Defense IME giving me a hard time
 

Hi Everyone.

I recently had my IME from both my attorney's doctor and one from the defense. Our doctor gave me a permancy (sp?) rating at 50% left leg and 10% lower back.

Defense doc gave me only 3-5% left leg and 0% lower back. my attorney is very troubled by this, as most ratings are usually only about 10% different. She told me that the defense doc does agree that I have RSD, but doesn't think it should be rated any higher. He also stated that PT won't help me anymore.

I know that our doc used the 5th edition while defense doc used the 6th.

Do any of you have any knowledge/advise on this? The rating was done in Delaware. Our hearing is scheduled for early August. fmichael.....I know you have vast knowledge on this.

Thanks in advance.

Kim

Here's an interesting article for you to read.

http://www.nytimes.com/2009/04/01/ny...p.html?_r=1&hp

If you have a WC claim, check out the WC forum here as well.

I was not aware that any states were using the 6th Ed. yet. The current mandate in most (if not all) states is the 5th edition. Presumabably you have a WC case; you need to find out which edition your state's WC goes by. Very likely, the 6th edition is less kind chronic pain patients...

The exact name of the text is "Guides to the Evaluation of Permanent Impairment."

I think a lot of it comes down to how the IME "doc" wants to interpret your symptoms & pain levels....:(

Does your atty have any info on that doc - ie: does that doc usually make reports stating very low impairment ratings?

if so that would be a major point to dispute - of course if pressed the doc could say it was a typo or the report was written up by another and a mistake was made that way..

Thanks everyone.

Jo*Mar - my attorney is not familiar with the defense doc. She is calling our doc to see if he can sway things a bit. I don't know what that will do, but I'm in a pickle if something doesn't change. Crossing my fingers.....I guess we will just have to fight at the hearing. Can't wait...

So,

Went to get meds last week and found out that they denied me again. (usually every six months). Well, today I received a letter from my atty. that w/c feels that I am able to return to work! YEAH, RIGHT! I will still collect my paychecks (thats what they tell me anyway). Hmmm, went to defense IME a few weeks back...but, I'm sure he would not do ANYTHING to hurt my case....

I need Rrae's exploding smily!!!!!

What the heck?

Kim, it sounds like WC got their copy of their 'IME' report and decided to try to cut you off. It seems strange that they are denying treatment/meds. Long before this injury, I had several instances of straining my back at work. Missed a few days of work and started with chiro visits. Quickly back to work and WC cont to pay for the chiro visits.

Is your lawyer SURE WC isn't going to file to deny or lower your pay ?

Hi finz (to the left...).

In the letter from my attorney it stated that my weekly salary would not be interrupted. There is a secondary fund for w/c in the state of Delaware that kicks-in for cases like this. All I know is that I've spend over $300.00 in the past week for meds. (After going almost 5 days without them). Withdrawals, sick to death, shaking so bad that I couldn't call the doctor...etc. I hope to get the money back; but I would really like just to maintain. I don't want to convulse (sp?), I don't want a heart-attack. I don't want to scare my kids to death. I just want to have everyone be honest and own up to their responsibilities.

We do have enough in our savings to hopefully cover this (we planned for this). I just don't understand why it is such a fight...It seems totally irresponsible for the medical profession to let this happen. I want to write a letter to the AMA and turn these people in.

Thank you and everyone else for your encouragement. Hope all is well with all of you. (Sorry, I am usually much jovial than I am now...).

Kim

Dubious -

Never knowing anything about WC (except how lucky I was not to have been injured at work) and no longer being actively engaged in the prectice of law, I can make only limited comments.

First, as a purely technical point, it's the hearing examiner rather than any particular edition of the Guides to the Evaluation of Permanent Impairment that is the "trier of fact." But what the Book does is establish the standard under which claims are to be evaluated. Thus, if in fact, by law or regulation, a state has adopted the 4th edition as the standard, and the IME relies on another, the proper objection may be one of relevance, as in, "that's nice, but what application does it have to this proceeding?"

More importantly, if there are significant divergences, they should highlight to the trier of fact (or any reviewing panel) that the IME was pulling a fast one. That said, it's always better practice to raise and thereby "preserve" objections at the time of the hearing. And basing an expert opinion upon inapplicable standard is about as good as it gets when it comes time for impeachment of the witness. Especially if the claimant's attorney can get the IME to read from the edition which is in force in your jurisdiction, and acknowledge that the two standards diverge. At which point the blade is thrust by asking why s/he chose to use the inapplicable version. :D

Mike

This is what I know on how wc works because I have fighting wc ever since 2003,I had a hearing on April 15th this year again and now waiting to hear the verdict again. We settled out of court in 2007 with an open file and wc renigged on what they said they were going to do so we had to take them back to court again. Wc likes to pick the crumiest docs they can to make you look bad. I should know I have gone to a few of them and there reports are very bad.They try to say that I am exagerating and that I do not have rsd. They are very manipulative. It may take years for you as well but it may not.It all depends upon how hard you are willing to fite because wc will try to pull all bad strings and they will be watching you and hope that you give up. I have been fighting since 2003 and I have not given up yet. I refuse to because this disease has turned my life upside down and I won't let them win. This disease has cost us a lot of money over the years but I keep turning my receipts over to my attorney and in the end will get back every dime we have put out for my rsd. The one big thing you want to keep in mind while fighting wc is NEVER let them close your file. As long as they keep your file open they have to pay for your meds and medical bills for the rest of you life. It is a long road to fite but you are a strong person and you can beat them at there own game. I have been fighting for a long time and I am not about to give up until I win. Good luck with everything. If you have anymore questions and want to pm me you are more than welcome to do so. Good luck on you quest to beat the wc!May God bless you and be with you the whole fight thru.

Sincerely,
Tracy

I completely agree with Screwballpookie. The kind of stuff mentioned is very similar to the stuff I have been referring to in my other posts.

My workers comp / disability fight took almost 8 years. It was intentionally dragged out in an effort to get me to quit out of frustration, and to make my legal bill so large that I would not be able to keep fighting.

Some of the endless dirty tactics that I have seen are “losing” paperwork despite my sending it in 3 times, each time with a return receipt.

Taking a multiple page medical report that obviously supports my claim, and ignoring the entire report except for one half of one sentence, and taking that half sentence totally out of context to try to make it seem like it is contrary to my claim.

Ordering me to take an IME, and scheduling me with a “hired gun” doctor that they were going to fly in from another state (despite there being dozens if not hundreds of qualified IME doctors in my area), because he was guaranteed to deny my claim no matter what evidence I had. On top of that, this doctor specialized in something that had absolutely nothing to do with my CRPS condition.

Without constant (and expensive) intervention by my lawyer, I would have certainly been denied my highly documented, extremely obvious, legitimate workers comp / disability claim. There was no justification for how I was treated except to try to get me to “voluntarily” drop my legitimate claim.

God Bless You All.

Bernclay- :holysheep:

IME docs are the worst. I try to keep a positive attitude that they are just "doing their job" but at times it is hard to believe that they are actual doctors and I wonder how they can actually live with themselves. I have been forced to have many IME's during the course of my disease (over 8 years). One was an OB-GYN who was doing an exam for RSD, one doc offered me a positive report for certain 'favors' and a psychologist who saw me fro depression that I had to see for a second time several years later, after he wrote a report that I did not have depression, the last time told me he saw no change in my depression since he wrote the last report! Many reports, C-9s and other paperwork have been lost over the years, along with partial treatment requests (how can you have a partial surgery). This system is a joke, and when you combine it with a self-insuring employer it becomes a nightmare. I have been waiting 6 months for a decision on a SCS, and my lawyer has had to file numerous objections and other things. Well, thanks for letting me vent, I guess I must just be in a mood tonight, Thanks all Lisa