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Self Insured Employer Confusion... please help.
#1
Hello, I am new to this forum and would like to say thanks in advance for any help or explanations offered.

I am currently employed by a very large Tennessee corporation that is self insured. In late January while at work I bent over to pick up something in the floor and wasn't able to straighten up. I went directly to the emergency room and was told to report to my companies work force physicians the next day. I was placed on workers compensation and assigned a doctor to report to.

To make a long story short, after several MRI's and six months later, I am still in pain and unable to perform my job. The MRI showed slightly bulging discs but nothing that would require any type of surgery. I am still in a lot of pain, unable to bend over or do anything physical. I am going to physical therapy twice weekly.. which temporarily relives my pain.

My company is still paying their portion of my medical insurance and paying me WC which ='s 2/3 or my regular hourly pay.

I have no idea what's going to happen when I go back to my doctor next week. Can anyone please give me some scenarios that might better prepare me for the visit. What if he gives me a maximum medical improvement? what will happen then??


I greatly appreciate help and info..
 
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#2
(08-06-2012, 04:32 PM)Yett Wrote: Hello, I am new to this forum and would like to say thanks in advance for any help or explanations offered.

I am currently employed by a very large Tennessee corporation that is self insured. In late January while at work I bent over to pick up something in the floor and wasn't able to straighten up. I went directly to the emergency room and was told to report to my companies work force physicians the next day. I was placed on workers compensation and assigned a doctor to report to.

To make a long story short, after several MRI's and six months later, I am still in pain and unable to perform my job. The MRI showed slightly bulging discs but nothing that would require any type of surgery. I am still in a lot of pain, unable to bend over or do anything physical. I am going to physical therapy twice weekly.. which temporarily relives my pain.



My company is still paying their portion of my medical insurance and paying me WC which ='s 2/3 or my regular hourly pay.

I have no idea what's going to happen when I go back to my doctor next week. Can anyone please give me some scenarios that might better prepare me for the visit. What if he gives me a maximum medical improvement? what will happen then??


I greatly appreciate help and info..

MMI would entitle you to an impairment rating and stop your temporary disability checks.
The rating will get you some additional disability payments to help with starting over at a new lighter work job.
It won't be enough to live on but a bit better then nothing.

Read more about tenn comp
http://www.tn.gov/labor-wfd/wcfaq.shtml#WCbenrev

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
delete please thanks billy
 
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#4

[/quote]

MMI would entitle you to an impairment rating and stop your temporary disability checks.
The rating will get you some additional disability payments to help with starting over at a new lighter work job.
It won't be enough to live on but a bit better then nothing.

Read more about tenn comp
http://www.tn.gov/labor-wfd/wcfaq.shtml#WCbenrev


[/quote]

Can you please explain in a little more detail? If I get an MMI rating my company will stop paying the 2/3 of my regular pay? If that happens will they offer some type of settlement? Do I need to ask for a settlement? I'm not familiar at all with the process..

thanks again for any help or knowledge you can share.
 
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#5

MMI would entitle you to an impairment rating and stop your temporary disability checks.
The rating will get you some additional disability payments to help with starting over at a new lighter work job.
It won't be enough to live on but a bit better then nothing.

Read more about tenn comp
http://www.tn.gov/labor-wfd/wcfaq.shtml#WCbenrev


[/quote]

Can you please explain in a little more detail? If I get an MMI rating my company will stop paying the 2/3 of my regular pay? If that happens will they offer some type of settlement? Do I need to ask for a settlement? I'm not familiar at all with the process..

thanks again for any help or knowledge you can share.
[/quote]

each case is different so it's difficult to be detailed without specific questions on a particular situation.
sometimes the MMI determination comes months before an impairment rating.
the ttd checks stop when you are MMI.
the finalization process can be very slow especially if there are disputes.
you may need to ask for a rating.
the labor law says the carrier has 30 days to make a settlement offer once the doctor give a rating.
If you have issues with any part of your claim, the state has a benefit review system that assists employees with resolving disputes with workers' compensation claims. The Tennessee Department of Labor and Workforce Development's Workers' Compensation Division can be contacted at 1-800-332-COMP (2667) (TDD) or 615-532-4812.

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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#6
delete please thanks billy
 
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#7
the last time i went to my WC doc he said he was ordering 4 more weeks of PT but would be giving me an MMI on the next visit. I am going in today. I am wondering once i get this MMI, what should i expect to happen. my Dr. insinuated the MMI would be a good one considering my injury and education level and the nerve damage I have suffered from it. My employer is privately insured so they do not have to follow TN WC law. again.. anyone have any idea what to expect..
 
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#8
I'm not sure what you mean by "good":

really messed up with a lot of impairment, disability, pain and need for much continuing medical just to function at all

or

successful recovery, did really well from a serious injury and not left with too much damage, impairment and disability and able to function pretty considering what could have happened


which one is "good" for you?
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.
 
Reply
#9
(12-14-2012, 01:38 PM)1171 Wrote: I'm not sure what you mean by "good":

really messed up with a lot of impairment, disability, pain and need for much continuing medical just to function at all

or

successful recovery, did really well from a serious injury and not left with too much damage, impairment and disability and able to function pretty considering what could have happened


which one is "good" for you?
let me clarify.. the dr said i would have an MMI and based on my education, injury my MIR would not be good. meaning I can't do my current job and the hosp is not likely to be able to find a job for me. my back injury has caused permanent nerve damage in my leg and foot resulting in permanent drop foot.
 
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#10
if they don't have to follow the comp laws then it's difficult to predict what they will do.
self-insurance does not mean they are immune from comp laws; it just means the employer pays all costs not a carrier.
sounds like you have some significant disability in which case your rating will be higher and entitle you to more benefits the someone who can return to their job with minimum difficulty.

of course no one on a message board can duplicate the doctor's impairment rating process and determine your permanent disability amount.
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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