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Old 11-01-2007, 08:10 AM   #1
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What is the PM doctors job?

I have been seeing a PM for about 16 mo now and so far he requested a tens unit which workman's comp let me use for a few months and took it back saying it wasn't for chronic pain and a multidisciplinary program which was also denied. All he will do now is write prescriptions. He will not even sit and talk to me and answer questions. I am so mad and hate going to see him but that is the only way I get meds. My surgeon requested a different pm but haven't heard back from WC but he said they will likely deny it. Do I not have any other options? Can you change WC doctors? I see no purpose to go other then meds. I am even the one who tells him what to try.

 
Old 11-02-2007, 09:44 AM   #2
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Re: What is the PM doctors job?

Hi back in the saddle, When comp cuts off pay and refuses procedures or treatment it's time to get a lawyer involved. This is their way of squeezing you into a crappy settlement. There is a lot a PM doc can do aside from prescribing meds. In fact you don't need a PM doc if that's all he is doing, Your GP can write a script just as easily. You do have the right to get another opinion in the comp system and there is certainly more that can be done than prescribe meds. It would have been best to get an attorney as soon as things turned advesarial or when you were unable to return to work when they wanted or expected.

My sugestion would be to get a true IME "independent medical eval" from a doc of your choosing. If comp is paying and it's a comp doc, It's not independent. If comp docs don't side with comp, they lose their lucrative contracts and steady referral of patients from comp. The more respected the doc you see for an IME, the more crediable the opinion will be be and the more likely comp will allow additional treatment. A dept head at a med school would be ideal and tough for a comp doc who works for comp, not you, to dispute.

Sorry your stuck in the system but a quick settlement just to get away from comp docs is a very short sighted solution. The meds alone to treat intractable chronic pain for one year cost more than comp will likely make in their first offer of settlement. You likely can contact your state ambudsman and the industrial commision and get a hearing to reinstate benefits and get aproval for additional treatment. Comp is counting on you doing nothing and simply going so broke you will take anything they offer to be done with this case and to have control over your own medical care.

This is really when you need a lawyer the most and there is a cap on what a comp lawyer can charge you. It's just a piece of the settlement, nothing up front or out of pocket other than your own outside opinion if you choose to get one.

Comp is playing a waiting game and it costs them nothing to wait while you loose everything you ever worked for. The only way to force comps hand is to prove they are denying you basic standards of care and you are going to have to get a non comp doc and likely an attorney to do that.

Good luck, Dave

Last edited by Shoreline; 11-02-2007 at 11:07 AM.

 
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Old 11-03-2007, 11:24 AM   #3
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Re: What is the PM doctors job?

Hi Dave thanks for all the information. Wish I knew more about this years ago when I started this ordeal. I do have an attorney and thanks to them I did just win against my WC insurance for my 3rd neck surgery. They denied that 3 times including the IMO so we went to the hearing officer and he sided with us. Now we have to wait and make sure that the city does not appeal that.

I work for a very large metropolitan city and there is no settlements with us. There is only medical for life (whatever that means). I will fight from now on for what I need. The deniel for the multidisciplinary program was over a year ago and I had no idea I could fight them. I didn't even tell my attorney about it since I didn't think of it. Now for the most part it is to late for much of that to work.

I chose my own PM who is with Baylor Hospital system. Wouldn't you think they would be good? Well, this doctor isn't. I want to go to a new one. I am going to go to a new one on my own and see if he thinks that the path we are on is all there is. I have to wait until this month sometime for this PM to take my insurance.

Sadly I have no idea what my future holds for me in regards to this chronic pain. I have been now going through this since 2002 and the worse of it since 2004. I am in the midst of deciding if I want to retire medically or not. My treating doctor says I should that my body needs to heal. The money is less then what I take home now and insurance is more. But I will have less in gas and childcare and time to heal and get back into some sort of shape. Right now I feel like crap every day and if i have a good day or so I completely go overboard trying to fit in everything I can't and then pay for it for days with horrid pain. Im only 44 and feel like 104. I hate it. I am scared though to make that committment.

I do appreciate your input and will try and get a IME with a different doctor soon. I am waiting to see if WC approves the one my doc has asked for me to see.

 
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