Q: My primary physician assigned by my workman’s comp insurance submitted a report that I am P&S but the insurance company
Disagreed and sent me to see QME the QME said that he doesn’t see anything really wrong but I’m still in pain so he recommended epidural lower back I jections and a cortisone shot for my elbow also recommended I see a pain management Dr and chiropractor. It doesn’t make sense to me why he recommends all this treatment if he said he didn’t see anything really wrong. Won’t the utilization review want proof that this treatment is needed? I’m confused. My primary Dr requested epidural and therapy for my elbow before and they denied it.
A: Sounds like you let the Insurer pick the worst doctors in the world for you. How sad! But the damage is done. It may be that the QME found you are not at Maximum Medical Improvement until you complete a course of conservative treatment, so the adjuster will just OK the Requests For Authorization. Sounds like the Primary Treater found too much Permanent Disability and the Insurance Adjuster is fighting against paying that. YOU WERE IN DESPARATE NEED OF AN EXPERIENCED ATTORNEY before these two doctors were chose, but now you're 'married' to them. An experienced attorney can make certain you get the very most disability found in the TreatingPhysician's report, the one that made the adjuster pick a QME. Make certain you get an actual attorney, not the "TV" lawyers where a secretary handles your case and you never talk to your lawyer.
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