(06-01-2016, 12:54 AM)beesgonz Wrote: I was injured at work back in 2014. I have disk protrusion and I need lumbar fusion surgery. For the time being the AME Doctor and a handful of surgeons don't recommend me the surgery. Maybe in the future. I am tired of going back and forth with the insurance. They don't approve anything that would help my conditions such as epidural steroid injection. My pain medications consist of norco and Percocet. They have only approved medication about 5xs since the case was opened over 2yrs ago. I just pretty much tired and want to end this already. I was wondering how much should I try to settle for. The rating from the AME Doctor was a total of 32%.
Who is saying you need a lumbar fusion surgery, your work comp primary doctor?
If you are in California, the AME no longer decides on the surgery. Are you? Your doctors requests have to go to utilization review. Has this happened and when there was a denial did your doctor do an internal appeal and did you request an IMR? This is the process of how surgery is approved in work comp, the same thing with epidurals etc. If you are not at a doctor who knows how to appeal UR denials then it will be extremely difficult to get anything approved.
You as an injured worker also have the right to do these appeals. I can show you how to do them if you would like, but you need copies of your medical records and testings. From here on out every time you are at your doctors office I recommend to ask for a copy of the previous months report. Keep these records in order by date.
Since you have an AME, this shows you have an attorney right? There are a few different ways to settle. One is with open medical where you are stuck in this system, and the other closes out your medical. Do you have alternative insurance? Have you applied for SSDI?
Also, please listen to the doctors who are advising you against a fusion as these fusions are not a quick fix. A pole on this forum was taken and I asked every injured worker if they were better, worse or the same after their fusion. EVERY injured worker stated they were worse, including myself. I thought pain was bad BEFORE my fusion, I had no idea how bad pain could get. There are patients who do have improvement from fusions as I have read about them on spine forums, but many do not.
Disc herniation can improve in time from what several surgeons have told me and this can take up to 4 years and they can also fuse on their own. I am not giving medical advice because I am not qualified and you may very well need a fusion... I am just giving you advice from myself a regular person who has had a muti-level fusion and I wish someone would have given me this advice. I also want you to be aware that spinal fusions are being done so much more in the work comp system than in regular insurance. They do not know if this is from lack of conservative treatments from being approved or it may be due to financial incentives to the surgeon. Fusions are big money to surgeons and if you are from California, there are unethical ortho surgeons who are doing these fusions at alarming rates, and many are doing on patients who do not need them.
Do you have a pain management doctor to help with your pain?
I am not an attorney.Anything I write should not be considered legal advice.I am writing from my own personal experiences,which is not from any sort of legal background. You should consult with an attorney over legal issues. In California, if you cannot get an attorney you can consult with an I&A officer.