how they could say Im 6 % disabled from a legal or moral stand point.

[butterfly300]

bodybuilder1958 Wrote:There is nothing that says you have to settle, I used to work with a girl that had 4 different WC injuries and she's never settled, each case is still open.

The insurance company will lie to you. The insurance company will tell you that you'll be taken care of. But the insurance company can't put you at MMI only your doctor can and you're still receiving treatment.

Call or email the adjuster and tell them you're not interested at this time in settling. Hire an attorney, get some strength behind you. Then stop talking to the adjuster, let your attorney deal with them. Get your lawyer to send you for an IME. Fight it, get the care you deserve!!!

We've all cried over our cases, you need someone else on your side fighting for you.
That person is a lawyer, I'm not a lawyer person but I'm glad I have one.

Take care,
BB

BB did you see a copy of the email? it wasnt my Dr's one of the dr's I have only seen once so they were not considered, couldnt have been. My delima is I need surgery but dont want wc doctor to do it so I dont know what else to do than settle. In FL we can only go to their providers.

copy of email...
The O/A is Rita and she is awesome. She has been with us for many years.
I assigned her to have a face to face metting with you to discuss settlement of your
claim. You have reached 104 weeks and I have sent to our Medical Director who
based on your medical records places you at maximum medical improvement with
a 6% disability. This does not mean you can no longer treat with authorized provider.

This disabiltiy rating allows you 12 weeks of benefits.

I am your adjuster, it's just that Rita is an outside adjuster who meets with injured worker's
face to face.

If we settle the claim then I will assign an attorney to draw up the paperwork, you may have to
appear by phone with Judge to confirm settlement. That's it. If you need some time to think
of settling your claim that is fine.

I am always here to answer any questions you have.

[bodybuilder1958]

If they can get you to settle for a low ball amount then that's a plus for them.

You have a neck problem and they gave you a rating of 6%, that's joke. I had a rating on my bad knee and the other as well. That was a 16%, 12% on the bad knee and 4% on the other.

An IME is very important at this time, the IME would say what your rating is and if you ask the right questions give you an idea as to whether or not you should settle or go for more treatment.

[AQA]

lets keep in mind that different states use different editions of the AMA.

[Cycler]

YOu may be then surprised to know that absent surgery, the overwhelming majority of neck impairment percentages are between 5 and 8 %, some 60 plus % actually, and that is regardless of 4th, 5th or 6th edition of the AMA Guides.

Additionally, a simple file review is often sufficient if using the 5th or 6th edition of the guides if the treating physicians medical records are reasonably complete but tis not done in most states except for evaluations for an increase from a previous award.. The 4th addition's lack of Diagnosis Related Estimate (DRE) groupings generally needs an actual exam but not always.

Just an FYI.

[bodybuilder1958]

Hi,
I understand you wanting to go to only certain doctors. I'm a former medical professional, I worked in surgery, heck I assisted with those surgeries. So I know how important it is to get the right surgeon with the right attitude who does a good job. There are doctors that I recommend to people all the time because I've worked with them. I know how well they perform in surgery, I can visualize the outcome depending upon the technique of the surgeon.

But my first work comp doctor ruined my left knee. I won't go into details, I was awake during surgery and I must of been dozing. But he left me with a draining fistula which he ignored. I had a fit, went to HR and got into another surgeon who worked hard for over a year to try and fix my knee. But the damage was already done. The only satisfaction that I got was that my first surgeon was told to retire, my 2nd surgeon was in the same practice. Within 4 days of my seeing the 2nd surgeon my original surgeon retired. He canceled surgeries, he was just gone. Two yrs later I asked my doctor about it, he told me that they told him to retire because of my case.

By hiring an attorney I got into see better doctors and even got opinions by doctors that I wanted to see. Not just doctors that the hospital I worked for. Doctors who I knew would side with me, doctors that didn't have the track record of always siding with respondent.

I dream a certain dream, that I fall, or get in an accident or something. Something that causes my insurance to pay for a surgeon of my choice to fix my knee. Then I take it further, that I get to the PT place of my choice, not the rehab hospital that has a so-so record.
But I'm stuck, I have wonderful insurance but I can't use it. Come Oct it will be 5 yrs since I was injured. I haven't worked in nearly 3 yrs. I didn't have a complicated case, I had a simple injury that a work comp doctor ruined. So now I also have a hip problem because I sit so much due to the pain and instability. My other knee has also had surgery due to the strain. But it was done under my insurance, done in 6 days and I finished rehab in 2 weeks.

I still hate lawyers with a passion. But I respect them for what they've managed to do in my case. My former employer is the largest health system in the world. That's alot to fight against. But with the assistance of my lawyer I've won each time I've gone to court. Never, ever lost a ruling, my lawyer says he's never had a client who's won each and every time on a case that's gone on for nearly 5 yrs. I guess one of the reasons I win is because I'm frankly a female dog when I see a doctor or get in court. I'm professional, curt and argumentative. I asked difficult questions, I argue and I counter each and every argument. I've had doctors write on reports that I'm rude and argumentative. That doesn't bother me what so ever.

Okay I need to end this soap box. We're all so very passionate about our cases. We all hate our lawyers but we understand that sometimes it's a necessary evil. I understand medicine, patient care, surgeries, PT, etc. I don't understand but I'm an expert in some things on WC. So I want someone in my pocket that does. Someone who can breeze thru the paper work and get it done. Someone who argues better in some ways than I do.

I close this rather long (and I do apologize) post with a bit of sadness.
Sad because I'm stuck in this system and I fear for the long term implications of not having surgery. Also sad because later today we leave for a 9 day vacation, a vacation that I'll have to take crutches with me. Bad enough needing to walk with a cane but now I need crutches because I over did it on Thursday.

Take care, hugs,
BB

[butterfly300]

Hi, Hope everyone is having a nice weekend
I had to get my tears out & regain myself some what before returning to the forum to not sound like a whinny mess but the truth is all of this has brought me to my knee's to the point wc agreed to a psychiatrist & 1 only had 1 visit when the rating thing happened. The psychiatrist said " I was depressed as hell" & anxiety mess. Not knowing me its hard to understand that is so not me & since this injury Ive lost my home, vehicle & ruined my credit. If I dont settle something soon after 13 yrs of being with the love of my life I could very well lose him to. he has went through 2 yrs of hell with me. with that said maybe its easier to understand that even from these stories I feel I have 2 choices #1 have surgery by incompetent doctor, did screwed up & then getting proper rating or settle medical now with them & take chances with surgeon i trust in hopes of not getting screwed up & end this. Thank you for sharing your stories really means a lot to me. My concern about coming up with all my medical cost that would be over $100k they will try to give me a lower amount that prevents me from getting surgery anyway so its kinda darned if u do darned if u dont. If I get a attorney at this point do u think he can change that disabilty rating without me going through surgery with the screwed up wc surgeon??

[butterfly300]

bodybuilder1958 Wrote:Hi,
I understand you wanting to go to only certain doctors. I'm a former medical professional, I worked in surgery, heck I assisted with those surgeries. So I know how important it is to get the right surgeon with the right attitude who does a good job. There are doctors that I recommend to people all the time because I've worked with them. I know how well they perform in surgery, I can visualize the outcome depending upon the technique of the surgeon.

But my first work comp doctor ruined my left knee. I won't go into details, I was awake during surgery and I must of been dozing. But he left me with a draining fistula which he ignored. I had a fit, went to HR and got into another surgeon who worked hard for over a year to try and fix my knee. But the damage was already done. The only satisfaction that I got was that my first surgeon was told to retire, my 2nd surgeon was in the same practice. Within 4 days of my seeing the 2nd surgeon my original surgeon retired. He canceled surgeries, he was just gone. Two yrs later I asked my doctor about it, he told me that they told him to retire because of my case.

By hiring an attorney I got into see better doctors and even got opinions by doctors that I wanted to see. Not just doctors that the hospital I worked for. Doctors who I knew would side with me, doctors that didn't have the track record of always siding with respondent.

I dream a certain dream, that I fall, or get in an accident or something. Something that causes my insurance to pay for a surgeon of my choice to fix my knee. Then I take it further, that I get to the PT place of my choice, not the rehab hospital that has a so-so record.
But I'm stuck, I have wonderful insurance but I can't use it. Come Oct it will be 5 yrs since I was injured. I haven't worked in nearly 3 yrs. I didn't have a complicated case, I had a simple injury that a work comp doctor ruined. So now I also have a hip problem because I sit so much due to the pain and instability. My other knee has also had surgery due to the strain. But it was done under my insurance, done in 6 days and I finished rehab in 2 weeks.

I still hate lawyers with a passion. But I respect them for what they've managed to do in my case. My former employer is the largest health system in the world. That's alot to fight against. But with the assistance of my lawyer I've won each time I've gone to court. Never, ever lost a ruling, my lawyer says he's never had a client who's won each and every time on a case that's gone on for nearly 5 yrs. I guess one of the reasons I win is because I'm frankly a female dog when I see a doctor or get in court. I'm professional, curt and argumentative. I asked difficult questions, I argue and I counter each and every argument. I've had doctors write on reports that I'm rude and argumentative. That doesn't bother me what so ever.

Okay I need to end this soap box. We're all so very passionate about our cases. We all hate our lawyers but we understand that sometimes it's a necessary evil. I understand medicine, patient care, surgeries, PT, etc. I don't understand but I'm an expert in some things on WC. So I want someone in my pocket that does. Someone who can breeze thru the paper work and get it done. Someone who argues better in some ways than I do.

I close this rather long (and I do apologize) post with a bit of sadness.
Sad because I'm stuck in this system and I fear for the long term implications of not having surgery. Also sad because later today we leave for a 9 day vacation, a vacation that I'll have to take crutches with me. Bad enough needing to walk with a cane but now I need crutches because I over did it on Thursday.

Take care, hugs,
BB

Hi BB,
Please do not apologize for your story I appreciate every word of it. I feel for you & see myself in your shoes if i allow surgery with this surgeon & no amount of $ is worth the hell you have been through. This is why I'm considering settlement now on the whole thing & getting my own surgeon so my thinking is not so far off. It sounds like they have to screw you up in surgery to give you help but by then you are permanently disabled & cant be helped.
i am very sorry that happened to you & hope you find relief in your pain. Family activities r so hard while dealing with pain & pretending all is fine & trying to have fun. I hope you enjoy your vacation pain free as possible

Take care, Sandy