Self Insured Employer Confusion... please help.

[Yett]

Hello, I am new to this forum and would like to say thanks in advance for any help or explanations offered.

I am currently employed by a very large Tennessee corporation that is self insured. In late January while at work I bent over to pick up something in the floor and wasn't able to straighten up. I went directly to the emergency room and was told to report to my companies work force physicians the next day. I was placed on workers compensation and assigned a doctor to report to.

To make a long story short, after several MRI's and six months later, I am still in pain and unable to perform my job. The MRI showed slightly bulging discs but nothing that would require any type of surgery. I am still in a lot of pain, unable to bend over or do anything physical. I am going to physical therapy twice weekly.. which temporarily relives my pain.

My company is still paying their portion of my medical insurance and paying me WC which ='s 2/3 or my regular hourly pay.

I have no idea what's going to happen when I go back to my doctor next week. Can anyone please give me some scenarios that might better prepare me for the visit. What if he gives me a maximum medical improvement? what will happen then??


I greatly appreciate help and info..

[1171]

(08-06-2012 04:32 PM)Yett Wrote:  Hello, I am new to this forum and would like to say thanks in advance for any help or explanations offered.

I am currently employed by a very large Tennessee corporation that is self insured. In late January while at work I bent over to pick up something in the floor and wasn't able to straighten up. I went directly to the emergency room and was told to report to my companies work force physicians the next day. I was placed on workers compensation and assigned a doctor to report to.

To make a long story short, after several MRI's and six months later, I am still in pain and unable to perform my job. The MRI showed slightly bulging discs but nothing that would require any type of surgery. I am still in a lot of pain, unable to bend over or do anything physical. I am going to physical therapy twice weekly.. which temporarily relives my pain.



My company is still paying their portion of my medical insurance and paying me WC which ='s 2/3 or my regular hourly pay.

I have no idea what's going to happen when I go back to my doctor next week. Can anyone please give me some scenarios that might better prepare me for the visit. What if he gives me a maximum medical improvement? what will happen then??


I greatly appreciate help and info..

MMI would entitle you to an impairment rating and stop your temporary disability checks.
The rating will get you some additional disability payments to help with starting over at a new lighter work job.
It won't be enough to live on but a bit better then nothing.

Read more about tenn comp
http://www.tn.gov/labor-wfd/wcfaq.shtml#WCbenrev

[hurt back]

1171 is correct.. I too am from TN, and from what I hear our W/C rules are alot different than others.. Your injury is similiar to mine. I do hope that you can find some relief..

[Yett]

[/quote]

MMI would entitle you to an impairment rating and stop your temporary disability checks.
The rating will get you some additional disability payments to help with starting over at a new lighter work job.
It won't be enough to live on but a bit better then nothing.

Read more about tenn comp
http://www.tn.gov/labor-wfd/wcfaq.shtml#WCbenrev


[/quote]

Can you please explain in a little more detail? If I get an MMI rating my company will stop paying the 2/3 of my regular pay? If that happens will they offer some type of settlement? Do I need to ask for a settlement? I'm not familiar at all with the process..

thanks again for any help or knowledge you can share.

[1171]

MMI would entitle you to an impairment rating and stop your temporary disability checks.
The rating will get you some additional disability payments to help with starting over at a new lighter work job.
It won't be enough to live on but a bit better then nothing.

Read more about tenn comp
http://www.tn.gov/labor-wfd/wcfaq.shtml#WCbenrev


[/quote]

Can you please explain in a little more detail? If I get an MMI rating my company will stop paying the 2/3 of my regular pay? If that happens will they offer some type of settlement? Do I need to ask for a settlement? I'm not familiar at all with the process..

thanks again for any help or knowledge you can share.
[/quote]

each case is different so it's difficult to be detailed without specific questions on a particular situation.
sometimes the MMI determination comes months before an impairment rating.
the ttd checks stop when you are MMI.
the finalization process can be very slow especially if there are disputes.
you may need to ask for a rating.
the labor law says the carrier has 30 days to make a settlement offer once the doctor give a rating.
If you have issues with any part of your claim, the state has a benefit review system that assists employees with resolving disputes with workers' compensation claims. The Tennessee Department of Labor and Workforce Development's Workers' Compensation Division can be contacted at 1-800-332-COMP (2667) (TDD) or 615-532-4812.

[hurt back]

Yett - below is a copy from our state (TN) website.. From the way it looks TTD is paid until the benefit review conference.. but I could be wrong...

I hope this helps...


When do workers' compensation benefits stop?
There are several circumstances under which benefits stop:

1.
When an injured employee is released by their treating physician to return to work.

2.
Whenever an injured employee refuses to comply with a reasonable request for medical examination or to accept medical treatment, compensation may be stopped for the period of time an employee continues the refusal.

3.
Whenever the employer or insurance carrier has been paying benefits and discovers those payments were made in error, the insurance carrier can stop payment but must file a Notice of Controversy (Form C-27).

4.
When an injured employee’s treating physician determines the employee has reached maximum medical improvement (MMI), and the compensability has not been contested. Payments must continue until the earlier of the following events:

5.
an injured employee accepts or rejects a job offered by the employer at a wage equal to or greater than the employee's pre-injury wage, or

6.
a benefit review conference is held and a report is filed.

[Yett]

the last time i went to my WC doc he said he was ordering 4 more weeks of PT but would be giving me an MMI on the next visit. I am going in today. I am wondering once i get this MMI, what should i expect to happen. my Dr. insinuated the MMI would be a good one considering my injury and education level and the nerve damage I have suffered from it. My employer is privately insured so they do not have to follow TN WC law. again.. anyone have any idea what to expect..

[1171]

I'm not sure what you mean by "good":

really messed up with a lot of impairment, disability, pain and need for much continuing medical just to function at all

or

successful recovery, did really well from a serious injury and not left with too much damage, impairment and disability and able to function pretty considering what could have happened


which one is "good" for you?

[Yett]

(12-14-2012 01:38 PM)1171 Wrote:  I'm not sure what you mean by "good":

really messed up with a lot of impairment, disability, pain and need for much continuing medical just to function at all

or

successful recovery, did really well from a serious injury and not left with too much damage, impairment and disability and able to function pretty considering what could have happened


which one is "good" for you?

let me clarify.. the dr said i would have an MMI and based on my education, injury my MIR would not be good. meaning I can't do my current job and the hosp is not likely to be able to find a job for me. my back injury has caused permanent nerve damage in my leg and foot resulting in permanent drop foot.

[1171]

if they don't have to follow the comp laws then it's difficult to predict what they will do.
self-insurance does not mean they are immune from comp laws; it just means the employer pays all costs not a carrier.
sounds like you have some significant disability in which case your rating will be higher and entitle you to more benefits the someone who can return to their job with minimum difficulty.

of course no one on a message board can duplicate the doctor's impairment rating process and determine your permanent disability amount.