Who's diagnosis is more credible in court, a Certified, Orthopaedic (foot) Surgeron, that has sports medicine credentials or a MD from the Emergency room?
The Orthopaedic surgeron saids it a sprain, the MD saids there is no injury at all , but precribes pain medicine.
Depends on the state in some cases. Also depends on the judge(using that term because in FL, that's who decides) Some states the presiding judge, court, board etc. have the discretion to decide who they find more credible.
In Fl, if the doctor wasn't authorized to treat you, they have no say.
We need a little more info. State you are in (forgive me if I missed it)
How did it happen? Did you report immediately? Was the treatment from the Ortho authorized or did you go on your own? I'm sure you may have given this info in previous posts but it's hard to backtrack so would appreciate a recap.
Thanks.
Hi Kate, thank you for your reply.
I live in OH, My doctor is the sports medicine surgeon. and she is the one that said I had a sprain and removed me from work.
I have a jones fracture 5th metatarsal on my right foot and I wear a air cast boot for 6 hours a day and for 2 hours a tennis shoe. My left foot has been bearing all the weight, for 5 months now, and that is the one with sprain, that the ER doctor said nothing was wrong with it, in the report that I rec"d today.
I did not get prior authorization from w/c to go to the ER at 9:30 at night for severe pain. I called my doctors office two weeks prior, complaining about the pain and was told she was not going to be back in the office for about 3 weeks, and they did not want me seeing different doctors, becuse of confusing opinions. I wish I knewthat before I went to the ER.
The ER Dr prescribe pain medicine, Tramadol. I saw ER Doctor Nov 26, and I saw my doctor exactly 3 weeks later, after she returned from out of town.
Let me know if you need any additional info. I hope I did't confuse you.
Ohio is one of 4 -5 states that is a "monopolistic" state. Which means the state itself handles ALL Work Comp issues. There are no insurance companies involved.
From what I have been able to research "Under the BWC’ (Bureau of Workers' Compensation's) health-care system, injured workers must visit BWC-certified health-care providers for treatment, except in an emergency or initial visit. The injured worker may continue treatment with a non-BWC-certified provider, but payment for the treatment will be the injured worker’s responsibility.
So from what I read from your post, you went to the ER. Which is normall, when you are in pain.
But then you say " I did not get prior authorization from w/c to go to the ER at 9:30 at night for severe pain. I called my doctors office two weeks prior, complaining about the pain and was told she was not going to be back in the office for about 3 weeks, and they did not want me seeing different doctors, becuse of confusing opinions. I wish I knewthat before I went to the ER."
It seems under the law you can go to the ER if its an emergency. That means hurt, can't get someone at work at the time of emergency to approve a doctor's visit.
The part that disturbs me is your quote of: "I called my doctors office two weeks prior, complaining about the pain and was told she was not going to be back in the office for about 3 weeks, and they did not want me seeing different doctors, becuse of confusing opinions."
Also from your post you say "My doctor is the sports medicine surgeon. and she is the one that said I had a sprain and removed me from work.
I have a jones fracture 5th metatarsal on my right foot and I wear a air cast boot for 6 hours a day and for 2 hours a tennis shoe. My left foot has been bearing all the weight, for 5 months now
"The part that disturbs me "
but you don't say what it is that disturbs you....
Netta; your ER visit will be covered under your comp IF the bill is submitted by the ER to ohio BWC. The ER may not or you may need to send any bill you receive from that visit to the BWC for payment or route it through you atty for payment.
The second issue is does the ER visit constitute a flow through condition from the original injury on the other foot. In order for BEC to accept this new injury there must be a statement by a physician that says so "to a reasonable degree of medical certainty" and it really really helps if those exact words are used by the Dr. in her statement of causal relationship.
It makes no difference to the BWC if you were just limping around in your boot for weeks on end or that you might have tripped and fell or even slipped on the ice and twisted your ankle IF the reason for doing so was the boot or the injury to the other limb.
You'll be fine. This happens every day and the system is well equippewd to handle such cases on their merits. Your Dr. explanation is all that's needed.
"The part that disturbs me "
but you don't say what it is that disturbs you....
What disturbed me, was the statement "I called my doctors office two weeks prior" (to the ER visit) and that "My left foot has been bearing all the weight, for 5 months now" Just trying to figure out when the additional injury actually happened. It could make a difference whether the ER visit is covered.
In most states you need to prove "causal connection" for treatment to be covered. Since the ER doctor, according to Netta, said "there is no injury at all" I was questioning whether the ER visit would be paid for.
Sorry I didn't make myself clearer.
Well, causal relation is simply a more likely than not; ie; 51 % likelihood test. It really wouldn't make a difference if she had or had not called her Drs. office. THere as a an ER visit with a noted chief complaint and evaluation and meds were dispensed, hardly "nothing wrong" or the Dr has some 'splainin to do, regardless of what he told the patient. I am sure, ie. 100 % sure, the ER doctor note does not say normal exam, nothing wrong. That an ER doc does not make a causal relationship statement will not matter , lucky she saw the Dr. at all the way ER's operate anymore.
As for which Dr. will be found to be more credible...I say that a lot of it depends on the judge that you happen to get. The reason I say this is due to what happened that last time I was in court, trying to get my bladder issue added to my w/c case.
There were 2 Drs. that said it was definately due to my back problem and 2 that said it was inconclussive as to why I was loosing control of my bladder. The 2 that said it was related, were my Urologist who wrote out in his statement that he had done an ultra-sound, and several other tests, to rule out any kidney problems etc. and there were none...his final opinion was that my issues were related to the spine. The other Dr. agreeing with that thought, was my Neurologist, who specialized in Chronic nerve disorder. Then the 2 that said they did not have enough evidence to suggest there was a connection, were a pain management dr. who never dx. anything...just treats the pain from the problem. The other was my original spine surgeon, who had not seen me in over a year and did not even realized that I was having this bladder problem.
The Judge's ruling, stated that she could not give more weight to the 1st 2 drs., over the last 2. My thought was a Urologist and Neurologist that specialize in this type of problem, would be more credible about the bladder, that the pain management Dr. and the surgeon.
I sure hope things work out well for you.
The urologist did not perform a uro-dynamic study ? That's how you determine a neurogenic bladder (spine) from not.
Thanks everyone for your comments and advice
My Orthopaedic (foot) Surgeron commented in her report how the air cast boot caused the sprain to the other foot when it is worn for a long period of time, which is considered a flow through. She also commented on the pain medicine that the ER doctor gave me and that I had diffused pain in that foot, meaning (all over). I will explain in more detail about my visit to my doctor yesterday in another thread because I have more questions that does not pertain to this thread.