Predesignation is still possible and highly encouraged. Once the City decides to implement a Medical Provider Network (MPN), you will only be able to seek treatment from a network of “Employer Chosen” doctors, unless you predesignate. The predesignated physician must have your medical history, have treated you in the past and agree to be predesignated. A Predesignation form needs to be filled out, signed and provided to your employer.
- Can I still predesignate my personal physician?
- What are these new “medical provider networks,” and when do they go into effect?
- My date of injury is March 12, 2004, and I’ve seen my chiropractor 11 times already. Do these visits count toward the 24 visit cap?
- My date of injury is Dec. 19, 2003. Do the limitations on chiropractic and physical therapy visits apply to my claim?
- I was injured on April 29, 2002, prior to the enactment of SB 899. Does the 104-week limit on temporary disability payments apply to my claim?
- What is the new permanent disability rating schedule (PDRS) and what cases will be affected?
- How else was my permanent disability affected by this bill?
- Does SB 899 change the medical evaluation process for employees not represented by an attorney?
- Does SB 899 change the medical evaluation process for employees represented by an attorney?
What are these new “medical provider networks,” and when do they go into effect? Top
Medical provider networks (MPN) may be established by employers on or after Jan. 1, 2005. The City has not yet implemented a network. When the City implements an MPN, the network will consist of physicians chosen by the City to provide treatment for a work related injury. These doctors will also be rendering opinions regarding your ability to return to work, full duty or light duty. If the City uses an approved medical provider network, covered employees would receive their medical care in this network, unless a predesignated physician is chosen prior to an injury.
My date of injury is March 12, 2004, and I’ve seen my chiropractor 11 times already. Do these visits count toward the 24 visit cap? Top
Yes. The limitation on chiropractic visits applies to dates of injury on or after Jan. 1, 2004. In addition to the chiropractic treatments already received, you still may have the right to seek physical therapy or occupational therapy.
My date of injury is Dec. 19, 2003. Do the limitations on chiropractic and physical therapy visits apply to my claim? Top
No. The limitation on chiropractic and physical therapy visits apply to dates of injury on or after Jan. 1, 2004. However, the American College of Occupational and Environmental Medicine’s (ACOEM) guidelines for medical treatment apply, regardless of the date of injury. The ACOEM guidelines are very conservative. It has become increasingly difficult to obtain on going chiropractic care, physical therapy and occupational therapy beyond the 24 visits, even when the injury occurred before Jan. 1 2004.
I was injured on April 29, 2002, prior to the enactment of SB 899. Does the 104-week limit on temporary disability payments apply to my claim? Top
No. The 104 week cap on temporary disability payments applies to injuries that occur on or after April 19, 2004. It is very important to remember that you only have TWO years of temporary disability from the first day of Temporary disability used. If you are off work immediately after the injury for a period of time, go back to work, then need surgery two years later, you will not be entitled to use TTD, nor sick time, and will be off without pay.
What is the new permanent disability rating schedule (PDRS) and what cases will be affected? Top
The new PDRS was adopted on Jan. 1, 2005. The statute states that the new schedule will apply to any case, regardless of date of injury, unless a comprehensive medical-legal report was issued, a treating doctor’s report indicating permanent disability has issued, or the employer has issued a notice regarding disability at the time of last payment of temporary disability. The new schedule is based on the American Medical Association (AMA) guidelines. These guidelines are very conservative. They are based on objective findings, such as an MRI or EMG. For example, if you do not have loss of range of motion, or a positive MRI, but do have back pain, you can end up with very little permanent disability, as the schedule only provides for a maximum of 3% disability for pain.
How else was my permanent disability affected by this bill? Top
Apportionment — how an injured worker’s permanent disability (monetary award) can be reduced due to a prior award or condition (industrial or non industrial) — was modified by SB 899. All permanent disability reports must discuss what portion is due to the work injury and what portion may be due to non work related factors. For example, with a specific injury resulting in a herniated disc with degenerative joint disease (DJD), a doctor may now say that the DJD was in part due to the aging process thereby reducing the City’s liability for permanent disability, even though you never had symptoms until the work related injury. The bill also establishes a presumption that any prior award of permanent disability exists at the time of any later injury. If you had an award in 1990 for a back injury, rehabilitated, continued to work, and in 2005 have another back injury, the City can still reduce any potential new award of permanent disability by the old award.
Does SB 899 change the medical evaluation process for employees not represented by an attorney? Top
Yes. After the injury is reported, the City still has 90 days to investigate the injury and make a decision whether to accept or deny the injury as work related. However, the City cannot schedule you to see one of their doctors; they can only offer you a Qualified Medical Evaluator (QME) from a panel of three evaluators provided by the State. When requested by the City, there is a ten-day time frame for the injured worker to submit the “Request for QME” form to the Division of Worker’s Compensation (DWC) Medical Unit. The “Request for QME” must indicate the QME specialty requested. If the unrepresented worker does not submit the “Request for QME” form to the DWC Medical Unit within the ten day time frame, the City may submit the form and choose the specialty of the physician for the unrepresented worker. Within ten days after the DWC Medical Unit issues a panel of three QMEs, the employee has ten days to select a QME, make the appointment and communicate the information to the City. If the employee fails to meet these time deadlines, the City may choose the QME and the date and time for the appointment for the injured worker. This process can make or break your case. If you or the City chooses a doctor who is not familiar with the various presumptions afforded to safety members, you may receive a very unfavorable result. Once you select a QME, and later seek the assistance of an attorney, your attorney will not be able to obtain another QME. Your attorney will be bound by the findings of your QME.
Does SB 899 change the medical evaluation process for employees represented by an attorney? Top
Yes. However, the QME panel process for represented injured workers applies to injuries occurring on or after Jan. 1, 2005. If the City is disputing the injury, the City and the attorney must try to select an agreed medical examiner (AME). If no agreement is reached within ten days, either party may file a “Request for QME” form with the DWC Medical Unit. The DWC Medical Unit then issues a panel of three QMEs, the parties can agree upon a QME selected from the panel to serve as an agreed medical evaluator (AME) or strike one name from the panel of QMEs. The remaining QME shall serve as the medical evaluator.
