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Permanent & Stationary (P&S) - Printable Version

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Permanent & Stationary (P&S) - DISGUSTED TO THE T - 12-28-2015

My case has reached and passed the P&S level -- permanent and stationary. I thought that P&S meant that I would be getting needed surgeries/treatment to repair/correct two work injuries and that the surgeries would allow me to go back to work. WC did many MRIs and X-rays and they all show some form/degree of damage. Of course I was 100% wrong. No surgeries were forthcoming. Instead my WC doctor doubled my pain pills to 180 per month. According to WC I am permanently disabled. So my question is: how can they say that my condition is P&S when they never tried to repair my injuries? I have new medical issues caused by the two original injuries. By my definition I am not P&S. My WC doctor did submit requests for Orthopedic consults, etc. But they were all denied. My Attorney is currently negotiating a WCMSA. But I still don't understand why WC did not do the surgeries in the first place and I probably could have returned to work at least two years ago. April 2016 will mark five years since i opened my case.


RE: Permanent & Stationary (P&S) - 1171 - 12-28-2015

Wrong question.
Correct question: " w hat can I do about it?"

Depends on your states comp laws. You didn't give your state so difficult to give you options.

It would also be nice to know what your atty and Doctors Responded when you pressed them with these questions.

Doctors generally are reluctant to try treatments that have little chance of success.

In any event:
What,s your state?
You can get or change attys at any time.
You can get other medical opinions at any time at your expense.
You can generally change treating doctors.
You can challenge a benefit decision like P&S or denial of consult with your states comp court any time.


RE: Permanent & Stationary (P&S) - California_Help - 12-28-2015

(12-28-2015, 01:12 AM)DISGUSTED TO THE T Wrote: My case has reached and passed the P&S level -- permanent and stationary. I thought that P&S meant that I would be getting needed surgeries/treatment to repair/correct two work injuries and that the surgeries would allow me to go back to work. WC did many MRIs and X-rays and they all show some form/degree of damage. Of course I was 100% wrong. No surgeries were forthcoming. Instead my WC doctor doubled my pain pills to 180 per month. According to WC I am permanently disabled. So my question is: how can they say that my condition is P&S when they never tried to repair my injuries? I have new medical issues caused by the two original injuries. By my definition I am not P&S. My WC doctor did submit requests for Orthopedic consults, etc. But they were all denied. My Attorney is currently negotiating a WCMSA. But I still don't understand why WC did not do the surgeries in the first place and I probably could have returned to work at least two years ago. April 2016 will mark five years since i opened my case.

I agree with 1171. Every state has different laws, so without writing what state you are from it is difficult to answer.
If you are from California, there is an appeals process when you are denied treatment. 

I assume you are on SSDI since your attorney is requesting a WCMSA, is this correct?


RE: Permanent & Stationary (P&S) - DISGUSTED TO THE T - 12-28-2015

(12-28-2015, 01:45 PM)California_Help Wrote:
(12-28-2015, 01:12 AM)DISGUSTED TO THE T Wrote: My case has reached and passed the P&S level -- permanent and stationary. I thought that P&S meant that I would be getting needed surgeries/treatment to repair/correct two work injuries and that the surgeries would allow me to go back to work. WC did many MRIs and X-rays and they all show some form/degree of damage. Of course I was 100% wrong. No surgeries were forthcoming. Instead my WC doctor doubled my pain pills to 180 per month. According to WC I am permanently disabled. So my question is: how can they say that my condition is P&S when they never tried to repair my injuries? I have new medical issues caused by the two original injuries. By my definition I am not P&S. My WC doctor did submit requests for Orthopedic consults, etc. But they were all denied. My Attorney is currently negotiating a WCMSA. But I still don't understand why WC did not do the surgeries in the first place and I probably could have returned to work at least two years ago. April 2016 will mark five years since i opened my case.

I agree with 1171. Every state has different laws, so without writing what state you are from it is difficult to answer.
If you are from California, there is an appeals process when you are denied treatment. 

I assume you are on SSDI since your attorney is requesting a WCMSA, is this correct?



RE: Permanent & Stationary (P&S) - DISGUSTED TO THE T - 12-28-2015

I am in California. Thank you all for your responses. All requests for treatment have been denied. My Attorney wrote many letters demanding explanations with no positive results. All that is in the past. I am not on SSDI: it was denied twice. I am within 2 1/2 years of qualifying for Medicare. I presume WC was delaying until I reached the 2 1/2 year benchmark. The WCMSA is still in negotiations. The negotiations for WCMSA actually started almost on the month that I reached the 2 1/2 year benchmark. Yes I understand I can get second opinions etc. I am in the process of doing that now. Every single WC doctor and MRI indicates some kind of damage/injury. As to new injuries that resulted from the previous injuries I will file a new claim shortly. Thank you again.


RE: Permanent & Stationary (P&S) - 1171 - 12-28-2015

I'm still not clear as to what you are looking for from your postings?
there is not anyone here who can give you an accurate reason for the carrier's treatment denials without more information.
you can go to court at any time benefits are denied; there is no requirement that you wait for CMS's review criteria to kick in.

are you satisfied with your atty?
was your claim ever accepted?
did you receive any comp benefits?
I'm also a bit confused as it sounds like you just want out with a settlement yet you are also pursuing more litigation with new claims.

P.S.
the 30 month requirement is only if you want a CMS review. it's the parties option to do an MSA or settlement without a review at any time.
https://www.cms.gov/Medicare/Coordination-of-Benefits/Workers-Compensation-Medicare-Set-Aside-Arrangements/WCMSAP-Overview.html


RE: Permanent & Stationary (P&S) - California_Help - 12-28-2015

(12-28-2015, 02:34 PM)DISGUSTED TO THE T Wrote: I am in California. Thank you all for your responses. All requests for treatment have been denied. My Attorney wrote many letters demanding explanations with no positive results. All that is in the past. I am not on SSDI: it was denied twice. I am within 2 1/2 years of qualifying for Medicare. I presume WC was delaying until I reached the 2 1/2 year benchmark. The WCMSA is still in negotiations. The negotiations for WCMSA actually started almost on the month that I reached the 2 1/2 year benchmark.  Yes I understand I can get second opinions etc. I am in the process of doing that now. Every single WC doctor and MRI indicates some kind of damage/injury. As to new injuries that resulted from the previous injuries I will file a new claim shortly. Thank you again.

Your attorney writing letters demanding explanation is not the process we have in California to get treatment approved. There is a internal UR appeal process. You, your doctor or attorney has 10 days after the UR denial to request this internal UR appeal with the UR company (directions for this is located on the last few pages of a UR denial). The second appeals process is with IMR. You, your doctor or attorney has up to 30 days to request this. I highly recommend using both appeals processes but UR internal appeal is easier to get things approved. If IMR is denying things without providing rational your attorney should be filing for a hearing within 30 days of the denial. Has he done this?

The fact that you have gotten some MRI's tells me you had those approved or they may have been done on a lien. If any body parts are denied, all requests for that body part can be ignored. Was your claim accepted?

There are a few different ways to get a consult with a specialist. One way is to have your doctor request it and the request will be approved by your claims adjuster or sent through UR. Your doctor has to send rational and medical guidelines on a current RFA form as to why this request is warranted. If your doctor is not doing this or not familiar with CA workers' compensation system it will be very difficult for you to get treatment approved. If he is not in the MPN the insurance carrier can ignore his requests. There has to be a disconnect somewhere for you to get everything denied including consults to specialist. Can I ask you what surgery has been recommended for you and was it recommended by an orthopedic surgeon?


RE: Permanent & Stationary (P&S) - DISGUSTED TO THE T - 12-28-2015

Again, thanks to all who have responded to my confusing inquiries. I now realize that I may be way out of my league asking these superfluous questions. I already received the temporary payments. My attorney is currently in the process of negotiating a WCMSA which started around August 2015—which is when I signed a form that starts that process. I presume that a WCMSA can take up to a year to iron out. Part of my original question asks in part “I thought that P&S meant that I would be getting needed surgeries/treatment to repair/correct two work injuries and that the surgeries would allow me to go back to work.” My WC doctor doubled my pain pills to 180 per month.” So on the one hand I’m criticizing the term “P&S” which to me seems to be a misnomer. My reason(s) for saying it’s a misnomer is because my injuries are not permanent and stationary because those original injuries have caused other injuries which manifested over time. I also used the terms “surgeries/treatment.” My WC doctor did request orthopedic consults several times over several months which were all denied. These requests were based on WC MRI reports. So I presumed that I would receive some kind of “surgery” or “treatment” to repair my two injuries – which never happened. It didn’t matter to me if it was surgery or treatment—I just assumed that whatever they decided on that it would fix me and allow me to return to work. Regarding filing a new claim: Months before the WCMSA process began I reported a new injury to my WC doctor that manifested as a direct result of my original injury. My original injury, a labral tear in the hip area, causes me to limp. I have been limping for more than seven (7) years. Over time my left knee became progressively painful. I developed a callous on my right big toe. The soles of my shoes wear out in weird places. My ankles get tired. This is a direct result from what I call “walking crooked” that is caused by my hip injury. I now have a new WC doctor as per my Attorney. When my new doctor requested knee treatment—MRI, brace, etc., it was denied because it was not a work-related injured body part. For that reason I want to file a new claim.
In closing I do have an attorney but it does seem to me that the WCMSA process is taking a long time. Maybe someone can recommend what questions to ask my attorney as to why the WCMSA is taking so long? I don’t expect this forum to do my case. The insights you provide help make the WC process easier to understand. Please advise or advise that this forum is not the correct venue for me. Thank you in advance.


RE: Permanent & Stationary (P&S) - 1171 - 12-28-2015

P & S= permanent and stationary.
if your condition is permanent or stationary, then only maintenance medical is contemplated.
if your condition is stationary, then it is NOT expected to change significantly in the future. the point of aggressive treatment like surgery would be change your condition. permanent & stationary is the exact opposite of what you assumed.
a permanent disability rating cannot be done until an injury has reached maximum medical improvement or P&S.

it depends on where in the set aside process your claim is at.
has the carrier submitted its medical settlement amount and medical file to CMS?

the carrier is not going to settle unless all your claims are included.
did they include the new claims in their CMS submission?
if not they should be added.

P.S. filing a new claim will not get treatment that they have already denied.

from what little you've posted it appears that you can only explore additional treatment after settlement and you were steared that way by both the carrier and your atty.


RE: Permanent & Stationary (P&S) - California_Help - 12-28-2015

(12-28-2015, 09:53 PM)DISGUSTED TO THE T Wrote: Again, thanks to all who have responded to my confusing inquiries. I now realize that I may be way out of my league asking these superfluous questions. I already received the temporary payments. My attorney is currently in the process of negotiating a WCMSA which started around August 2015—which is when I signed a form that starts that process. I presume that a WCMSA can take up to a year to iron out. Part of my original question asks in part “I thought that P&S meant that I would be getting needed surgeries/treatment to repair/correct two work injuries and that the surgeries would allow me to go back to work.” My WC doctor doubled my pain pills to 180 per month.” So on the one hand I’m criticizing the term “P&S” which to me seems to be a misnomer. My reason(s) for saying it’s a misnomer is because my injuries are not permanent and stationary because those original injuries have caused other injuries which manifested over time. I also used the terms “surgeries/treatment.” My WC doctor did request orthopedic consults several times over several months which were all denied. These requests were based on WC MRI reports. So I presumed that I would receive some kind of “surgery” or “treatment” to repair my two injuries – which never happened. It didn’t matter to me if it was surgery or treatment—I just assumed that whatever they decided on that it would fix me and allow me to return to work. Regarding filing a new claim: Months before the WCMSA process began I reported a new injury to my WC doctor that manifested as a direct result of my original injury. My original injury, a labral tear in the hip area, causes me to limp. I have been limping for more than seven (7) years. Over time my left knee became progressively painful. I developed a callous on my right big toe. The soles of my shoes wear out in weird places. My ankles get tired. This is a direct result from what I call “walking crooked” that is caused by my hip injury. I now have a new WC doctor as per my Attorney. When my new doctor requested knee treatment—MRI, brace, etc., it was denied because it was not a work-related injured body part. For that reason I want to file a new claim.
In closing I do have an attorney but it does seem to me that the WCMSA process is taking a long time. Maybe someone can recommend what questions to ask my attorney as to why the WCMSA is taking so long? I don’t expect this forum to do my case. The insights you provide help make the WC process easier to understand. Please advise or advise that this forum is not the correct venue for me. Thank you in advance.

This is an injured worker forum, so you are in the right place. Please know I am just an injured worker like yourself, so this is not a place to get legal advice. I reply with my own knowledge from being in this horrible system. I will give you a link to the states website. This is where you can search a lot of your questions in the search bar. On the first page you can order a guidebook. I highly recommend it.

http://www.dir.ca.gov/dwc/InjuredWorker.htm

Next, let me explain to you P&S. This means your condition is not likely to have a dramatic change with or without treatment in the next 12 months. Usually, this is when you also receive a PD rating. Did you go to an AME or QME and did they rate you and P&S you? This can also change as I know people who have been P&S'd several times during their claim. P&S has nothing to do with obtaining medical treatment.

Your doctor is the gatekeeper of your medical treatment. Not only should he be using your MRI when requesting a specialist but he should also use medical treatment guidelines. If you have a doctor who is not well versed with work comp, is not making these requests appropriately, or is not actively participating in peer to peer phone calls and UR appeals you are not going to get treatment approved. Please read my first response about the UR denial appeals process. If he does not do these appeals, you have to wait 12 months before he can request this again (unless change of condition). It should not be this difficult to see a specialist. Your attorney should also know how he can get you to a specialist. You can also change doctors to a specialist. Be careful when you do see an work comp orthopedic doctor. Some of these WC doctors are surgery happy and are in my opinion over operating on many people. Have you had any type of physical therapy?

You do not have to file a new claim for the body parts that your doctor feels are a result of your accepted injury. Your attorney needs to amend your claim and add those body parts/injuries. If the insurance company denies these injuries then you will be sent to an AME or QME who will make the determination if they are work related. In the mean time you can use private insurance if you have it for the denied injuries and brace etc.

I have read MSA proposals take a long time. Hopefully someone else on this site will have more knowledge on this.

PLEASE, PLEASE do not allow any doctor in this system to make a decision for you with surgery. Get a second opinion and do a lot of research on both the doctor, the facility he uses and the procedure before allowing any doctor to operate on you. There are good doctors in this system and there are also bad doctors in this system who do over operate on trusting people like yourself, who are willing to do anything to get better and back to work.

Sorry, I must have been typing at the same time as 1171. (exactly what they wrote above)