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Ohio-Employer appeal schedule loss/dr appt
#1
Hello. This is in the state of Ohio. My son (who was a minor when injured) was granted by the BWC an award for 2/3 loss of his index finger which allows him to receive compensation for 23 weeks and 2 days (by the state calculation). His finger was amputated just above the PIP joint. The middle phalanx is gone except a little piece. The ER report, the OR report, all subsequent dr's reports and the Xray confirm this. The employer/MCO is appealing this ruling. They have scheduled him to see a new dr. I am confident that this ruling will stand as the state rule for this is pretty cut and dry. They have a chart that spells out what defines what amount of compensation. What should we expect at this dr's appointment and is it possible this will not actually go to a hearing? He is almost 2 hours away at college and can not keep missing class for their games. Not to mention I will have to take off of work to go with him. I am slightly nervous about going to a new dr if they don't believe the xray what kind of dr are they sending us to?
 
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#2
It should rate the same. Its probably routine for them to get a second exam on any rating.
 
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#3
I did speak to someone at the MCO. I am not concerned that anything will change. Can't fake an amputation, it is just a hilarious attempt on the employers part to validate not paying this kid. She told me that the xrays are not an accurate enough of proof of where the finger was amputated. I laughed. Some how a diagram of a hand with a line thru it is more accurate and said that is fine you are just wasting my time and someones money for a dr to tell you the exact same thing that was reported. (The issue was in 2 of the hand surgeon's reports he made an error-he stated something about the dip and pip joints being something- I don't recall exactly-My son does not have a DIP joint and all other records-the OR report, the therapist reports, the ER report and the rest of the hand dr's reports confirm but since he messed up one sentence in all the reports they are questioning it). I am hoping that once their Drs report confirms what everything else states they will drop the appeal. We already have a fight on our hands for the rest of the claim that they owe him more for code 4123.89 and neither of us get paid days off to go to hearings for blatantly obvious things like this. Blah.
 
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#4
Does anyone know in Ohio is there anyway to veer off the state's amounts or policy of how they pay?

Explanation. My son's finger is missing the dip joint and all of the middle phalanax except a tip that sticks just above the PIP joint. The form states they pay in 1/3rds. They can't argue that it is, lets say 1/2 instead of 2/3 loss if the states policy and formula is to pay in 1/3 or 2/3 or full loss. Right? I hate to get an attorney for this since it is easily shown and will be confirmed by their doctor that his finger is clearly cut off in the 2/3 loss range.
 
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#5
What form?
 
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#6
(04-04-2017, 01:21 PM)1171 Wrote: What form?

C-196. I will try to attach the link to this post. His finger is the left index finger. It is gone from the tip to just above the PIP joint. He has the PIP joint but no usable length above that joint. 

https://www.bwc.ohio.gov/downloads/blankpdf/C-196.pdf
 
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#7
Your concern might be premature as the physician has to indicate the impairment leveL.
What was the doctors rating?
Also I believe it would be difficult to find an atty willing to take on such a dispute as the fee would be minimal.
I don't know Ohio case law on challenging their rating guidelines but it's generally difficult to have guidelines that were fixed by the state legislature overruled or modified by the court.
 
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#8
(04-04-2017, 03:44 PM)1171 Wrote: Your concern might be premature as the physician has to indicate the impairment leveL.
What was the doctors rating?
Also I believe it would be difficult to find an atty willing to take on such a dispute as the fee would be minimal.
I don't know Ohio case law on challenging their rating guidelines but it's generally difficult to have guidelines that were fixed by the state legislature overruled or modified by the court.


There is no impairment rating as it is a schedule loss award not PPD. BWC does not use % for that award. Strictly the form sent above.
 
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#9
(03-28-2017, 01:02 PM)brandallee3 Wrote: Hello. This is in the state of Ohio. My son (who was a minor when injured) was granted by the BWC an award for 2/3 loss of his index finger which allows him to receive compensation for 23 weeks and 2 days (by the state calculation). His finger was amputated just above the PIP joint. The middle phalanx is gone except a little piece. The ER report, the OR report, all subsequent dr's reports and the Xray confirm this. The employer/MCO is appealing this ruling. They have scheduled him to see a new dr. I am confident that this ruling will stand as the state rule for this is pretty cut and dry. They have a chart that spells out what defines what amount of compensation. What should we expect at this dr's appointment and is it possible this will not actually go to a hearing? He is almost 2 hours away at college and can not keep missing class for their games. Not to mention I will have to take off of work to go with him. I am slightly nervous about going to a new dr if they don't believe the xray what kind of dr are they sending us to?

The proper thing to do here is obtain a Functional Capacity Evaluation (FCE). Doctors can determine impairment, but disability is determined by specialized physical therapist. You will need a doctors script to see the PT for an FCE. Loss as you stated is rather cut and dry, but the MCO will attempt to stall any payment and frankly when it gets down to it, your son's attorney will negotiate, but your attorney should stick to the states determination at this point. Your attorney is motivated based upon their percentage collection of the settlement and the fact that they want a final decision. This may lower at a few points. Be sure that your attorney includes a date of settlement payment as part of the overall settlement. Often these facts are negotiated and the MCO sits on the check for an extended period of time, requiring another visit to the hearing officers to force payment.

Also be sure to include, complicating factors found on ODG, page 1883, appendix D, since these factors relate to this issue and can result in an even higher settlement.

Your son should have an another opinion from a board-certified orthopedic specialist in hand surgery to combat any information provided by the MCO's physician, who is basically paid $500 to say whatever they want them to say.

Make no doubt about it, there are no rules of evidence in the Ohio BWC system.

Depending on the injury, I would also suggest a nerve EMG nerve study to rule out other potential injuries to the soft tissue that may not be visible, including Phantom limb pain.

http://www.DrDavidRyan.com
 
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