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Injury Doctors Blog

This blog contain information for personal injury, workers injury, chiropractic care, and DOT exams.

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Workers’ Compensation Maximum Medical Improvement Errors

work injuryMaximum Medical Improvement (MMI) occurs when an injured employee reaches a state where his or her condition cannot be improved any further or when a treatment plateau in an injured workers’ healing process is reached.

However, many patients are placed at MMI ahead of when they should be and as a result the amount of treatment they receive is limited by this decisions. Many their treating doctors later realize the diagnosis is incorrect but they Workers’ Compensation process do not know the well enough to correct the previous decision.

How do treating doctors make this mistake?

Workers’ compensation guidelines are complicated for most, and many treating physicians do not know the process of how to progress a patient through care. Workers’ compensation rules are much different that rules for regular private insurance and many physicians office do not deal with enough injured workers to fully understand the workers’ compensation process. Additionally, workers’ compensation guidelines change frequently and physicians don’t have the patient volume to justify staying up to speed with the new regulations. For this reason many physicians don’t treat work injuries and often instead choose to pass patients to clinics such as ourselves at San Antonio Pain and Injury Workers' Compensation Doctors who specialize in treating injured workers.

What is the impact of Workers’ Compensation Maximum Medical Improvement Errors?

Workers’ Compensation cases are time sensitive. If a treating physician can’t get a patient into the proper program to fit the injured patient’s injury, insurance companies can deny any request for therapy.

Often the patient loses a much of their treatment time because they don’t realize the worker’s compensation forms were incorrectly completed. The treating physician and patient must wait for the denial to be received and then figure out what they did wrong to resubmit for care. This creates a gap in care. Gaps in care are detrimental to a workers’ compensation case. Insurance companies and independent medical examiners use this gap in care to convince Texas Division of Workers' Compensation into thinking that the patient no longer needs therapy or help. If the gap is significant or long enough, the patient runs the risk of missing their window for help through the Workers Compensation system.

When a designated doctor sees this gap in care and there are no more requests from the treating physician for care, the designated doctor sees this as a patient being well enough to return to work or determines that too much time has passed for a patient to benefit from any care at that point and the patient may be placed at maximum medical improvement incorrectly.

When this happens, inexperienced treating physicians accept the decision and the patient is either forced to return to work with their injuries or the patient is unable to return to work within a timely fashion and loses their job. This is unacceptable.

Correcting Workers’ Compensation Maximum Medical Improvement Mistakes

Luckily for those patients, our physicians at San Antonio Pain and Injury Workers' Compensation Doctors won’t accept an inappropriate MMI decision. We have the experience and the success of fighting claims that have been inaccurately determined to be at MMI. Many patients come to us for workers’ compensation second opinions and many times we have helped them receive the care they need.

If you feel that your claim was inappropriately placed at Maximum Medical Improvement, please contact us today at San Antonio Pain and Injury Workers' Compensation Doctors 210-446-5115 to help get your case back on track and receive the help you need.

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Workers’ Compensation - Extent of Injury

workers comp doctorWere you injured at work and sent to a clinic the company recommended, only to see a physician who had no interest in your case, diagnosed you with an injury that does not match the symptoms you are experiencing and then told to go back to work with restrictions or worse, full duty? If this is what has happened to you, you may not be receiving the treatment you deserve for your work injury. If you feel your physician has not properly diagnosed your workers’ compensation injury it may not be too late to get your case fixed, call our San Antonio Workers’ Compensation Doctors today to schedule a free consultation to discuss your situation.

Many workers’ compensation patients are misdiagnosed

Often patients are directed to high volume clinics that have agreements with the employer or insurance carrier in order to get the patient evaluated right away and diagnosed with the lowest possible injury. This favors the employer and the insurance carrier, but not the patient. In Workers’ Compensation the initial diagnosis of a case is crucial to the type and amount of care you will be entitled to receive. In Texas, you have the right to see any physician you want to see for your injury, especially when you first get injured on the job. However, if you are with a company that has an In-Network Policy (making your injury an In-Network Claim), you will be told that your care will only be paid for if you see a physician within their network. If you wish to see a physician outside of the employer’s insurance network you will often be required to pay for care out of your own pocket. While it will cost you some of your own money, it may be the best choice for your care because your initial visits will set the tone for the rest of treatment. Employers and insurance carriers may tell you cannot choose your own doctor because they want to send you to doctors they have favorable relationships with, but the pages of the Texas Department of Insurance state you can see your own doctor.

Selecting the best physician for your work injury

Seeing a physician of your choice, especially at the beginning of your care, may be the best choice you make for your case. Call us today to request a free consultation regarding your injury. We have physician in many workers’ compensation networks, and even if we do not have a physician in your network, we will ensure that you get the proper diagnosis for your injury from the start.

Our physicians can help you petition Extent of Injury workers’ compensation review

If you have already been seen by a physician who in your opinion has given you a diagnosis that does not accurately describe your symptoms, we may still be able to help you. We can petition for you to start a process in which your injuries can be re-evaluated by a state workers’ compensation Designated Doctor and have your diagnosis codes updated to match your injury so that you can get the care you deserve and are entitled to. This process is called Extent of Injury and the purpose is to get your correct injury or injuries recorded and added to your case. This is very important because it will determine the type of therapy and amount of care you can receive in order to get you back to pre-injury status. As an employee injured while performing your required duties, it is the responsibility of your employer and their insurance carrier to get you back to where you were before you got injured. If you feel that this is not being done and your treating physician is no longer helping you, you must act quickly. Workers’ Compensation injuries are time sensitive. Schedule a free consultation today with one of our San Antonio Workers’ Compensation Doctors or experts to review your case and ensure you are on the right track by calling us at 210-446-5115.

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A beginner’s guide to Workers' Compensation – Notifying your employer and filing a claim

workers compensationYou have been injured at work. You can’t perform your normal work activities because of your injury or you are in constant pain when you work.

Now what? Who is going to pay the bills? What can I do if I can’t work? Will I be fired? These are the first things that go through the minds of many patients who have been injured on the job.

Workers' Compensation cases are time sensitive and the details of the process are important. If you don’t start your claim off properly, it will affect you and your benefits.

Step 1. Notifying your employer of your workplace injury

You must report your injury to your employer within 30 days from the date of the injury, or from the date you knew your injury or illness was related to your job. Fill out any necessary paperwork related to your claim with your employer right away. Make sure write down who you spoke to and the date and time. We are aware of many cases where an injured worker informs their managers, but does not document the conversation or perform any paperwork and several weeks or months later, the managers have no recollection of the conversation or the meeting. If possible follow up any conversation with an email confirming the conversation and capturing the details of the discussion. This is also a good time to get a folder and begin filing anything related to your injury and case.

If you do not notify your employer within these 30 days, you may lose your right to obtain benefits.

Step 2. Filing a claim to the Division of Workers' Compensation

You must send a completed Employee's Claim for Compensation for a Work-Related Injury or Occupational Disease (DWC Form-041) to the Texas Department of Insurance’s Division of Workers' Compensation (TDI-DWC) within one (1) year of the date of injury to protect your rights. Candlewoood Pain and Injury Doctors can help you with this form, as it can sometimes confuse first time patients. It is important to fill out the form correctly the first time or it will get rejected weeks later when it is reviewed by the Division of Workers’ Compensation. Any errors will require re-submission and will delay your case. This will delay your ability to receive treatment from physician and get the services you need. The sooner you can get these basic steps taken care of, the better your odds will be of having your case accepted and your treatment approved.

Once we have taken care of these first 2 steps, you are on the way to having your claim approved and getting the help you need to get better. Very little can be done for you until you have first reported your injury to your employer and the Texas Department of Insurance’s Division of Workers' Compensation. If you have not reported your claim please make it your priority, if you need help with the process please Candlewood Pain and Injury Doctors a call at (210) 446-5115.

Do not be afraid to report your injury to your employer. You are protected!

It is against the law for an employer to discriminate against you for filing a workers' compensation claim. If you believe you are being treated unfairly by your employer, please contact us and we can give you the guidance you need. We can help you get in touch with the proper professionals to ensure you are given the care and treatment you are entitled to.

You are not in this alone. We help many injured workers just like you get through this troubling time. Many Doctor’s shy away from Work Injuries because they are unfamiliar with the process, but at Candlewood Pain and Injury Doctor’s we specialize in workplace injuries and deal with them every day. Our specialist are waiting to help you. Still have questions?

Call us today for a no risk Free Consultation (210) 446-5115.

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San Antonio Pain and Injury Doctors
15679 San Pedro Ave.
San Antonio, TX 78232