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Impairment rating post ACDF Texas

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  • Impairment rating post ACDF Texas

    I am at a loss. I received a letter today from the Texas Workmans Comp to go to a designated doctor to rule if I had reached my mmi. I just had the surgery in February and am still having pain in my neck, shoulder, arms, wrists and hands. I am being referred to a pain management doctor and waiting for that now. How can they send me to a doctor who is not even the surgeon for a rating? Last time I was given a rating from my treating doctor and then they sent me to a WC doctor. I obviously have not reached MMI yet as I was told by two surgeons it would take 12-18m to reach max improvement. I plan to return to work next month. I wondered if anyone knew what the WC rule was. I do no that 2 yrs post injury date is when they want the mmi and I am that however I did not have the surgery 2 yrs ago.


  • #2
    Independent exams to evaluate progress and determine if a consult to a specialist such as pain management is a perfectly normal part of most claims. In order to be an independent exam it would have to be with someone other than your treating physician.

    I don't know what other claim you are referring to, nor why it might have been handled differently, only that what you describe is very common and not cause for concern. Just go to the exam and be honest about your condition.
    I post with the full knowledge and support of my employer, though the opinions rendered are my own and not necessarily representative of their position. In other words, I'm a free agent.


    • #3
      Thanks EllenMD. I am always honest with the doctors as I do understand how much dishonesty has and does go on with WC and disability. In my profession I have seen many so called disabled people fully capable of work. Anyhow my first claim was after a posterior decompression surgery I had in 2003 from a fight at work. I still had residual pain and limitations and was rated 15% by my treating doctor and the WC doctor dropped it to 5%. According to the rules of impairment ratings the WC doctor did not use the correct form and ruled my surgery as minor. My doctor disputed the claim on her own. Still pending. I fear another WC doctor only interested in WC and not the injured party. I was referred to a pain management doctor almost 3 weeks ago and have been calling back and forth to see what the status is and have not been informed that WC denied it or now. May be the case. I have a call into my surgeons office who is checking on it.

      That said my doctors PA told me that they would not recommend a rating at this time and that I am not at max. improvement. I was told my WC that if the doctor turned in a MMI before the designated doctor then they would use it. I am planning on returning to work in a few weeks. I need and want to return but do not know how or what I will do if I do not get any medication to resolve or help resolve the neck to finger pain. This is nothing new from shortly after the second accident.

      A response to your response on another thread. Stenosis was caused by the accident. My prior MRI did not show it. The one following it did. I had both a herniation and a bone spur centrally located. Not sure if it is just a difference in words.


      • #4
        Stenosis itself is a degenerative condition. It may have been asymptomatic before the accident, but it couldn't have been caused by it.

        A difference of 10% isn't unsual and in fact is fairly close in the world of WC. While there is a formula, there is still a large subjective component which accounts for the differnces. I'm not sure what you mean by "My doctor disputed the claim on her own." There isn't anything for a doctor to do other than render their opinion.
        I post with the full knowledge and support of my employer, though the opinions rendered are my own and not necessarily representative of their position. In other words, I'm a free agent.


        • #5
          Hmm guess I will just have to differ with you on it being congenital. I never had hernations and bone spurs in that region before. I have had plenty of MRI's from the prior injury to show that. I do know that some spinal canals are narrower then normal and that is congenital. But having two areas poking inward causing central stenosis is not congenital. At least not according to my Neurosurgeon and Orthopedic Spine Specialist who did my second surgery. I have no other areas with stenosis. I do have other areas with arthritus and herniations that appreared after the first injury.

          Texas has the worst WC ratings around. There are many cases fought over the low ratings you receive in Texas. According to the guidelines regarding cervical surgery my first surgery was not a minor surgery. Who knows I will let my attorney and WC fight that one out.

          All I know is I had a very physical job considering car accidents, fights and foot chases and all that goes along with it after 17 years on the streets. I know I did not have any neck issues prior to the 2002 injury. I was told at that time that the disks above and below would become weaker and likely need treatment down the road by my NS. He was right.


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