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Claim Disposition Agreement Offer Made...Need help!
02-02-2011, 08:51 PM, (This post was last modified: 02-02-2011, 08:58 PM by injuredinidaho.)
#1
Claim Disposition Agreement Offer Made...Need help!
Injured in Oregon on 2/22/2010 and currently in Pain Management.

Injury is an "SI Joint" strain and I am currently taking Cymbalta for pain/depression and Opana ER for pain. My pain management doctor releases me monthly back to work but my job is 55 miles from where I live and is in law enforcement so therefore, my employer won't allow me to come back to work on narcotics nor can I drive on them.

SAIF Corp. offered me a CDA for $12,000 and have sent paperwork in the mail although I have not received it yet. I do not have an attorney.

IC is telling me if I get rated for PPD, my claim isn't worth hardly any money as my injury is reported as a strain and no surgeries are recommended at this time. They said if I get rated, it will be such a low percentage that I would only receive between $1,000 to $2,000. Pain Mgt. doctor told me last week he was going to try and rate me between 1% and 2% based on AMA Guidelines. He didn't seem to know what he was doing and he is in Idaho and is unaware of Oregon rating practices and procedures.

IC told me yesterday that my pain management doctor was going to take me off of narcotics for pain at the end of this month. My claims adjuster had a phone conference with my pain doc last week. She thought my pain doctor would have told me this but he didn't say anything about taking me off narcotics at my last appt.

IC/Claims adjuster tried to make me feel like my claim wasn't worth anything at the end of February but then turned around and offered me $12,000 to settle. I asked for $15,000 but she said my claim isn't worth that much because my pain doc is going to take me off of pain meds at the end of February no matter what and then make me go back to work...no talk of pain symptoms or if I would be able to go back. I can hardly walk/move or sit for any period of time without them.

Questions:

1. Can/will the pain doc just take me off narcotics to force me back to work regardless of symptoms or my ability to go back to work due to pressure from insurance company?

2. As long as I have the need for help with my pain, aren't I entitled to receive pain management care?

3. Can the pain doc just give me a PPD rating super low to end my claim for the IC and stop the wage reimbursements? I was told by my pain management doctor's physicians assistant last month that they don't do disability ratings at their office and I would have to be referred out so this all seems fishy to me.

I just started with this pain doc a few months ago and even though I found him and asked him to take on my case, I feel like he is working for SAIF Corp. and has had their best interests in mind since the start. I do know they have had a lot of communications back and forth.

The current pain meds have improved my life by taking the sharp edge of my pain and that gives me a little more mobility around the house.

Any help or guidance would be greatly appreciated! I feel like I am in a corner and the IC makes me feel like they are doing me a favor by offering this much even though they say my claim isn't worth anything...although I know they wouldn't really be offering me $12,000 if my case is only worth $1,000.

Am I in the pickle they make me feel like I am???????
Reply
02-02-2011, 09:10 PM,
#2
RE: Claim Disposition Agreement Offer Made...Need help!
you questions are very specific to your claim and require detailed analysis and development of different options for you to chose from. I would discuss your options with the oregon ombudsman
http://egov.oregon.gov/DCBS/OIW/index.shtml

in any event you have the option of having them pay for your travel to oregon to get rated by a physician that knows the Oregon impairment system.
you also have the right to have the work comp court evaluate the rating and award benefits rather then accepting a settlement directly from the carrier.

you should talk to the ombudsman about your situation or retain an oregon work comp atty
you can contact the oregon state bar for a referral
http://www.osbar.org/public/ris/ris.html#referral
or try here
https://www.wilg.org/index.cfm?pg=publicdirectory

Reply
02-02-2011, 11:09 PM,
#3
RE: Claim Disposition Agreement Offer Made...Need help!
(02-02-2011, 08:51 PM)injuredinidaho Wrote: Injured in Oregon on 2/22/2010 and currently in Pain Management.

Injury is an "SI Joint" strain and I am currently taking Cymbalta for pain/depression and Opana ER for pain. My pain management doctor releases me monthly back to work but my job is 55 miles from where I live and is in law enforcement so therefore, my employer won't allow me to come back to work on narcotics nor can I drive on them.

SAIF Corp. offered me a CDA for $12,000 and have sent paperwork in the mail although I have not received it yet. I do not have an attorney.

IC is telling me if I get rated for PPD, my claim isn't worth hardly any money as my injury is reported as a strain and no surgeries are recommended at this time. They said if I get rated, it will be such a low percentage that I would only receive between $1,000 to $2,000. Pain Mgt. doctor told me last week he was going to try and rate me between 1% and 2% based on AMA Guidelines. He didn't seem to know what he was doing and he is in Idaho and is unaware of Oregon rating practices and procedures.

IC told me yesterday that my pain management doctor was going to take me off of narcotics for pain at the end of this month. My claims adjuster had a phone conference with my pain doc last week. She thought my pain doctor would have told me this but he didn't say anything about taking me off narcotics at my last appt.

IC/Claims adjuster tried to make me feel like my claim wasn't worth anything at the end of February but then turned around and offered me $12,000 to settle. I asked for $15,000 but she said my claim isn't worth that much because my pain doc is going to take me off of pain meds at the end of February no matter what and then make me go back to work...no talk of pain symptoms or if I would be able to go back. I can hardly walk/move or sit for any period of time without them.

Questions:

1. Can/will the pain doc just take me off narcotics to force me back to work regardless of symptoms or my ability to go back to work due to pressure from insurance company?

2. As long as I have the need for help with my pain, aren't I entitled to receive pain management care?

3. Can the pain doc just give me a PPD rating super low to end my claim for the IC and stop the wage reimbursements? I was told by my pain management doctor's physicians assistant last month that they don't do disability ratings at their office and I would have to be referred out so this all seems fishy to me.

I just started with this pain doc a few months ago and even though I found him and asked him to take on my case, I feel like he is working for SAIF Corp. and has had their best interests in mind since the start. I do know they have had a lot of communications back and forth.

The current pain meds have improved my life by taking the sharp edge of my pain and that gives me a little more mobility around the house.

Any help or guidance would be greatly appreciated! I feel like I am in a corner and the IC makes me feel like they are doing me a favor by offering this much even though they say my claim isn't worth anything...although I know they wouldn't really be offering me $12,000 if my case is only worth $1,000.

Am I in the pickle they make me feel like I am???????

I wanted to asked you about your si joint and pain.
I had a slip and very hard fall.
My injury happen in 2008.
I think the (QME) called mined a lumbar strain but future medical were for si joint injections. 3% whole person = $2700.
I'm in California.
This is very painful. I walk with a limp. No prolong standing or setting. No heavy lifting. When I pick up 1 gallon of milk I can feel it. Meds or not.
I developed dvt and pulmonary embolism.
Lost my position.
I'm living a nightmare.
The 2008 MRI show I torn a disc. Problem is....it wasn't in the report.
Found this out 2 weeks ago.
I called the hospital where it was done. They admitted that there was a torn disc but, my Doctor put right side pain so the Doctor reading it didn't feel it had anything to with my right side pain. Actually I got the call back today. I can't believe the response.
It's in the same area where I'm having all the problem only left side.
So over the last two years I have reported shooting pains down both my legs. Once I said I wasn't getting very much relief from the right si joint injection those stopped and now only pain meds and muscle relaxers and I know my day is coming to that I will get cut off those too.
Depression is a understatement.
I use a heating pad alot. I think I should be using ice too.
I don't think this will ever end. No treatment since July 2010 only meds.
The Specialist mention nerve ablations. That doesn't sound good.
Well hope you end up with treatment of some type before cutting everything off. I don't even want to think about that. Sad Sorry I don't ever heard about someone else having si joint problems.
Reply
02-03-2011, 01:02 AM,
#4
RE: Claim Disposition Agreement Offer Made...Need help!
SI joint pain can be horrible, I am another one that suffers from it. When I was injured my pelvis broke off from the left side SI joint, and now have the left si joint fused. Even while healing it hurt like a sob now after 3 years It still hurts and now the right side SI joint is hurting due to the stress from the left side being fused.


injuredinidaho, I dont know why your pain dr would just take you off narcotics (like flipping a switch). Some narcotics have to be slowly downed by less dosages without having major withdrawls.. Here in wi you have the right to have a second oppinion, and you may want to seek a lawyer asap because that dr seems to be batting for the wc ins..
Reply
02-03-2011, 01:57 AM,
#5
RE: Claim Disposition Agreement Offer Made...Need help!
(02-03-2011, 01:02 AM)bronco54501 Wrote: SI joint pain can be horrible, I am another one that suffers from it. When I was injured my pelvis broke off from the left side SI joint, and now have the left si joint fused. Even while healing it hurt like a sob now after 3 years It still hurts and now the right side SI joint is hurting due to the stress from the left side being fused.


injuredinidaho, I dont know why your pain dr would just take you off narcotics (like flipping a switch). Some narcotics have to be slowly downed by less dosages without having major withdrawls.. Here in wi you have the right to have a second oppinion, and you may want to seek a lawyer asap because that dr seems to be batting for the wc ins..

That is really bad. Reading that was like nails going down a chalkboard. Very scary because you never know it can happen to anyone. I was getting to the point of almost dragging my leg and I had to say enough is enough. I was seeking treatment the whole time. Treatment is slow but, being made P&S is fast.
Yes I agree needs a atty. Check around first and try and get a good one. I didn't and I feel trapped. A good atty. can really make the difference. Help take the stress off of you. Good luck.
Reply
02-03-2011, 12:15 PM,
#6
RE: Claim Disposition Agreement Offer Made...Need help!
When I was first injuried company doc after having me try a home PT work out said that I only had a lower back strain and they would not be doing any more for me. Now that was almost 6 years ago and I'm off work for life and getting SSDI and have not settled with WC yet. Part of my pain is from the SI joint. What I'm try to say is if I had not went to my own doctor after they said they were not going to do anything more and I should see my own doc who knows where I would have been now if I just tried to make it without treatment. I now have a SCS and have trouble walking very far and some days it almost impossible to just walk to the bathroom. Do what you have to and get the treatment you need, living everyday in pain is nothing I wish on anybody
Reply
02-03-2011, 01:26 PM,
#7
RE: Claim Disposition Agreement Offer Made...Need help!
(02-03-2011, 12:15 PM)Manley2 Wrote: When I was first injuried company doc after having me try a home PT work out said that I only had a lower back strain and they would not be doing any more for me. Now that was almost 6 years ago and I'm off work for life and getting SSDI and have not settled with WC yet. Part of my pain is from the SI joint. What I'm try to say is if I had not went to my own doctor after they said they were not going to do anything more and I should see my own doc who knows where I would have been now if I just tried to make it without treatment. I now have a SCS and have trouble walking very far and some days it almost impossible to just walk to the bathroom. Do what you have to and get the treatment you need, living everyday in pain is nothing I wish on anybody

I fear everything you just wrote. I see no end to my w.c. case. Out of work and applied for retirement. Now I will be seeing a (IME). Haven't gotten the date yet.
My legal secretary for atty. office says I threaten to get an MRI and I said I will show Blue Cross my denial. She said w.c. doesn't have to accept the findings and either will their office and I may be stuck paying for the whole thing. And later if w.c. decides to aprove it I would have to get a new MRI.
On the other hand if the atty. office says we have everything we need stay as comfortable as you can and we will file for a emergency hearing. That never happen. That was telling me what I wanted to hear and it didn't go anywhere.
I feel I have to help myself and get help. I complain to much about atty. It's my own fault. I don't fire them and get a new atty. For one I can't find one and I can't do this myself.
Now here's a joke for the day.....
My legal secretary says want would you do without us fighting for you?
My (AME) report was done over 1 month ago and never received a copy from atty. office. They said that they would investigate that and get back to me. I think they gave me a nervous breakdown because its became a joke.
I was really active before accident and as time past became immobile and developed dvt. That almost did me in. You know that saying "What doesn't kill us makes us stronger." I don't know about the stronger part. Sad
Reply
02-03-2011, 05:26 PM,
#8
RE: Claim Disposition Agreement Offer Made...Need help!
next time remind the sercretary its people like you that pay her salary and your tired of paying for nothing....you better get some starch in your backbone or at least lay down so it doesnt hurt so bad everytime she smacks you....start emailing that female dog all your questions and keeping copies of all responces.....it will help if you do need to find a new lawyer.....
........I love cats, I just cant eat a whole one by myself......







Reply
02-03-2011, 06:41 PM,
#9
RE: Claim Disposition Agreement Offer Made...Need help!
(02-03-2011, 05:26 PM)jayne Wrote: next time remind the sercretary its people like you that pay her salary and your tired of paying for nothing....you better get some starch in your backbone or at least lay down so it doesnt hurt so bad everytime she smacks you....start emailing that female dog all your questions and keeping copies of all responces.....it will help if you do need to find a new lawyer.....

Actually she did tell me that what they will make off me won't pay the light bill. I have kept all the email and the other Attorney who I wanted to hire wanted to see her emails. Probably thinking no way would she put that in writing. That atty. pass because they for the most part don't pick up someone else case. I like to call it mess. Or maybe they were being nice. You are right what happen to my backbone. I use to have one. My job required one. I wasn't a Correctional Officer but, I ran large inmate crews and I did my job well.
I know what the problem is..... I can't find a new Attorney and I hold back my true feelings to the legal secretary. She only get 1/4 of what my mouth wants to say. If I file a complain I think it will go nowhere. Some of the people in this forum I admire because even if they have a bad atty. or judge, they take the stand no I'm not going to be treated this way. W.C. is hard enough without the garbage. It seems like for the most part in works out better for them. I need to take that leap of faith. Thanks
Reply
02-03-2011, 08:40 PM,
#10
RE: Claim Disposition Agreement Offer Made...Need help!
I was lucky I had an awesome lawyer......a long time on WC tends to take the starch out of our backbones...the way to get it back is to read your state rules and regs on WC.... ask questions on here..we will answer what we can but your best bet is to read your state law
........I love cats, I just cant eat a whole one by myself......







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