CA- Need some suggestions

[MrsMitch]

Okay lets start by saying my husband is the injured worker. We have fired two lawyers and basically have given up. Unfortunately the Claims Administrator is hard to work with and very unresponsive.

My husband had a discectomy was given ppd at 18% WPI. An IME said he was MMI and was put on PPD. We obtain a new dr who took a new MRI and notice my husband was re-herniated and was re-operated after UR.

Does my husband get re-rated after second discectomy? by an IME? the same IME?

First surgeon requested fusion and now the second surgeon has requested a fusion and the ime said a fusion would probably be necessary. Can we send request for UR re the fusion request or can only adjuster's do that?

We can see that we are going to have to be on our toes and have read everything from DIR over and over again and hope together "we - that's you guys and us" can do this - we have to do as good as the two horrible attys did. NOTHING

[1171]

Yes since he was no longer at MMI and not finalized he'll need Re-rating.
California uses QME or AME
Same doctor is not requied-QME only used if either party objects to treating MD.
Surgeon or treating doctor makes request.

And my fee is reasonable as well..........

[MrsMitch]

Thank you. Trust me if you could be hired I would hire you. I have been watching you post and appear to have plenty of experience and are "on it".

Surgeon or treating doctor makes request to the UR???

Thanks again.

[1171]

thank you.
many, many contribute here. each in their own way.
hope you will as well.
I have some knowledge of california rules.
generally the physican is the one that requests a certain treatment from the carrier or their UR unit based on ACOEM or other medical protocols.
some basic info about how UR works in california
http://www.dir.ca.gov/dwc/FactSheets/FactSheet_A.pdf

detailed Medical treatment rules including UR are here
http://www.dir.ca.gov/dwc/MedicalUnit/imchp.html