1171 and Cycler

[Manley2]

Sounds like youare saying the could force you to get on the table and have your back cut open??? Sure you can deny surgery and sure they maybe able to stop paying you.

My point was I was wondering what would have happened if one out of three said surgery would help and I said no. It's sad that we might have a hearing officer deciding what is good for you. I could understand if everybody agreed this surgery would help, but what happens when not everybody does? How can they say what is best. I'm not wanting a yes or no answer I'm just wanting poeple to stop and think about it.

[Still in Limbo]

Manley, Sometimes it takes a Judges Decision at a Hearing to Stop a Surgery, such as in My Situation, but if You have 2 Saying No and One Saying Yes, chances are the Evidence will Out way the need for the Surgery. I know it's Scary putting Your Health Care Decisions in Someone else's Hands for Review, but You have to remember w/c and the i/c's are Interested in getting You Back to Work, and if they feel the Surgery would do it, they are going to Fight to have it Done. They are the One's Paying for Everything, and Sometimes the Burden of Proof is Put on the Injured Workers Shoulders to Fight for what they feel is Right! My Best, and I Hope it goes in Your Favor!

[Cycler]

No one can make anyone have a medical procedure or medical care they do not want. Period. In any state and in any jurisdiction. End of story.

How that may or may not affect some arbitrary rating is a local issue but no one is allowed to stop paying you disability as it is a completely separate system. Why are you not getting this information form your attorney ?

If I am understanding your question correctly I think YOU are assuming something that actually does not happen.

[Still in Limbo]

Cycler, are You Talking of a Private Disability Payment vs. a w/c Payment? I am almost 100% Sure that Here in Pa. if a Surgery is Deemed Reasonable and Necessary to get an Injured Worker as Close to Pre-Injury as Possible, and the Claimant turns it down, Their Benefits from w/c are at Risk. Mr. Belt may be able to Clear this Up if I'm Wrong, but I believe that to be so. Private Disability I have no Idea of, I'm Sure that's a whole New Set of Rules!

[AQA]

Just to clear the air, I am in no way asking the question because of my claim. I did use the state i live in and my injury in the scenerio. My monitary benifits have expired. I have medical for the injury for life and I am assuming nothing, hence; the question.

1171 did answere the question. It does not make sence that an employee could just refuse to have a procedure so they could get more money. There had to be some type of a check and balance in place to keep that from happening.

[Cycler]

re" There had to be some type of a check and balance in place to keep that from happening."

In my state AQA that is not the case at all. I can't imagine it the case in other states either as it makes no sense. You saying a state's law may allow some interested party to "protect itself" from the threat of a harm by a person who would voluntarily live their life in pain or loss of function for a few extra dollars a month?

I doubt it.

Limbo - I am sure that the benefits "at risk" are simply determination of Maximum Improvement or whatever your state might call it, and cessation of TTD payments. That may well lower payment to an IW but it would NOT change an estimate of impairment under the AMA Guides and those Guides are used by most states to determine monetary loss by one formula or another.

[Manley2]

In my case all three said no to the surgery but I had wondered where it would have went if even one had said yes. Part of what I was wondering about was aside from what wc would do how would one decide which doctor to believe in?

[AQA]

Cycler, I am not saying that a IC can force someone to have a surgery. I think everyone knows better. If someone refuses reasonable and necassary surgery with nothing else involved (ie. any other medical issues) for the gain of more money is wrong. I was asking if the IC had a way to protect themselves from that. Nothing more or less. 1171 answered that question.

Other than that, maybe we are not understanding each other, for this is a one dimentional way of communication. I will say, I have heard before, and undesrtand what Still In Limbo is saying.

Manley2, What you have question is an interesting one. The only way I would see that being answered (strictly in my mind). would be if there was some type of peer review. Meaning a panel of maybe 5 dr's of the same type of specialty as the other 3. And those 5 dr's reviewing the reports and then deciding on the appropriet action.

Just my thoughts.

[Cycler]

AQA,
I understand your question and agree that it would certainly be wrong but I am of the opinion that there is no mechanism in place in any state that would prevent a person choose to choose a few dollars over recovery. In the grand scheme of things who would really care, or be harmed other than the Iw themselves ? The dollar amount would be a pittance in any relevant budget.