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Medical Care after MMI Status
#1
Hey guys,

New question for you. Short version... hurt my back at work 11/10. Surgery 01/11. Problems recurred, scar tissue, and was sent to pain management doc. Tried PT, TENS, drugs, epidurals, etc... doc saying eventually will prob end up with spinal cord stimulator but it's too early for that.

My question is if they make me MMI in the next few months (which they are talking about) what happens when they decide that the SCS is the only option left? Would the surgery be approved/covered if I'm at max medical improvement? What of the follow up care that would be required after the surgery and the drugs I'm on now?

Oh, and if anyone else has back injuries and are on drugs, any thoughts on stuff that worked? I'd really really like to avoid surgery again if there's something that might work.

Thank you all for any insight. Sorry for the long post.

Oh, I'm in KY. Tongue Additionally, KY is a medical for life state, if that means anything, but I don't understand how it works exactly.
 
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#2
depends on how your case is finalized.
if you buyout all benefits then everything afterward is on you.
if you take the open medical then treatment is on them including recommended implant.
all treatment is controlled by cost containment programs so any options has to get thru the approval process before and after finalization.
 
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#3
(07-20-2011, 01:31 PM)1171 Wrote: depends on how your case is finalized.
if you buyout all benefits then everything afterward is on you.
if you take the open medical then treatment is on them including recommended implant.

Thanks 1171, but I'm still confused *blush*. I thought MMI just meant that the TTD ended, but the case was still open? I have been reading up and following the forums, but each state seems so different. Am I wrong in my deductions of what MMI meant?

No one has mentioned closing my case. Does that happen when you are designated MMI?
 
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#4
yes.
MMI means end of recovery period; it may not end the claim.

no.
to pay for treatment a claim is open.

treatment for life does not mean no MMI.
there is no time limit to reopen a claim for medical treatment.
 
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#5
When you are found at Maximum Medical Improvement, The IC will work swiftly to close your case. "Most IC's" do not like to close with open medical which generally means a WCMSA (Workers Compensation Medicare Setaside) which should include the cost of the SCS and what other drugs and treatment you will need for your work related injury.

But you stated that Kentucky is a medical for life state which is different but all states are different. You must become educated of your system

I have a friend who was told he was a candidate for a SCS. When the WCMSA proposal was sent to CMS for approval, CMS which is Medicare added funds in the WCMSA for a SCS.

There is a lot to learn here. You need to do some "homework" and become very familiar with the WC system in Kentucky.

If you and your Doctor feel a SCS is a GREAT option for you, I would push for it before I signed anything concening a settlement.

I have been considered MMI since March 2009 and I have not settled as of today. I still draw a weekly check and all my benefits are taken care of but I still have to fight certain issues at times and I want to settle with a C&R and a WCMSA. All states are different.

I have a back injury at the T11, T12 area. I have a titanium cage with plates and screws and a bone fusion from one of my ribs.

I think a SCS would be "minor surgery" compared to mine but I would not have a SCS myself.

Did the Tens Unit give any relief?

As far as Meds go, I would not take a narcotic unless it was my last resort. I take 5 different drugs; 3 are narcotics. The drugs work but they are addicting. I know I will get some "smack" for saying this but I know from 6 years of use and the dependency that is formed from many angles.

What drugs are you currently taking? What is your future diagnosis as far as pain?

Have you had a FCE? (Functional Capacity Examination) If you have, what was the end analysis? I doubt you have had a FCE because this happens after a MMI.

Research and become knowledgeable.If needed, get a Attorney onboard who know the WC system of your state. This is critical.

Some information to read;

http://www.pcmmlaw.com/practice/workers-compensation/
 
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#6
bird posted a good link for basic information in easily understood text for those with Kentucky claims.
often times third party sites have more practical information then the agency pages.
 
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#7
Thanks so much. I knew that MMI ended TTD, which is fine, I've been applying for jobs that didn't violate my work restrictions for several months, so I'm not worried about that part. Going crazy laying flat on my back for 8 months... Still trying to figure this whole thing out. Reading posts from everyone who has been dealing with this for years has been humbling as well as inspiring. 8 months appears to be a drop in the bucket lol.

Mostly trying to make sure I can continue to get medical coverage while the docs are trying to find something that helps. Thanks for relieving my mind on that point.

To Freebird... nope TENS didn't work. Tried it for 2 weeks with no effect. PM doc told me to try it again at my appt yesterday so I'm doing that today.

Thanks for the link I will look at it as soon as I'm done with this post.

I haven't had an FCE yet. THey were talking about work hardening and then FCE before the epidurals failed (first worked for 4 weeks, pain came back, 2nd failed and doc is pushing the IC to approve the third as "I"m running out of options".

They have me on Neorontin, Zanaflex and Mobic as of yesterday. Tried Topamax and that gave me bad side effects. My PM doc doesn't believe in narcotics for back pain, so no worries there. Did PT for almost 3 months with no effect except strong stomach muscles lol. But I'm still trying to do some of the exercises that I can at home. Bought a yoga ball and everything. Still can't stand, sit or walk for more than 30 minutes without seriously exacerbating the pain, and my leg dragging behind me if I am walking.

Have my six month follow up with the surgeon coming up, but doubt that there's anything he can do as they say trying to surgically remove the scar tissue usually makes it worse.

Off to the link. Back later... thanks so much guys!



 
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#8
As for med I'm on 40mg Oxycontin twice a day and dilaudid 4mg for break thru pain during the day. And I can use the lidoderm patches. Also now trying cymbalta to see if that doesn't help the pain level. It all helps but then everybody is different and pain levels are so different
 
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#9
Manley2, thanks for the info. I am a little worried about what happens if the new anti-convulsant (Neurontin) and the anti-inflammatory (Mobic) don't work. My PM doc was very clear yesterday that he will NOT be prescribing any narcotic pain meds, and the only anti-convulsant left to try (according to doc) was Lyrica.

Freebird and 1171 I went to the link you gave me and boy you were correct! Way easier to understand than reading the statutes and rules on the KY WC website. Now I know that I will have medical coverage for 2 years after they stop paying TTD and that I have to actually file with the courts for lifetime coverage. That is seriously vital info ... wish they didn't make it so difficult for the injured workers to understand their rights!

I've been really lucky so far, I have a great nurse case manager who actually pushes the insurance company for treatments, even after they have been denied. She's gotten everything denied overturned to date. I know she's employed by the IC, but she has been really helpful to me as well. IC has also been really decent, approving most treatments/drugs even it takes a few days and payments are steady, no game playing. The biggest issue (besides the injury) I have been facing is my own ignorance of the whole system and I am working on that.
 
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#10
you forget, the "they" are your state legislators who are mostly attys.
making laws complex so most of us need attys is part of what they do.....

the website is run by attys so naturally they want your business.
if there are little or no other issues you can file for the lifetime care directly without having to litigate against your employer.
contact the ombudsman for help with that
http://www.labor.ky.gov/workersclaims/Pa...en%29.aspx

they are usually helpful.

 
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