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PPD Rating Questions - JHagen - 02-20-2018

I ruptured my EPL tendon in my right thumb (dominant hand) which required surgery. The doctor performed an EIP to EPL tendon transfer which required him to three incisions. One larger one (3") at the wrist to locate the ends of the ruptured EPL tendon, one smaller one (1") on the back of the hand at the knuckle of the index finger so he could cut the extra extensor tendon (IEP) that goes to the index finger and the third incision (1") just above the wrist so he could tunnel under the skin and pull the end of the IEP tendon down and reroute it to connect it to what was left of my EPL tendon of my thumb.

I received a letter from my WC Resolution Manager saying that they would most likely rate my hand to at least 5% which in Wisconsin would rate 20 weeks of PPD payments. The resolution Manager stated that payments legally had to begin while they were waiting for the doctor's final rating.

I received the first six payments right on schedule, then they stopped. I e-mailed the RM to see if something had changed and she stated that the doctor came back with a rating of only 2% and just for the thumb, not the hand.

I am very surprised that the doctor isn't considering the entire hand. The entire back of my hand is still numb and the doctor says that may never return. The strength in my hand is slightly above 50% of what it was before the operation and he cut one of the tendons to my index finger which is now gone forever.

Does this rating seem right, especially the part about just limiting the rating to the thumb even though the hand was affected by the surgery? What recourse is available to me to try to get the rating changed?

Thanks to anyone who will share their thoughts.


RE: PPD Rating Questions - 1171 - 02-20-2018

What did the doctor say about recovery time?
Are you still getting treatment? How long has it been since the surgery?
Have you returned to work?
How do you know strength is 50%; were measurements done?
You can request a second opinion or another treating doctor

Employee Allowed First And Second Choice Of Doctor

If the employee is not satisfied with the first doctor, one more choice is allowed; however, the worker must notify the employer of this second choice. The law recognizes that if the employee does not have confidence in the first doctor, recovery may be delayed. If the attending doctor refers the employee to a specialist or a series of specialists, this referral is still considered to be treatment by one doctor. If several doctors in one partnership or clinic are seen, these are all considered one doctor. After changing doctors once, any further change may be made only by mutual agreement between the employee, employer and insurance carrier.

Failure to notify the employer of the initial selection or of a change of doctors can lead to a disputed claim and the possibility of the injured employee having to pay for the entire cost of treatment.


https://dwd.wisconsin.gov/dwd/publications/wc/WKC-7580.htm#select

Request a copy of the report.
Why do you think the resolution manager is more credible then the doctor?
You will need a different medical impairment rating to change the disability amount.

More information on how impairment is evaluated:
https://dwd.wisconsin.gov/dwd/publications/wc/WKC-7761-P.pdf


RE: PPD Rating Questions - 1171 - 02-21-2018

Hope that helped.
Thanks for posting.


RE: PPD Rating Questions - JHagen - 02-21-2018

(02-20-2018, 07:45 PM)1171 Wrote: What did the doctor say about recovery time?
Are you still getting treatment? How long has it been since the surgery?
Have you returned to work?
How do you know strength is 50%; were measurements done?
You can request a second opinion or another treating doctor

Employee Allowed First And Second Choice Of Doctor

If the employee is not satisfied with the first doctor, one more choice is allowed; however, the worker must notify the employer of this second choice. The law recognizes that if the employee does not have confidence in the first doctor, recovery may be delayed. If the attending doctor refers the employee to a specialist or a series of specialists, this referral is still considered to be treatment by one doctor. If several doctors in one partnership or clinic are seen, these are all considered one doctor. After changing doctors once, any further change may be made only by mutual agreement between the employee, employer and insurance carrier.

Failure to notify the employer of the initial selection or of a change of doctors can lead to a disputed claim and the possibility of the injured employee having to pay for the entire cost of treatment.


https://dwd.wisconsin.gov/dwd/publications/wc/WKC-7580.htm#select

Request a copy of the report.
Why do you think the resolution manager is more credible then the doctor?
You will need a different medical impairment rating to change the disability amount.

More information on how impairment is evaluated:
https://dwd.wisconsin.gov/dwd/publications/wc/WKC-7761-P.pdf

Thanks for your reply. To answer some of your questions:
- The injury happened on 9-6-17.
- The surgery was on 9-15-17.
-Measurements were done throughout PT including grip strength in my right hand which is just over 50% of pre-op values.

It's not that I think the Resolution Manager is more credible than the doctor, it's just that the surgery to repair the tendon in my thumb has negatively affected the way my hand works more than it improved the way my thumb works and it seems like that wasn't taken into consideration when calculating the impairment rating.


RE: PPD Rating Questions - 1171 - 02-21-2018

You may be correct but you won't know for sure how/what the physician reported until you see the report yourself. Was the grip strength included? (I don,t see grip loss in the rating criteria guide...?) Is there sensory loss? Is there loss of motion in the wrist?
Once you've seen the findings and factors you can discuss it with your doctor and maybe get a supplemental.
Do you think you have reached maximum Improvement?
If not, That would be another discussion to have with the doctor.
Any rating done too soon will be in error when trying to state what is permanent and what is temporary and correctable.

from the link I posted:

WISCONSIN ADMINISTRATIVE CODE
DWD 80.32 Permanent disabilities. Minimum percentages of loss of use for amputation levels, losses of motion, sensory losses and surgical procedures.
The disabilities set forth in this section are the minimums for the described conditions. However, findings of additional disabling elements shall result in an
estimate higher than the minimum.

The minimum also assumes that the member, the back, etc., was previously without disability. Appropriate reduction shall be made for any preexisting disability.


ADDITIONAL ITEMS TO ASSIST DOCTORS
Interpolating from the guidelines.Having used the guidelines in the rule as starting points, doctors must then ask what other elements of disability are present and what wouldconstitute an appropriate allowance.
Questions doctors should ask are:

Is pain present?
How extreme is the pain?
Does it limit activity and to what extent?
Is it constant or intermittent?
What is my professional judgment on an appropriate disability evaluation for pain?
Is there altered or absent sensation?
Is there sensitivity to heat or cold?
Are there unstable grafts?


have these Q? been addressed by the doctor?
Wisconsin has developed these guidelines to be used in rating; factors outside of those specified are not to be used.