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 08-10-2012, 07:22 AM #1
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Default Getting wc to pay for spread?

Ok. PM confirmed spread to left foot and stomach issues are probably from medications, only way to tell is to come off all my medications and i am not willing to do this.

So how do you get workers comp. to pay for and start treatment on spread? Any ideas is greatly appreciated.

Thank you
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Old 08-10-2012, 07:34 AM #2
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Only way I know of is to get the doctor's report that confirms spread and have your lawyer ask them to start paying for it. If they don't then take them to court with the report from your doctor and ask them to order work comp to start paying for it. They should because if not for your work accident you would not have RSD and therefore it would never have spread. So it's all related and should be covered.

My experience has shown me that the most likely scenario is having to take them to court about it. They may even want to send you to an IME (though if they just sent you to one recently then I don't know if they will be able to) to see if their doctor agrees with your doctor's assessment.

Good luck. Definitely start the process as soon as possible just in case it takes a while to get those approvals.
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Old 08-10-2012, 01:14 PM #3
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My treatments for spread are really the same as for my original sites. Ketamine! And the WC insurance company has been awful about just about everything to do with ketamine, which is so ironic because if it wasn't for ketamine I wouldn't be where I am today (back to work FT and doing a whole lot of things I never dreamed I'd be doing several years ago)!!

What does your PM doc have in mind for treatments?

Good luck!! Lidocaine infusions and ketamine infusions helped me more than anything else.

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Old 08-10-2012, 02:26 PM #4
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If you have already settled with wc on the original injury you may have an extremely difficult time getting them to pay for any spread.

Work Comp laws vary greatly from state to state!!!

I highly recommend talking with your attorney.

I wish you the best.
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Old 08-10-2012, 07:28 PM #5
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I sent my attorney an email yesterday. NO word. Dr. says we are going to do more lsb's for original foot, but says it is going to be difficult to get wc on board for 2nd foot.

so I guess it is a waiting game for the attorney. Oh! my IME went ok. The dr. agree'd to all my medications. (1/2 of which wc has not been paying for.)
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Old 08-14-2012, 10:53 AM #6
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Got copy of my IME report. Dr. agrees with rsd dx but letter from wc states my pm is not certified. I have been seeing my pm for well over 2 years with no problems until now. I can't stand it. Any suggestions?
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Old 08-14-2012, 10:43 PM #7
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Quote:
Originally Posted by alt1268 View Post
Got copy of my IME report. Dr. agrees with rsd dx but letter from wc states my pm is not certified. I have been seeing my pm for well over 2 years with no problems until now. I can't stand it. Any suggestions?
You really are behind the eight ball. Most states follow the AMA Guides on Disability and/or the ACOEM Guidelines. Neither are sympathetic towards RSD/CRPS and the rules are written in thier favor. Your best bet is to aggresively treat according to your WC attorney's network of docs then hope and pray for an opening created by the industrial carrier where they have violated code, in some manner.
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Old 08-15-2012, 01:36 AM #8
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Definitely work with your lawyer on this. WC has a way of trying to wiggle out of things...often with lies and half truths. I don't know the laws in your state but your lawyer can help you navigate this. A lot depends on whether or not you are allowed to choose your own doctor and what the rules are with that.

Also important is what the laws were when your injury occurred. For example, in IL when I was injured the law was that the injured worker got two choices of their own doctors. Now the law is one choice AND you have to choose from a list of doctors approved by work comp. In my case, even though the law has now changed, the previous law is what applies in my case (or would if I hadn't settled). Work comp tried to tell me on a number of occassions about the NEW law (so did MY lawyer but he was a jerk trying to bully me) but in my case the old laws still applied.

So you really need to rely on your lawyer for this and I hope they are good and know their stuff. The laws vary so much from state to state and you really need an expert.

But the good news is that the IME report agrees with what your doctor said. They have no good reason to deny treatment. Your lawyer should be able to petition the courts to have treatment ordered if that is the issue. Better to do it sooner rather than later. Often all it takes is the scheduling of that hearing for work comp to do what is right.
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Old 08-15-2012, 07:23 AM #9
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spoke with Atty. He says just because he is not certified in my state does not mean I can't see him. On the other hand, it may be a fact that my pm will have to accept my state payment and not the other state.

If I am forced to switch I will really be ******, because my wc law says I can choose who I see. But I am glad about the medication being resolved. I have 5 medications they aren't paying for. now they are paying for 2 more. Yeah!
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