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P&S with restrictions but no disability rating. What?
#1
Hi folks, I'm new to this page so please bear with me. I have searched all the threads but haven't found anything quite like what I'm going through so hoping for some advice. I injured my back bathing a patient over 6 months ago in California. I've been working sedentary modified duty since then with the exception of a handful of full-duty shifts that lead to flare-ups and more modified duty. I was just made P&S with a permanent weight-lifting restriction of 5 lbs but not given a disability rating despite the  fact that my job has a 50-lb lifting requirement. Not to mention that I'm in constant pain  and have difficulty sitting, standing, sleeping, driving and bending. I had no  pain or back  issues prior to this. I was also given a work limit of 12 hours per week. How is this not a partial disability?
 
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#2
You may have disability just not one in the form that qualifies for work comp benefits.
Disability systems like work comp are allowed to make rules as to how their benefits are determined.
It may qualify as disability in other benefit systems, but California now uses the AMA guides-5th edition to determine the extent of permanent impairment and permanent disability benefits under work comp law.
If your physician is unable to give you an AMA rating you can request that a Qualified Medical Examiner perform one.
More on QMEs here:
http://www.dir.ca.gov/dwc/medicalunit/faqiw.html
And on PD & QMEs in the fact sheets:
http://www.dir.ca.gov/dwc/iwguides.html
 
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#3
1171, what is your opinion of how this IW was P&S'd only 6 months after her injury with a permanent lifting restriction of 5 pounds and also stating she can only work 12 hours a week? She now does not qualify for TTD or state disability.
I am not an attorney.Anything I write should not be considered legal advice.I am writing from my own personal experiences,which is not from any sort of legal background. You should consult with an attorney over legal issues. In California, if you cannot get an attorney you can consult with an I&A officer.
 
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#4
sounds like the behavior of an older Physician that was trained under the prior comp rules and has not done much comp since.
the doctor is basically saying they can't help the patient any more and wants them out of their practice.
the patient will qualify for unemployment.
I'd also recommend the worker select another doctor. get one or two consults to see if there is indeed any conservative treatment that might help.
unfortunately there is no more rehab benefit; this situation might have helped get the worker into another profession while still providing transitional TD.
the worker should look to use the voucher and other job replacement funds.
 
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#5
The doctor who saw me to evaluate my P&S was a licensed QME. He did recommend further treatment but as I have not seen the report yet I don't know the extent. Since he didn't give me a disability I don't qualify for state disability either? That's unfortunate since he told me it would be at least six months to a year before I would recover. Wondering if my best shot is to see a QME or get a lawyer and see an AME? Or should I just skip workers comp and get a disability lawyer? All advice welcome. Lawyer referrals in California also welcome. Thank you so much.
 
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#6
(06-06-2016, 12:32 PM)1 Hurt nurse Wrote: The doctor who saw me to evaluate my P&S was a licensed QME. He did recommend further treatment but as I have not seen the report yet I don't know the extent. Since he didn't give me a disability I don't qualify for state disability either? That's unfortunate since he told me it would be at least six months to a year before I would recover. Wondering if my best shot is to see a QME or get a lawyer and see an AME? Or should I just skip workers comp and get a disability lawyer? All advice welcome. Lawyer referrals in California also welcome.  Thank you so much.

Many doctors are QME's some are insurance company/employer friendly QME's. Who sent you to him?

State disability usually stops paying when a patient is P&S'd. Your rating has nothing to do with state disability. I would recommend to contact them and ask if you qualify. Your doctor has to state you qualify for benefits as well for state disability. Is this doctor your primary treating doctor? Weird he P&'S 'd you and then also stated it would take 6 months to a year for you to recover. This does not make sense to me.

 I don't know if other doctors would have P&S'd you so soon, but you need another doctor to write/state it if they believe you are not yet P&S. I would recommend as 1171 wrote to transfer out of this doctor because this one is not helping you, he is helping the insurance carrier (IMO). I also recommend seeing an information and assistance officer where your case is located at and discuss what has happened to you and maybe they can assist you in picking another doctor. You can meet with a work comp attorney as well. What you may not be aware of is in this system there are some doctors who are insurance company/employer oriented and may not always look at the best interest of the patient. There are those on the other side as well who over treat and test. It is not good either.
I am not an attorney.Anything I write should not be considered legal advice.I am writing from my own personal experiences,which is not from any sort of legal background. You should consult with an attorney over legal issues. In California, if you cannot get an attorney you can consult with an I&A officer.
 
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#7
we now have the critical context of the nurse's version of the QMEs opinion.
since Nurse doesn't have the actual report, the post is probably a verbal summary from the doctor or staff.
the doctor's full opinion will be in the written report to the DWC and the carrier.
it could very well contain a full AMA disability rating as well as the work restrictions.

Nurse, you seemed confused about the difference between temporary disability and permanent disability.
the doctor may have given you permanent disability just not temporary.
not all disability is the same.

if you "skip" comp, how will you handle treatment? most insurance excludes work injuries.

yes, you may wish to have an experienced comp lawyer handle your claim and disability issues.
good place to start is caaa.org.
be aware that lawyers are not good at educating clients on how the system works or with those that want details communicated to them regularly. attys can handle interactions with the comp court and will focus on a buyout settlement for those employees that are no longer with their employer.

if it's likely you'll be out of work for a year you should apply for ssdi.
 
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#8
(06-06-2016, 01:45 PM)1171 Wrote: we now have the critical context of the nurse's version of  the QMEs opinion.
since Nurse doesn't have the actual report, the post is probably a verbal summary from the doctor or staff.
the doctor's full opinion will be in the written report to the DWC and the carrier.
it could very well contain a full AMA disability rating as well as the work restrictions.

Nurse, you seemed confused about the difference between temporary disability and permanent disability.
the doctor may have given you permanent disability just not temporary.
not all disability is the same.

if you "skip" comp, how will you handle treatment? most insurance excludes work injuries.

yes, you may wish to have an experienced comp lawyer handle your claim and disability issues.
good place to start is caaa.org.
be aware that lawyers are not good at educating clients on how the system works  or with those that want details communicated to them regularly. attys can handle interactions with the comp court and will focus on a buyout settlement for those employees that are no longer with their employer.

if it's likely you'll be out of work for a year you should apply for ssdi.

I am still confused on what kind of evaluation she had, or if this doctor is her treating doctor who also happens to be a QME?
I am not an attorney.Anything I write should not be considered legal advice.I am writing from my own personal experiences,which is not from any sort of legal background. You should consult with an attorney over legal issues. In California, if you cannot get an attorney you can consult with an I&A officer.
 
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#9
Here's the report from my 'primary physician' who was assigned by Occupational Health. He also happened to be a QME which I don't think matters at this point but I may be wrong about that. I have been getting temporary partial disability for 6 mos. but now I'm P&S. Not sure whether to pursue another opinion or not although I heartily disagree with this one because I feel the system is rigged and I'm not sure how much more energy I want to give it. Please advise. Thank you. W

I wanted to update you regarding Dr. 06/02/2016 P&S Report. Attached is another copy of his report. After further discussion with my supervisor on the late afternoon of Friday 06/03/2016 we have decided to agree with Dr. report. What this means is that if you disagree with the report you can request a Panel Qualified Medical Evaluation (PQME). I will be sending that form to you as well as a copy of the P&S report and a PD Denial Notice. 
 If you wish to dispute Dr. report you can fill out the request form for  PQME and mail it to the address that will be listed in the instructions on the form. The form will be attached to the PD Denial Notice along with a copy of the P&S report which will be going out in today’s mail. 

 
You will also receive a Supplemental Job Displacement Benefit Voucher for $6,000.00 which you can apply for since Hospital will not be able to accommodate your permanent restrictions.Once you receive the PD Denial Notice and the other forms I have outlined above, if you need assistance in filling them out you can call me and I can walk you through them. 

 


If you are unable to open the attachment for the P&S Report I have outlined what the report says below so you can review it before you get a report in the mail with the other notices that will be coming to you.
Date of Exam: 06/02/2016

 

Permanent and Stationary Date: 05/10/2016

 

Relevant Medical History:

There is no prior history of low back injury or surgery.

 

Physical Examination:
Thin pleasant female who is guarded in her low back movements. She is tender palpating the lumbar spine. There is normal lumbar lordosis. There is no hypertonicity or spasm. Her forward flexion is limited fingertips to above thighs. She has symptoms a supine position with some guarding. Straight leg raising is negative. Strength in EHL, gastro soleus and anterior tibialis 5/5 with referred pain to the low back.

Gmail



Hello W,

 

I wanted to update you regarding Dr.  06/02/2016 P&S Report. Attached is another copy of his report. After further discussion with my supervisor on the late afternoon of Friday 06/03/2016 we have decided to agree with Dr. report. What this means is that if you disagree with the report you can request a Panel Qualified Medical Evaluation (PQME). I will be sending that form to you as well as a copy of the P&S report and a PD Denial Notice. 

 

If you wish to dispute Dr. report you can fill out the request form for  PQME and mail it to the address that will be listed in the instructions on the form. The form will be attached to the PD Denial Notice along with a copy of the P&S report which will be going out in today’s mail. 

 

You will also receive a Supplemental Job Displacement Benefit Voucher for $6,000.00 which you can apply for since S Hospital will not be able to accommodate your permanent restrictions. 

 

Once you receive the PD Denial Notice and the other forms I have outlined above, if you need assistance in filling them out you can call me and I can walk you through them. 

 



If you are unable to open the attachment for the P&S Report I have outlined what the report says below so you can review it before you get a report in the mail with the other notices that will be coming to you. 

 

Date of Exam: 06/02/2016

 

Permanent and Stationary Date: 05/10/2016

 

Relevant Medical History:

There is no prior history of low back injury or surgery.

 

Physical Examination:

Thin pleasant female who is guarded in her low back movements. She is tender palpating the lumbar spine. There is normal lumbar lordosis. There is no hypertonicity or spasm. Her forward flexion is limited fingertips to above thighs. She has symptoms a supine position with some guarding. Straight leg raising is negative. Strength in EHL, gastro soleus and anterior tibialis 5/5 with referred pain to the low back.

 

Diagnostic tests results: 

MRI lumbar spine 12/22/15 small broad-based central disc protrusion L4-5, L5-S1 small right paracentral disc protrusion. There is no central or foraminal stenosis.

 

Diagnoses

Strain of muscle, fascia and tendon of lower back, subsequent encounter

 

Impairment Rating: I have reviewed the fifth edition of the AMA guides. Based on the objective and subjective factors of this case there is no apparent ratable impairment Patient’s condition is best characterized by DRE lumbar category Pain assessment:

Not indicated

 

Apportionment: Not indicated

Explanation:

For this patient I have determined that no impairment exists consistent with the American Medical Association Guidelines to the Evaluation of Permanent Impairment, therefore apportionment is not indicated.

 

Future Medical Treatment:
Treatment for possible flare-ups should be made available for this patient. This would include additional physical therapy, acupuncture or chiropractic treatments. Additional imaging or orthopedic evaluation would not be indicated in light of her current MRI and objective findings. Patient is encouraged to continue with her therapeutic exercises. With additional time is likely that her symptoms will attenuate. The patients lack of sleep should be addressed. A trial of trazodone, or Elavil and if unsuccessful Lunesta may be helpful. Pain assessment:

Not indicated

 

Apportionment: Not indicated

Explanation:

For this patient I have determined that no impairment exists consistent with the American Medical Association Guidelines to the Evaluation of Permanent Impairment, therefore apportionment is not indicated.

 

Future Medical Treatment:

Treatment for possible flare-ups should be made available for this patient. This would include additional physical therapy, acupuncture or chiropractic treatments. Additional imaging or orthopedic evaluation would not be indicated in light of her current MRI and objective findings. Patient is encouraged to continue with her therapeutic exercises. With additional time is likely that her symptoms will attenuate. The patients lack of sleep should be addressed. A trial of trazodone, or Elavil and if unsuccessful Lunesta may be helpful.

 

Environmental restrictions (e.g. heights, machinery, temperature extremes, dust, fumes, humidity, vibration etc.): None

 

Can this patient now return to his/her usual occupation? No. 

 

Permanent Restrictions: 

Stand = 2-4 hours

Walk = 2-4 hours

Sit = 2-4 hours

Bend = Not at all
Squat = 2-4 hours

Climb = Not at all

Twist = Not at all

Reach = 6-8 hours

Crawl = Not at all

Drive = 2-4 hours

Grasp = 6-8 hours

Push/Pull = 6-8 hours

No lift/carry at a height of waist more than 5 lbs. for no more than 4 hours per day. 

 




 
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#10
Can you edit out your post deleting your name, doctors name insurance company name and anything else that can identify you? This is just for your protection. There is an edit button and you can go back any time and take out any identifying info in posts.

It looks like you are getting taken advantage of (IMO). If you want to move forward with your work comp claim I highly recommend objecting to his report and fill out the panel QME form. You have a limited amount of time to do this. If you decide to do this you can pick the specialty of the PQME. I were you, I would pick chiropractor as the specialty to examine you as  they appear to be the most unbiased/fair evaluation, but this is my own personal opinion. I am not an expert. Once you request the PQME specialty you will then receive a panel of 3 doctors to chose from. I would recommend asking a work comp applicant attorney his advice on the panel, or at least do a google search. I can try to do a case look up on them as well if you would like. This is to find out what types of reports they write. You want an honest doctor who will look out for your nest interest.

If you do not want to fight this I understand, but from what I read above you have a zero PD rating and your employer does not want you back. The doctor also P&S'd you which took away TTD. TTD could have been paid up to 104 weeks or until you are P&S'd. I feel bad for you because it sounds like in time you may heal. It is unfortunate what this doctor did and in my opinion he did you a great disservice by P&S'ing you so soon.

I want to add on top of the voucher your claims adjuster wrote about you also may qualify for an additional $5,000. voucher that can be used on anything. If you decide not to move foreword with PQME I can send you info where to get the additional voucher. These vouchers are supposed to be for injured workers who employers cannot take them back. In my opinion this seems to be rushed in your case and just wrong with discontinuing TTD, a zero PD rating and not being able to return to work.

It sounds like you may be at an insurance friendly industrial work comp clinic or doctor. You can change treating doctors and I recommend you do if you are staying in this system. Did you receive a medical provider network list of doctors?

Again, you can take this report down to the work comp board your case is located at and ask if an I&A officer can sit down with you and help you. You can also meet with some work comp attorney's. I can also help guide you, but I am not an expert just an injured worker like yourself, but happy to help if you want it.
I am not an attorney.Anything I write should not be considered legal advice.I am writing from my own personal experiences,which is not from any sort of legal background. You should consult with an attorney over legal issues. In California, if you cannot get an attorney you can consult with an I&A officer.
 
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