Bummer Knees Wrote:It has been almost 5 years since I was injured and last month I was placed at MMI.

My attorney is sending me to a doctor for a rating next week.
This is a doctor who knows how to communicate with the hearing impaired and this makes things much easier for me.

((((Just remember, every time you see a doctor for something like this (Rating), the Insurance Carrier has the right for their Paid doctor to do the exact same thing.))))

Next month I will be evaluated by a rehabilitation consultation who will look at my work history, the goal is to make a work disability claim. (I am still trying to understand this)

((((Rehabilitation Consultation - Is based on life care planning and forensic rehabilitation. Rehabilitation Consultation impacts rehabilitation-specific medical issues, long-term functional outcome, and healthcare costs ))))

I spoke with the attorney today, he said the insurance company is wanting to settle and are getting their ducks in a row. They have requested the original benefits letter I received from Social Security Administration in 2007, they want proof I am on SSDI and receiving medicare. My attorney says this information is for the set-aside.

((((The very first thing they do, and want this for, is to see if you have used Medicare to pay for any medical treatment related to your injury, as I have recently had to do this. This is not to set up a Medicare Set-Aside Fund. Medicare Set-Aside is based on your work injuries, and is done differently. Also remember, the Insurance Carrier will now see what you used your Health Insurance and Medicare for, meaning any and all medical treatment, work related, or not now.))))

I do worry the recent neck injury may cause problems with the evaluation next week, as there are several things I simply can not do due to the neck injury. (Certain movements & activities start the headaches and shooting pain up the neck & into the head with the headaches getting to the severity that I have trouble being able to function)

((((You need to remember, your being rated, for your work related injuries only. Not Auto Accidents. But, this doctor can rate each body part anyway's, if asked to do so. But the Insurance Carrier will only view the areas you claim were injured, nothing more. Also keep in mind, body parts that have been accepted by the Work Comp Court only count also. Not body parts the Court order to repair, only the ones that have been accepted by the court, not those waiting to be accepted.))))

Thanks for reading & have a good day.

Bummer Knees

Bummer Knees Wrote:Bad Boy I have already been rated by the insurance company, I expect if the insurance company do not like the rating to be done Monday, they will send me again to a doctor of their own for another rating.

I have used medicare to pay for the lumbar spine but that was before it was approved by the ALJ and upheld by the appeals court.

((((What I am saying if approved for treatment; Meaning was it approved as a relationship to first injury? See, if only the treatment was approved, it does not mean it's part of an accepted Work Comp Claim. As there is a huge difference between the 2 meanings of the Terms. Approved for treatment - Doesn't mean approved as part as the WC Claim. Only once the Work Comp Court has settled the issue of what body parts are approved, and part of the claim, is when the Insurance Carrier will then accept it as part of the settlement then.))))

Bad Boy I am an honest person and my concern is the neck reinjury has made the neuropathy issues in the legs & feet worse. How do I address this next week when being rated?

((((I know your honest, I have never questioned that. And never will))))

I understand I will only be rated for the approved injuries upheld by the appeals court. (((( Correct, only the body parts that are court approved as part of the claim, not those court approved for treatment. ))))

Thanks for your help.

Bummer Knees Wrote:Bilateral knee and lumbar spine are approved for treatment and related to the original injury.

The wc treating doctor wrote in is written report the lumbar spine and right knee are related to the original injury. This also appears in the appeals decision.((((( If it's being Appealed, then it is still found as not part of the Claim or accepted as a body part as part of the claim, till it has been settled in the Court. Once the Appeal is done, and then those body parts have been accepted as part of the Claim, is when we can say they have been approved by the Court, as a body part accepted by the Court, as part of the WC Claim then. Now, I understand what a doctor may have written. That doesn't mean it is a court accepted and approved claim. It's only a medical report in your best interest.)))))

I lost on the hand, by the time the decision had been made on the hand I had already had the surgery & paid for it.