db55/question for you

Author Subject: db55/question for you
Denise Posted At 12:54:05 07/13/2001
I'm having a little problem that maybe you can comment on. I worked for a school district when I was injured. Everyone has been doing just fine (with a few kinks) with my medical care and such, until I was referred to an ortho Dr. This Dr did a bad thing to my knee and mad it worse, and diagnosed a problem that was not consistent with my MRI report or with the trouble I am having. I spoke to my adjuster and told her about this, and asked if I could see someone else for another opinion. That was agreed to and an apptment set. I was so looking forward to getting some more experienced help, and someone who could tell me why my knee wasn't improving as expected and to figure out what is wrong. Imagine my shock when the doc came in, sat down, asked where the pain was, read the MRI report (MRI is read by the doc at the facility, as you know), asked me to walk (took about two steps...all he seemed to need). He then promptly decided there was absolutely nothing wrong with my knee. He hadn't even bothered to look at the MRI films hanging on the light board, or to physically test my leg. Didn't ask any questions about when it hurts or under what conditions.....I was in shock! I said to him, "There is SOMETHING wrong with my knee!" He sort of smirked and said there absolutely was nothing wrong with it. I asked how he could possibly say that when I had an obvious bulge sticking out of my leg from a swollen bursa (swollen for 2 months) and swelling around the tibia head, not to mention the pain (which of course is subjective, bt come ON). This all took about 10 minutes. His reply was that he would send a report to WC.

I was a little upset, because this exam sounded just like what I read happened at a IME, which was perported to be a way for WC to get out of providing care. I really did NOT think the adjuster was setting me up for denying a claim. I still am having a hard time thinking this, yet isn't that exactly what will happen, even though I have two other diagnoses? Should I call the adjuster and suggest that she not send anyone to this person anymore, because he is ripping them off? As far as I am concerned, he could have come to the conclusion he did just by seeing the MRI report, which is the only thing he went by. The MRI doc was not looking for anything specific,so wouldn't it be possible he missed something? AND MRI's are not 100 % accurate anyway. They are highly accurate, but not 100%.

So of course I am now worrying about what is going to happen. I'd like nothing better than to have absolutely nothing wrong with me (as would my children!), but it is just not the case.
db55 Re: db55/question for you (Currently 0 replies)
Posted At 19:52:47 07/13/2001

Denise...What state are you in? The IME/second opinion protocol are different in each state. I would suggest you call the adjuster and/or the
doctor and request a copy of the report he issued. Review it for any inconsistencies in the exam he gave you versus the report he wrote. Then tell the adjuster what really happened. They may not necessarily use this opinion to deny the claim especially if the mri results are inconsistent with the doctor's opinion. It is possible the MRI did not pick up your problem. This sometimes occurs when the problem area is behind the patella. Be patient and wait for the report. Then depending on your states statutes consider an IME or another second opinion. Was this last visit your or the carrier's choice of physician? To obtain more infor on your state's statutes go to www.workerscomepensation.com.
Hope this helps and everything works out for you.
Denise Re: db55/question for you (Currently 0 replies)
Posted At 23:23:29 07/13/2001

Thanks db55. The exam was at my request, but the adjuster told me they tried to find someone who was a knee specialist....they did choose the Dr. I'm in NJ by the way. I have tried to find things written about specifics on WC laws, but everything just seems to be generalities. Very frustrating. I would go for another opinion, but am worried that they don't have anyone on their list who will do a better job. Would it hurt my claim if I went to someone privately? I know some people in the medical profession who may be able to suggest someone.

I did ask the doc's office how I can get a copy of his report when it is finished, and they said I would have to get it from the WC office. No other doc's have said this to me. All the others have given me copies, so I was thinking this was pretty fishy too. Maybe he IS one of the bad IME doc's that people are sent to by the shady WC co's people on here talk about. He was just soooo quick, and soooo smug. Maybe my first doc spoiled me. He was very caring and interested in helping. It didn't seem like this last guy was used regularly by my co. The adjuster had to look around to find him I think.

I'll try to call Monday to see if the adjuster has the report. I did mark down the times and what happened after that exam, because I was so stunned by it.
db55 Re: db55/question for you (Currently 0 replies)
Posted At 08:34:54 07/14/2001

Denise...Your welcome. Go to that website www.workerscompensation.com to find the statute for new jersey. it also will list the rules and such. It is really very helpful. That is odd that the doctor would not give you a copy of the report but that is porbably par for the course with the way he treated you. It is possible if you go to a doctor on your own and it i not authorized by the carrier they could reject his opinion.
Hope all turns out good for you.

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