RSD MMI impairment changed

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Latest post 03-05-2007 3:53 AM by Allen the sleepy. 1 replies.
  • 03-02-2007 2:24 PM

    RSD MMI impairment changed

    I had posted my story in another thread but it's been closed, so I letting everybody know what happened. Since the end of Dec. 06 I have been trying to get the MMI doctor who was appointed by the state to change my MMI rating. Finally yesterday I got a letter in the mail from the TWC saying the doctor had changed his report for me and rated the RSD and gave me a 16% impairment. The first time he only gave me 4% and said the RSD wasn't rateable. You would have to read the old thread I posted. So I thought everything was great until today TWC called and said the insurance company is refuseing to pay and don't agree with the new MMI rating and also says that my RSD is not caused by the on the job injury. The never disputed it until I saw there doctor mid Jan 06 and his report said I was 100% healthy and I never had RSD and didn't need knee surgery. So now what's next. TWC said my doctor needs to send medical evidance to the issurance company and I need to request a hearing. The issurance has had all the medical info avaliable to them since day 1 from both the pain management doctor and the Othopedtic doctor(my treating doctor). What do I do to get what is owed to me? Also the company I work for finally let me go saying I missed to many days under their rules(can't be out no longer than a year) . I had a work release back in dec 06 to return to full work but still had to be treated for RSD and the company should know that I still have RSD. Also they would never give me light duty even though I could do light duty. In my company rule book it clearly says we return injuried workers back to work by doing light duty or full work release. The company also told me they went a head and used my family medical leave act for me. I never told them to do that. My dad seems to think I might have a discrimination lawsuit along with wrongful termination. My dad says that they terminated me even though I had a full work release before it become to be I was out a year because they knew I still had RSD and didn't want me to return , so they keep stalling me telling me they where looking for me a spot on a crew till I hit my year mark giving them the right to terminate me under their rule(which I never seen any manual or workers book) Thanks
  • 03-05-2007 3:53 AM In reply to

    Feedback [*=*] re: RSD MMI impairment changed

    You have several issues.

    Concerning the 16% impairment rating:
    The insurance company has the right to dispute the impairment rating. You have the right to ask for a hearing. The hearing officer is the "finder of facts". The hearing officer will hear arguments from you and the insurance company's attorney and will review all the medical records and the DD findings. Then will decide which impairment rating is correct.

    You and the insurance company both have the right to appeal the hearing officers findings to the appeal panel. The appeal panel will decide if the hearing officers opinion is correct.

    You and the insurance company both have the right to appeal to a court to reverse the appeal panel's decision.

    Since January 1st, the DD has additional duties including extent of injury.

    You and the insurance company have the right to request a DD exam to determine the extent of the injury. You might want to consider doing this.
    The DD opinion has presumptive weight unless the great weight of the medical evidence is against it.

    The insurance company will send your records to a "chart reviewer" (I have another name but it is not nice). The reviewer will write what ever the insurance company wants. Remember they work for the insurance company.


    If the reviewer did not exam you insure he is asked if he examined you. Get the "no" in the records.

    If a physician assistant shows up, ask if he is a licensed physician. Ignore all the experience he has (it is comendable that he was a medic in the army and went college on the GI bill, and worked during college, and volunteers at the animal shelter, and doesn't mean a thing concerning your case).

    Get into the records that he is a PA and not a licensed physician. You may have to ask him specifically if he is a doctor of medicine or a doctor of osteopathy.

    Some PS's think they are licensed physicians. Don't get buffaloed. Don't get angry at a hearing, just get the facts into the record.

    If the insurance company doctor did not exam you, point that ouit at all hearings.

    If an insurance company doctor does exam you, take your treating doctor with you to the exam. You have that right and the doctor will be paid for attending. You need to do this so your doctor can report at a hearing if the examination was complete. It won't be unless another doctor is there. Insurance company doctors are so good, they can do a full history and physical examinations in five minutes or less and while talking of the telephone.

    Having your doctor report that at a hearing in front of the insurance comapny doctor and attorney gets everyones attention.

    Your employement issues are not in the scope of the Division of Workers Compensation. Texas is an 'employee at will' state. The company can end your employement for any reason not forbidden by federal law.

    If your compnay violated it's own rules, contact the human resources department and file a greivance.

    I do not know if RSD is a condition that is covered by the federal disability laws. If it is you may also have a case. It might be particuly if you were issued a disable parking permit.

    I am not a lawyer, so I cannot give any legal advice, these are just my opinions based on going around the block a couple of times with workers comp issues.

    The DWC has an Office of Injuried Councel (an ombudsman program). If you do not have an attorney already on your case, call the field office handling your case and ask to talk with or see an ombudsman. They will help guide you through the DWC maze.

    Has your treating doctor done an impairment rating. If he/she is not impairment rating certified, you may want to have him/her do a referral to a doctor who is impairment rating certified and have a third impairment rating determined.

    Right now, a hearing officer has only two options, 4% and 16%.

    Don't get discouraged, keep working the system.

    If you use an omudsman, ask if there is any other DD examination that needs to be done in addition to an extent of injury.

    Expect several months delay as your case works its way through the system.

    Did the DD reexam you or use the previous findings. Can a case be made that you were not at clinical MMI; ie, that your condition was not stable on the day of the DD exam.

    Are you at/near statutory MMI? That is 104 weeks after you start drawing benefits.

    Good luck. Allen
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