Was hurt on a drilling rig in Tx 2 yrs ago. skull fracture,broken leg and messed up knee. received benefits for one yr then WC sent me to a doc and one week later payments stopped. got a knee scope feb 08 and need another knee surgery but have been turned down 3 times. my casr hearing is june 4th. talked to a lawyer but he said its too close to get involved. my surgery is being turned down bc the IC says the surgery falls outside the guidelines. the only way i can win is 1. my doctor calls in and says why i need the surgery which he doesn't have time for.2. he finds a case like mine that he has done before3. he finds a case another doc has done like what he wants to do to me. no doubt i need sugery. the MRI shows that a the doc says that in my reports but IC says the surgery doesn't fall in the guildlines. any points i can make to the judge to help my case? ALSO, i'm an EMT and HAD to start working again for money even though my knee kills me every day. will this hurt me in my case for my knee surgery or when its time for a settlement?
I don't know any specifics about how TX works, but could you request an extension for the hearing for your attorney to get up to speed on case?
Did the Dr refuse to participate in the hearing telephonically? That's unusual, did he at least submit a written report or affidavit
My experience from other states is that if you were able to return to work without limitations there usually isn't a settlement. The settlement is for future lost wages due to an inability to work.
You need to find out how and which guidelines they are talking about before you can come up with a counter strategy.
Good Morning...I haven't a clue ....but I'm bumping this up for you, as there are several well informed people on here re: Texas WC rules.
Lilly
No he wont release me to go back to work on a drilling rig because my knee is too unstable but my head injury left me with headaches everyday,dizzyness and the most important was memory loss. example would be ill brush my teeth sometimes and set the toothbrush down and not know if i just brushed them. oilfield is dangerous enough so sending someone out there with memory loss would be no good
cnaz Wrote:I don't know any specifics about how TX works, but could you request an extension for the hearing for your attorney to get up to speed on case?
Did the Dr refuse to participate in the hearing telephonically? That's unusual, did he at least submit a written report or affidavit
My experience from other states is that if you were able to return to work without limitations there usually isn't a settlement. The settlement is for future lost wages due to an inability to work.
You need to find out how and which guidelines they are talking about before you can come up with a counter strategy.
have your doctor write a letter to the comp court explaining why you need the surgery.
no, trying to work may help.
He has wrote letters explaining why i need surgery the first 2 times i was turned down but they keep saying its outside the guidelines. ok thank you. for a second i was thinking doing EMT work might hurt my case but i know for sure ill never be able to work on a drilling rig again. i guess that will help my settlement amount later on? thanks again
1171 Wrote:have your doctor write a letter to the comp court explaining why you need the surgery.
no, trying to work may help.
In the state of TX, you have 104 weeks for treatment and such before you are basically put at MMI unless there is a demanding reason that you get an extension, which is very hard to do. After that time, you are to be allowed treatment, but will not receive any monetary benefits until you are given an IR if there is need for one.
Going back to work, even if it is not your job that you were injured at, shows that you can work. So there won't be any voc rehab or such. However, it won't hurt your IR. That has to be done by the book...meaning the AMA guidelines.
What 1171 said, about getting your Dr to write a letter in regards to you needing the surgery and present it to whoever is presiding over your hearing in June, not the IC. You don't say what kind of hearing you are having. Is it a benefit review ?? Or contested claim?? I know that there are a few others. If a benefit review, then you will try to get the IC to agree to the surgery using the letter that you need the Dr to write, no good giving it to just an adjudicator as they have no power to help your case, just mediate between you and the IC. If it is a contested claim, then the letter might do you some good as you can present it as evidence as long as you get it done ASAP... you have to send a copy of the letter to the judge, as well as the IC withing 10 days of the hearing.
You can ask for a continuance if a contested claim, as long you have a valid reason to do so..such as getting an attorney to help you. However, this will probably delay your case by 3 months or more while they set it for another date. It is entirely up to you on how you want to handle this. So I would think long and hard before making any decision.
Angel ^j^
have those previous letters from the doctor been sent to the judge so he can see them by the time of the hearing?
if not, you can't be sure the judge will understand both sides.
whether it's outside the guidelines or not will be up to the judge to decide not the carrier.
conatact your health insurer about providing the rejected treatment.
It is a contested hearing for my surgery so we will be going in front of the judge. Im going to the doc to get an IR on the 29th since last year the doc i went to see for WC gave me a 0 IP. i'm able to work but cant stay on my knee for more than 5 min without it really hurting me. again my doc has sent MANY letters but they are saying the letters aren't good enough because the surgery doesn't fall in the guidelines. one last question. if i get my IR, COULD my settlement be done before my contested claim? or do benefit settlements usually take a long time?
UndercovrAngel Wrote:In the state of TX, you have 104 weeks for treatment and such before you are basically put at MMI unless there is a demanding reason that you get an extension, which is very hard to do. After that time, you are to be allowed treatment, but will not receive any monetary benefits until you are given an IR if there is need for one.
Going back to work, even if it is not your job that you were injured at, shows that you can work. So there won't be any voc rehab or such. However, it won't hurt your IR. That has to be done by the book...meaning the AMA guidelines.
What 1171 said, about getting your Dr to write a letter in regards to you needing the surgery and present it to whoever is presiding over your hearing in June, not the IC. You don't say what kind of hearing you are having. Is it a benefit review ?? Or contested claim?? I know that there are a few others. If a benefit review, then you will try to get the IC to agree to the surgery using the letter that you need the Dr to write, no good giving it to just an adjudicator as they have no power to help your case, just mediate between you and the IC. If it is a contested claim, then the letter might do you some good as you can present it as evidence as long as you get it done ASAP... you have to send a copy of the letter to the judge, as well as the IC withing 10 days of the hearing.
You can ask for a continuance if a contested claim, as long you have a valid reason to do so..such as getting an attorney to help you. However, this will probably delay your case by 3 months or more while they set it for another date. It is entirely up to you on how you want to handle this. So I would think long and hard before making any decision.
Angel ^j^
Hurt in TX,
What 1171 is saying, is get a new letter that can be presented as evidence to the judge hearing your contested claim. You must also provide a copy to the IC, and it must be received at least 10 days prior to the hearing.
As for the IR, I had mine done on the 16th of last month. I got 8% as a whole person for right shoulder, elbow and wrist. All I had done was diagnostic treatments since Feb. 2008 as it is also a contested claim. I haven't heard a word yet from my attorney on any kind of settlement. If nothing by the time I get back from a 10 day trip to MI and CO, I will be having her file for a contested claim hearing. I am so tired of all the games. Funny how they were able to find me MMI when I have had no treatments or medications since time of injury, and still have 8 months before my mandatory MMI date.
So what I am saying is... yes, you can get an IR now, but that doesn't mean that the IC has to accept it. They can make you go to a Dr of their choosing and have another one done that will be in favor of the IC, then you would have to go in front of a judge to see what his ruling is. So, it is doubtful that it would be completed by your contested claim hearing.
Looking back at your old posts, there is definitely no way a settlement could be arranged from an IR done on the 29th and the hearing the 4th. It takes up to 7 days just for the IC to get a copy of the IR rating. And then they have to make an offer based on that. Once you agreed to it, then it has to be approved by TDI. And that just ain't gonna happen in a span of 6 days. Sorry.
Just go to your hearing, present your case and the judge will decide which side is credible and either approve or deny the surgery. If your attorney has all his ducks in a row, he will have the proper medical documentation to prove your side and get you the surgery that you need.
Angel ^j^