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Nevada second opinion
#1
Hello all,
Question, hurt at work and going to comany Physical Medicine and rehabilitation Dr.
Who has insisted I have lumbar back sprain
Even though condition continually worsened with extreme leg pain now and numbness in feet. On pain meds and therapy 3 months. Dr states should be getting better not worse. Finally agrees to second opinion to be fair as he states before relasing me off light duty. Insurance sends me to back surgeon for consultation only to read mri which first dr say negative.
Second opinion says no way is this mri negative here is your problem, mild disc bulge, mild facet and moderate ligmentum
Flavum hypertrophy. Significant encroachment on both lateral recesses.
Bla bla bla but anyway says thats causing your pain. Puts in report recomends treatment under workers comp system, agrees it happened because of accident
And recomends injection and if no result surgury (laminectomy) to both dr and to insurance co.
Heres the kicker first dr reads this in front of me and shakes head no I dont agree
I am sending you for FCE then back to work
Live with the pain your getting old live with it.
No response from ins. Co except made FCE appoint in one day a record.
They didn't send me for second opinion till
after 90 days want to change dr but no response been 9 days. Also want surgon to treat me. Also no response from ins. Have lawyer they say go to fce or lose workers comp. Dont want to be bothered with fighting anything.
Dont I have any rights as far as what second opinion said that ins co sent me to?
Thank you for any help
In nevada.
 
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#2
you have some rights.
you may be required to select a physician or chiropractor from a list provided by your workers’ compensation insurer, if it has contracted with an Organization for Managed Care (MCO) or Preferred Provider Organization (PPO) or providers of health care. If your employer has not entered into a contract with an MCO or PPO, you may select a
physician or chiropractor from the Panel of Physicians and Chiropractors.

here is the list of approved treating physicians.
http://dirweb.state.nv.us/wcs/treatingpanel.pdf

you can change attorneys at any time.

more on workers comp in Nevada here
http://dirweb.state.nv.us/WCS/employee.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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#3
I hate to tell you but you are a number to them and that is how much is this going to cost. Once they are looking at spending money you are going to have to fight to get the treatment you need. Now they could be playing a little game and just seeing if you will give up quick and go away, and once they see our not they might start covering this and get it taken care of. But they could fight you all the way. If you got a lawyer you must have known there was going to be trouble.
In my case it was pretty much the same thing. In the beginning they said it was just a lower back strain and they were done with me. Well this all started in Nov 2005 and we are still in the fight.
Right now it looks like you have to decide to play their game or throw in the towel and just hope you will recover on your own. I'm thinking your going to need treatment to get better but you have to decide. Sadly once you get injured and it's not something simple you are going to get the run around.
 
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#4
Thanks for response just needing to know what to do about not going to FCE. Can I make them follow 2nd opinion.
Thank you
 
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#5
You need to follow what they are wanting you to do. If they set up a FCE then you need to go and do what you can do. This FCE should show them what you can or can not do. Now if you hold back and don't try to do what they ask this will show up in the report and will not look good for you. You can not just stand up and make them follow the 2nd opinion. As the title says it is a 2nd opinion and just that. They right now have two opinions as to your condition. This FCE should help to put a little weight behind one of those opinion. What it is going to take is enough medical opinion on your side to show that you need this treatment.
If you don't go to the FCE they will say you are not following the program and cut you off
 
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#6
(02-16-2014, 02:22 PM)johnny1999 Wrote: Thanks for response just needing to know what to do about not going to FCE. Can I make them follow 2nd opinion.
Thank you

no but a judge can if the medical opinion is more persuasive then the other.
you would have to litigate the issue. in that case you may wish to discuss your situation with an experiened work comp atty.
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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#7
Thank you for the help everyone
Much appreciated
 
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#8
What is sad in cases just like yours is that sometimes the doctors opinion is based on who is paying them. It would be nice if all doctors would just give you an honest opinion on what they see. And sometimes its not who is paying them but do they think they can make some money on your injury. Now do not get me wrong most doctors will give it to you like they see it but a work comp injury is a fight to save money but I'm sure there are cases where the carrier would have saved money if they would have just treated the injury and not made them jump through hoops. As 1171 said a judge can make them follow what ever he thinks has the most persuasive information. Now in the 2 opinions you have a judge may have enough information to make that decision. A good lawyer can help you get the treatment you need
 
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#9
Yes it is always a battle for every little thing
Now have to hope FCE shows what it should
Thank you for help.
Still dont understand why ins comp doesnt have to respond to second opinion dr request for treatment when ins. Company sent me there
 
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#10
On another day note 4 months later job has still not sent wage verification to ins. Co.
 
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