Reflex Sympathetic Dystrophy (RSD and CRPS) Reflex Sympathetic Dystrophy (Complex Regional Pain Syndromes Type I) and Causalgia (Complex Regional Pain Syndromes Type II)(RSD and CRPS)

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Old 05-14-2010, 04:22 PM #1
Kakimbo Kakimbo is offline
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Default 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
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Old 05-14-2010, 05:41 PM #2
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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.
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Old 05-14-2010, 11:41 PM #3
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Quote:
Originally Posted by kim ames View Post
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

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."
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Old 05-14-2010, 11:47 PM #4
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Quote:
Originally Posted by Dubious View Post
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."
Okay, here is a link that describes state by state, who uses what:

http://www.impairment.com/Use_of_AMA_Guides.htm

Hope this helps!
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Old 05-14-2010, 11:55 PM #5
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Quote:
Originally Posted by Dubious View Post
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."
Kim,

Here is what the link states for Maryland (if that is where you live):

"Eight states still commonly make use of the Fourth Edition (published in 1993): Alabama, Arkansas, Kansas, Maine, Maryland, South Dakota, Texas, and West Virginia. Two states use the Third Edition, Revised (published in 1990): Colorado and Oregon. Connecticut does not stipulate which Edition of the Guides to use."

The 4th edition is likely much more favorable for you. If this link is correct, then have your attorney investigate this. If the 4th edition is the presumption of correctness and is the commonly used guide in your state, then it would seem that you could have the defense report thrown out as the 6th edition has not been labled to be the trier of fact (Mike, help me on this!) for WC injuries in your state.
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Old 05-15-2010, 12:01 PM #6
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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..
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Old 05-15-2010, 01:42 PM #7
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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...
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Old 05-18-2010, 06:15 PM #8
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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?
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Old 05-19-2010, 02:47 AM #9
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Quote:
Originally Posted by Dubious View Post
Kim,

Here is what the link states for Maryland (if that is where you live):

"Eight states still commonly make use of the Fourth Edition (published in 1993): Alabama, Arkansas, Kansas, Maine, Maryland, South Dakota, Texas, and West Virginia. Two states use the Third Edition, Revised (published in 1990): Colorado and Oregon. Connecticut does not stipulate which Edition of the Guides to use."

The 4th edition is likely much more favorable for you. If this link is correct, then have your attorney investigate this. If the 4th edition is the presumption of correctness and is the commonly used guide in your state, then it would seem that you could have the defense report thrown out as the 6th edition has not been labled to be the trier of fact (Mike, help me on this!) for WC injuries in your state.
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.

Mike
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Old 05-21-2010, 02:24 PM #10
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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
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