I'm new to the Board, so please bear with my "story" and questions. Any guidance would be greatly appreciated :)
DOI: Feb. ' 06 (yes, I worked almost a year injured before filing a WC claim trying to resolve through my chiro and PT through my own insurance with no resolution - that's loyalty for ya!)
WC claim filed: 10-13-06
TTD since 1-8-07
37 y/o - secty
Current diagnosis: Right CTS; cervical sprain; cumulative/overuse/repetitve of my right upper extremity areas (neck, shoulder, trapizus, scapula)
T'ment to date:
Various Pain meds since claim filed
Mar. '07: addition of a TENS unit
Mar. '07 - Aug. '07: IC sporadically approved 22 PT sessions, and continuance of pain meds
Sept. '07: PTP referred me to a Pain Mgmt Dr.
Oct. & Nov. '07: 2 sessions of injections (TPI & nerve block)
This past week I received from my IC a request for a QME (and I have signed and mailed it in per its instructions). In the letter the IC states they're "objecting to my PTP's most recent report, more specifically they're objecting to my level of permanent disability, duration of TTD and/or the extent & scope of medical treatment."
My PTP office stated to me that the doctor's report is one page and simply states: I'm TTD; to follow up with PTP at my 12/24/07 appt; and continue with the pain management doctor I've been treating with.
I called my CA and asked specifically what they're disputing because my PTP is simply agreeing with my pain mgmnt dr who is requesting another session of injections (TPI & nerve block).
The CA literally stated to me that she feels my PTP doesn't know what he's doing; is relying to heavily on the pain mgmt doctor; and doesn't feel my PTP really has a t'mnt plan for me - - therefore, they're requesting a QME to resolve the dispute.
Here are my questions/concerns:
1. Am I going to get a "fair deal" from a QME? I have an uncanny feeling that while supposedly a QME is supposed to be unbiased, the doctor is going to do whatever will please the IC.
2. Does a QME truly take several months to book, attend and get a report? Because I've been TTD for almost a year already and from the message board it appears I'm going to have a problem with "disability income"? i.e., this whole confusing thing about EDD/SSDI and not qualifying because I've been TTD for so long...
3. Does a QME's report trump what my PTP feels my t'mnt should be and/or my diagnoses and/or how disabled I am? I believe it does, and then I'll have to do some WCAB procedure? And should I get an atty for this procedure to protect my rights?
4. Do I need to get a lawyer now rather than waiting for the QME results because waiting until then may put me dangerously close to this 104 week cut-off for disability benefits, and whatever the QME says is pretty much written in stone?
5. Can I go through my own insurance to see an ortho or neuro? I believe these WC doctors are missing something because my CTS supposedly shouldn't be causing pain, etc. in my neck and shoulder, yet being TTD for almost a year hasn't resolved the pain, or significantly improved my ROM in those areas.