[beesgonz]

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%.

[1171]

Each state has different benefit levels.
Each state has different medical costs
Buying out all future benefits without knowing what you need and what you are entitled to
Makes doing it yourself problematic.
If you post your state I can give you some helpful links or if you don,t want to do that you can search prior posts on this board.

[California_Help]

(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?

[beesgonz]

Thanks for the reply. I know each case tends to be a bit different. Just last night after posting this I got a letter from the insurance saying they were terminating temporary disability payments & will be starting permanent payments. It states it's only good & will only be paid for a total of 85 weeks. If it's permanent shouldn't that be a forever payment? Also, are permanent payments going to be deducted after a settlement?

[California_Help]

(06-01-2016, 05:49 PM)beesgonz Wrote: Thanks for the reply. I know each case tends to be a bit different. Just last night after posting this I got a letter from the insurance saying they were terminating temporary disability payments & will be starting permanent payments. It states it's only good & will only be paid for a total of 85 weeks. If it's permanent shouldn't that be a forever payment? Also, are permanent payments going to be deducted after a settlement?

I am assuming you are from California as every state has different laws?

Permanent disability payments does not mean they are permanent, unfortunately. It is a term they use to pay out your estimated disability rating. You wrote above the AME stated  your disability rating. This will in turn turn into payments. The notice  you received should tell you how much and for how long you will get these payments. TTD has a cap on it at two years in California, and once you are deemed permanent and stationary this can also stop TTD. PD payments are less than TTD payments and they only pay until the amount of PD estimated is paid out. This is essentially your settlement, paid to you in advance.

[1171]

You need to give your state.
Others that search this board need to know if this information can help with their issues and each state is different.
As was posted, your disability may be permanent but if it's only partial then the duration is limited; the greater the disability (as determined by the rating) the longer the payments last.
If the payments are being made prior to a formal award by the comp court, then they are advances and will be credited to whatever is finally determined.
The i mpairment rating from the doctor is not the same as your disability rating from the state.

[beesgonz]

I am from CA. Thank you for responding.

[1171]

Read the fact sheet on pd for a better understanding of California's permanent impairment comp process.
http://www.dir.ca.gov/dwc/iwguides.html
Only if the parties agree on an amount can you buy out of all your future benefits including medical.
The default finalization is periodic permanent disability payments and open medical.
Your atty will have a better idea of what your case is worth.

[Cycler]

(06-01-2016, 09:20 PM)beesgonz Wrote: I am from CA. Thank you for responding.

As a OccMed/ Rehab Dr.  for 25 yrs I just want to comment on your stated need for a fusion. In short- don't.  

There is no scientific data that bulging discs are abnormal, there is no data that bulging discs cause any symptoms. In fact three bulging discs are normal finding by age 35 in half the population and as high as 70 % of the population by age 60. 
First, be aware that lumbar surgery is only designed to relieve motor loss/ progressive peripheral neuropathy to the lower extremity ( and maybe the leg pain of you get lucky /bowel and bladder dysfunction. 

Second, there is no data that lumbar surgery relieves back pain. It might but that's not the goal of the surgery.  There IS quite a bit of good data that lumbar fusion patients rarely return to work and rarely experience the relief they were hoping for.  There is also reams of data on fusions that most of the time it should not have been done at all and wold not have been save for the financial incentives provided to the surgeons as the "distributor " of the device so double dips.  Fusion is necessary for spine instability, not back pain.

And, most importantly, chronic back pain is more often than not a mechanical problem, not a disc problem, and procedures to identify that are not the type of things surgeons generally due: i.e. medial chain branch blocks to assess the facet joint itself as the source of the pain ( most of the time), poor core stability- painful damaged soft tissues which respond to McKenzie and other Core rehab approaches.  

BTW- all studies have demonstrated that chronic opioid use actually INCREASES pain level experience by a complicated receptor and brain re-wiring mechanism.

Physiatrists with Pain Fellowship training tend to get better outcomes when there is no frank radiculopathy present.


Just my thoughts. Good luck.

[California_Help]

(06-04-2016, 10:33 AM)Cycler Wrote:

(06-01-2016, 09:20 PM)beesgonz Wrote: I am from CA. Thank you for responding.

As a OccMed/ Rehab Dr.  for 25 yrs I just want to comment on your stated need for a fusion. In short- don't.  

There is no scientific data that bulging discs are abnormal, there is no data that bulging discs cause any symptoms. In fact three bulging discs are normal finding by age 35 in half the population and as high as 70 % of the population by age 60. 
First, be aware that lumbar surgery is only designed to relieve motor loss/ progressive peripheral neuropathy to the lower extremity ( and maybe the leg pain of you get lucky /bowel and bladder dysfunction. 

Second, there is no data that lumbar surgery relieves back pain. It might but that's not the goal of the surgery.  There IS quite a bit of good data that lumbar fusion patients rarely return to work and rarely experience the relief they were hoping for.  There is also reams of data on fusions that most of the time it should not have been done at all and wold not have been save for the financial incentives provided to the surgeons as the "distributor " of the device so double dips.  Fusion is necessary for spine instability, not back pain.

And, most importantly, chronic back pain is more often than not a mechanical problem, not a disc problem, and procedures to identify that are not the type of things surgeons generally due: i.e. medial chain branch blocks to assess the facet joint itself as the source of the pain ( most of the time), poor core stability- painful damaged soft tissues which respond to McKenzie and other Core rehab approaches.  

BTW- all studies have demonstrated that chronic opioid use actually INCREASES pain level experience by a complicated receptor and brain re-wiring mechanism.

Physiatrists with Pain Fellowship training tend to get better outcomes when there is no frank radiculopathy present.


Just my thoughts. Good luck.

Cycler, thank you SO much for your thoughts.

There are several injured workers on this site from California who are being told they need fusions and a few of them are arthrodesis 360 (front and back) fusions. I am very concerned. I am aware of what has been going on in California work comp with spinal fusions. Patients in pain who are desperately looking for someone to "fix" them can become an easy victim, especially if they have been denied alternative therapies, testings etc as the patient above and do not have a good advocate to guide them. Many of the ortho surgeons who are known to be doing unnecessary fusions are also among the most used by WC applicant attorney's and they are sending their clients there.

Can you please advise what a patient in CA work comp system should do when their doctor has stated they need a fusion? Also, where can a patient find a good, ethical doctor (within their MPN ) who can review if the proper testings were done and also where to find a good physical therapist to guide them on core rehab techniques if needed?

The only thing I would like to add is what also can happen to the spine after a fusion, the discs above and below can be affected and in time many patients end up being told they need another fusion.

I am very thankful to you for taking the time to provide a response about fusions. Hopefully this post will help other patients who are researching this and see your comments.

Thank you.

 "California help"