Patients routinely come in to his office with significant injuries, only to find out that the E. R. doctor diagnosed them with a contusion, which is a fancy name for a black and blue mark.
Still hurting six months later for this so-called bruise, most patients are at a loss, since there is not much in their favor for arguing why they can't return to work. Routinely, nurse case managers throw at them that, "you should be healed by now". And then this follows with them sending their, get this, "file" for a review!
Not sure when "file" acutally started getting hurt, but this is what happens at "the bureau". Naturally the bureau finds a "doctor" on their payroll who is more than happy to write a report based upon their review that, "they see nothing that would prevent the injured worker from returning to their former position of employment".
So how does a patient successfully argue this? There aren't many options, since almost all medical doctors won't treat a patient unless they have prior authorization. That simply means, "I won't see you unless I get paid". This arrogant form of "practice" is nothing new by the medical establishment.
That's where I can help. I know that the claim was probably mishandled from the beginning. That's why "your employer sent you to their doctor at the start". Even if you wen to your own doctor, chances are it was a medical doctor who spent 5 minutes with you and scribbled on a "note pad" a prescription for some useless pain medication.
When patients come to me with pain and claim problems, as long as they have a valid claim and some representation who will help me fight for them, we take the case. We don't need to be paid up front. If I believe we can win, then let's get you back on the road to recovery today.
That was the case with one of my patients. Diagnosed with a lumbar contusion from a slip and fall down a flight of steps onto the hard concrete surface below, I knew there was more going on. The claim had stagnated like this for 5 years. We got the MRI and I noted a slight disc herniation at the L5/S1 level that was protruding on the left causing pressure on the spinal nerve.
The patient complained of left leg pain, and this correlated clinically with the MRI findings. So, we accepted her as a patient in August of 2008. I submitted my documentation to get the disc allowed and of course it was initially rejected.
We knew that was coming so we filed an appeal. They then sent her to one of their doctors and of course he "couldn't see how this herniation was causing all these problems". He even had the nerve to say that "most people have this condition and are aymptomatic!"
So, we held our ground, waiting for the hearing at the bureau. When the time came, we were ready. Being an engineer as well as a chiropractor, I drew out a diagram labeling all of the forces that impact the spine from such a slip and fall. I explained how it was extremely probable for the mechanism of injury to create the disc herniation.
I related it to her current complaints. She also had a very good lawyer who found several pertinent contradictions in the "company doctors" reports.
Two weeks later, the BWC order came back stating:
BWC ORDER: It is the order of this district hearing officer that this claim be approved for:
L5/S1 disc herniation.
This was based upon the testimony of Dr. Larry Van Such and the argument that the employer had conflicting statements in their documentation.
Now the patient is able to receive the care she deserves as well as the workers compensation benefits that were being withheld.
We routinely go through this process. We are glad to help and quite frankly, we are getting good at fighting back for our patients.
Its a shame we have to go through this, but if that is what it takes, then so be it.
NEED HELP? Call us. We'll see what we can do for you.
(614) 428-9310
