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I need help for the next steps!!
#1
Hello, I will keep this brief. Basically I need to know what to expect from the point I'm at. Quick background. I live in Vegas. I was injured working out of town in North Dakota. I injured my lower back at work. I qualified for the state maximum weekly benefits which is $995.00 per week. I have jumped through many many hoops to get to this point. It has been 16 months since my injury and I've only received my third wage loss check. This is because they have fought me every step of the way. Then they would only approve everything up to a certain date. So I've gotten back pay checks of 13k, 23k, and 7k. They are finally up to date in paying me and I've received the last three checks on time. However I'm worried. If you are in this forum you probably know what it's like to deal with these mooks. If you don't reply in 30 Days we close your claim. If you don't submit a written appeal in 40 days we close your claim. If you don't send us you wage loss paperwork to this address between these hours, in this colored envelope on a half moon during low tide then you will no longer be eligible. Yadda yadda... so I'm naturally worried because I am finally caught up and what not but if I miss just one check it's back to late fees and bologna sandys. My life is in there hands and I don't want it like that anymore. My injury has left me unable to work due to 10lb weight restrictions along with no sitting, standing, walking, bending. So here's where my questions lie. Physical therapy has not helped. I have two more sessions. At which point my physical therapist will submit to my Dr that I have made nobprogress, or I have in fact been set back by some treatment. (Traction machine tore me up) at which point my Dr will then suggest injections. NOW... do I need to take these injections??? I am led to believe no. Because they will not help my condition. Only make it more tolerable. I refuse to cover the problem and have a useless back in 7-10 years. (I am 25). Next, if I refuse injections do I need to accept surgery? I MAY be open to surgery. Also would like to avoid if possible. Can they deny my benefits for refuse get either. Now I'm led to belive that they won't even want me to go for surgery. Due to risk and cost. So I believe they may try the settlement route. Which brings up my last question. What would I expect for an mmi? I've tried working at a help desk to supplement some of what wc is paying get me in good faith and my dr. Said no. So being that I can basically not work, what should my mmi be? I've read people having like 6%mmi or whatever. Getting offered 30k. That's bogus for me to think. Considering I will never work doing what I've went to school for again. I know how much this injury will cost me the rest of my life. So I won't accept no bogus offer. Nor will I hire an attorney to wait around on my sure fire case and dip his hand in my cookie jar when it all said and done. So any advice? Thanks in advance!
 
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#2
all treatments prescribed are merely recommendations. as the patient covered by workers comp you are not required to accept any treatment you choose not to.
benefits are determined by your disability status not what treatment is being provided.
Nevada comp law requires your permanent impairment rating conform to AMA 5th edition rating guide.
you do not get to choose what benefits you are entitled to or what they are worth.
any settlement/buyout is based on the present value of the benefits you are likely to receive.
you need to know what benefits you are entitled to before making decisions on your claim.
more on Nevada comp here:
http://dirweb.state.nv.us/wcs/wcs.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
(06-20-2014, 03:07 PM)1171 Wrote: all treatments prescribed are merely recommendations. as the patient covered by workers comp you are not required to accept any treatment you choose not to.
benefits are determined by your disability status not what treatment is being provided.
Nevada comp law requires your permanent impairment rating conform to AMA 5th edition rating guide.
you do not get to choose what benefits you are entitled to or what they are worth.
any settlement/buyout is based on the present value of the benefits you are likely to receive.
you need to know what benefits you are entitled to before making decisions on your claim.
more on Nevada comp here:
http://dirweb.state.nv.us/wcs/wcs.htm

Thank you for the quick know response but I am under north Dakota law.

 
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#4
I suspect you have a choice.
North Dakota also uses the AMA 5th edition.
information on their benefits is here
http://www.workforcesafety.com/
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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#5
(06-20-2014, 03:24 PM)1171 Wrote: I suspect you have a choice.
North Dakota also uses the AMA 5th edition.
information on their benefits is here
http://www.workforcesafety.com/

I've been in and out of that website thousands of times lol. I cannot find exactly what I am looking for. I guess I wanna know what that MMI "checklist" would look like and how my injury would translate into a percentage. They have to have some sort of a formula. If you have a 60% MMI rating does that mean you can only do 40% of your "physical" life? Do they then just pay you 60% of my weekly wage, which is currently 995/week? Then times the max number of weeks eligible which is until I'm 65 then use that to propose an offer?
 
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#6
as far as I know there is no "check list" in the law; just a physician's opinion.
disputed evidence is resolved by the comp court or negotiated.

AMA guides are proprietary. your physician might have a copy to share or you may find it in a medical school library.
not all functions are ratable.
the rating is used to determine the duration of impairment benefits as outlined by the comp law; it does not directly relate to your physical life.
the calculation of a full body rating can be quite complex.
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
#7
(06-20-2014, 03:55 PM)1171 Wrote: as far as I know there is no "check list" in the law; just a physician's opinion.
disputed evidence is resolved by the comp court or negotiated.

AMA guides are proprietary. your physician might have a copy to share or you may find it in a medical school library.
not all functions are ratable.
the rating is used to determine the duration of impairment benefits as outlined by the comp law; it does not directly relate to your physical life.
the calculation of a full body rating can be quite complex.

Well you basically answered it. There's no formal equation. I do not trust the insurance company, but I do trust my doctors and physical therapists. They know what condition I'm in. Thanks for your replies.
 
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#8
just to clarify:
there is no "check list" for determining when a patient is thought to have reached Maximum Medical Improvement.
the AMA guide to rating permanent impairment is quite detailed (approximately 600 pages) with precise measurements/conditions for determining the impairment rating.

your next step depends on your treatment decisions.
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
(06-20-2014, 04:09 PM)1171 Wrote: just to clarify:
there is no "check list" for determining when a patient is thought to have reached Maximum Medical Improvement.
the AMA guide to rating permanent impairment is quite detailed (approximately 600 pages) with precise measurements/conditions for determining the impairment rating.

your next step depends on your treatment decisions.

I don't plan on doing injections or any "pain management". I don't even take the prescription drugs. So the next would be surgery. At which point I hope they try to settle. The cost of surgery, or multiple surgeries, meds, my wage loss... adds up fast. Not to mention the risks involved. I no longer want to jump through the hoops and play the games they play. I want to go about treatment my way.
 
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#10
as always each has to evaluate the value of control vs $$.
they will discount the value significantly and the maneuvering & negotiations could take a while.
always the trade offs.
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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