I was assign a medical case worker tomy workers comp claim. I had injured my shoulder on the job. I have been off of work for 5 weeks now! I...

Question

I was assign a medical case worker tomy workers comp claim. I had injured my shoulder on the job. I have been off of work for 5 weeks now! I was referred to a specialist...the case manager told the Dr.how long I have been outof work. The specialist now wants tosend me back to work w/o fixing problem! Can I drop my case manager and seek a second opinion from anouther Dr.?

Answer

CALIFORNIA LABOR CODE has no requirement you deal with any 'nurse case manager.'

They tell doctors what to write if the doc wants to stay on the insurer's good side.

YOU MIGHT BE ABLE TO SWITCH TREATING PHYSICIANS.

This one is useless, as he does whatever the non-doctor tells him to do.

PROBLEM: DID THIS 'insurance" doctor already write "PERMANENT & STATIONARY" ??

Does the PR-2 state Maximum Medical Improvement / MMI? or P&S ??

Then it's too late for another treater, you're sort of 'married' to this jerk treater doc.

IF HIS LATEST report says you are not yet MMI and not P&S (so still recovering), ONLY THEN CAN YOU SWITCH TREATING PHYSICIANS.

CHALLENGE: if you're not labeled MMI and not P&S, you must pick a decent doctor from this insurer's MEDICAL PROVIDER NETWORK. You should have an "MPN" Letter from the INsurer by now with the website.

Shoulders typically are evaluated by Orthopedic Surgeons or Physiatrists.

So you very quickly select a new Ortho or Physiatrist from that insurer's MPN... and CHOOSE VERY, VERY CAREFULLY.

Find one on the list who has good reviews online at Manta and Vitals and Healthgrades. Choose one with only one or two locations... the guys with 6 locations are typically friends with insurers, not too helpful to injured workers.

The BEST doc from the MPN would be one with a yellow-page ad that advertises he helps Injured Workers and people in great pain. The guys 'in bed' with the insurance companies have no advertising to reach individual people in pain... beware guys without details.

AND WITH THE NEW DOCTOR, YOU PUT IN WRITING HE IS NEVER TO SPEAK DIRECTLY WITH ANY NURSE CASE MANAGER or is violating your patient/physician privelege.

You fax the adjuster (save the fax transmission report) and carbon copy the Nurse Case Manager a short note you will never speak with any nurse case manager again and they are going to be kicked out of any medical appointment you attend for violating patient/physician privilege.

IF YOU HAVE BEEN DECLARED MMI OR P&S, and you're 'married' to the current treater, your only option is a Panel QME, which will take months and months and months...

Go on to www.dir.ca.gov , click on the workers comp tab... there will be lots of details about the QUALIFIED MEDICAL EVALUATOR.

A form gets mailed to the Medical Unit in Oakland, sits on a state worker desk for 12 weeks, then they mail you a list of 3 orthos... and then you schedule a visit with one of those three and the adjuster mails all the medical evidence to that guy on the list.

and if that guy on the list is a jerk, you're screwed.

So you see the main reason to have an attorney is for their expertise in selecting the right doctor from the Medical Provider Network and then from the QME list. You pick wrong, you get nothing.