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Newby needs insight
#1
Hope I am doing this right. I am in California. I was injured 2 1/2 years ago. The first month I was tossed around by my HR department and Workman's Comp. I got a lawyer after that and all has been pretty smooth sailing. A few bumps here and there, nothing like some of the things I have read in here. A year after I had an operation for 3 discs to be fused together, I was put at MMI by an IME doctor. Now here is where I need the insight. Once I got my lawyer, nothing regarding treatment has been denied. My case worker, doctors and my lawyers have called back each time in a timely fashion. There have been no issues from the Workerman's Comp insurance.
Since I have been at MMI, I have had 2 doctor appointments cancel on me. Treatment has, for the first time been denied, with the explanation, in their words, 'we feel that the treatment will not improve your condition'. There has been no call back why they 'feel' that way. Insurance company has cancelled 2 appointments, both the day of the appoinment, for a discussion they want to have with us. I have called my Workerman's Comp doctor each of the last 4 business days as I have been having stomache and chest pains from the new medication I was given. No response. Even now my lawyers don't call back until I have left 3 or 4 messages.
I have read many a post from 11xx, cannot remember the last 2 numbers, who states to change doctors or lawyers if unhappy. 2 1/2 years into this I don't want to as it has been uncomplicated and I feel like it would be starting over when I seem to be near the end.
Once you go MMI, does everything just stop? Is this now my time that this system is going to fail for me?
Any advise would be appriciated. Thank you in advance!!!
 
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#2
when you are represented -whether you are at MMI or not -they should not talking to or discussing your case.

when recovery ceases (MMI) temporary disability stops.
treatment is controlled by utilization review regulations.

more info on treatment regs
http://www.dir.ca.gov/dwc/MTUS/MTUS_FAQs.html

mmi by itself shouldn't have changed anything but the disability type.
Reminder :
........Each state has their own comp system; POST YOUR STATE to get accurate information. Use the search feature to find information from similar questions.
THANKS FOR POSTING.
 
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#3
(03-14-2011, 08:45 PM)1171 Wrote: when you are represented -whether you are at MMI or not -they should not talking to or discussing your case.

when recovery ceases (MMI) temporary disability stops.
treatment is controlled by utilization review regulations.

more info on treatment regs
http://www.dir.ca.gov/dwc/MTUS/MTUS_FAQs.html

mmi by itself shouldn't have changed anything but the disability type.

That was a lot to read. Thanks for the info. Sorry I didn't remember the '71' part.

If MMI doesn't change anything else, do we then chalk it up to just coincidence that the above happened? Unless there is another explanation, I guess it is what it is.
Regarding the treatment, do you know how the review works? What was requested for treatment has a large success rate, but the review board said it would basically do no good. I guess they saying they 'feel' verses saying 'studies show' makes a difference.
 
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#4
if your doc has a copy of the ACOEM
(American College of Occupational and Environmental Medicine ) guidelines he mght be able to give you a better idea as to why the treatment was rejected.
they are also available at any DWC office.
or you can ask your adjuster or the UR doctor to provide copies of the relevant portion of the ACOEM they used to justify their decision

see the bottom of the the page of this link
http://www.dir.ca.gov/dwc/UR_Main.htm
Reminder :
........Each state has their own comp system; POST YOUR STATE to get accurate information. Use the search feature to find information from similar questions.
THANKS FOR POSTING.
 
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