Re: IME's, PCE's, what to do?

[Guest guest]

This is a matter for the attorney, as it is primarily about his economic

status, rather than his health status. You're right to push for the PCE to

document his employability as a result of the accident. Let the attorney

figure out how to strong-arm the insurers. The greatest impact would be

economic loss due to loss of earning power, and possible medical costs due to

work caused aggravations.

Roy Steinberg DC

[Guest guest]

,

What does his atty say?

Have you chatted with the adjuster to respectfully make your case?

Terry Petty

IME's, PCE's, what to do?

>I have a 22 year old patient who worked 12 hr. shifts at a warehouse, was

in

>a MVA, found to have 4 moderately herniated lumbar discs which were

>asymptomatic prior to accident.

>The neurosurgeon recommended work hardening rehab.

>I've treated him successfully with lumbar traction, rehab exercises, spinal

>adjusting, etc.

>Now he is med. stat. but will not be able to return to 12 hour shifts

>lifting freight. I have set him up for a PCE (Physical capacity exam) to

>demonstrate that he may pass a simple IME but he will become symptomatic

>with extended effort.

>The lab wants pre-authorization from the ins. adjuster for payment. These

>exams can run 2hrs., 4 hrs., 8 hrs. or 3 days! He is set up for a 2-3 hr.

>exam.

>The adjuster rather than authorizing payment, set him up for an IME. This

is

>so frustrating! He will likely come out of the IME with a clean bill of

>health. He may then go to the PCE and be found to be disabled.

>(In tone like the McLoughlin Group)

>QUESTION: Do I send him to both exams and try to argue the merits of the

>PCE's opinion risking him losing the accuracy of his current assessment OR

>does he refuse to attend the IME, thus closing his claim and attend the PCE

>paying for it out of his pocket.

>This is absurd! I just want an accurate assessment of his current status

>which cannot be adequately documented for work purposes with a simple

office

>exam. His insurance carrier is effectively halting the process before such

>an assessment can be made.

>Any comments?

>He has an attorney and I will defer to him but as his chiropractor, I can't

>blindly accept the curve balls that are thrown at him as they will affect

>his future. --

>Dr. Abrahamson

>

>

>

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>

>

[Guest guest]

I have left 3 voice mails and 2 faxes with the adjuster. I just can't figure

out why she doesn't want to discuss this with me...respectfully or

otherwise.

His atty says nothing, he's out playing golf. Will let you know when I hear

from him.

--

Dr. Abrahamson

> From: " jhp " <jhp@...>

> Date: Wed, 3 Apr 2002 15:03:06 -0800

> " DC group " < >, " Abrahamson "

> <drscott@...>

> Subject: Re: IME's, PCE's, what to do?

>

> ,

>

> What does his atty say?

>

> Have you chatted with the adjuster to respectfully make your case?

>

> Terry Petty

>

> IME's, PCE's, what to do?

>

>

>> I have a 22 year old patient who worked 12 hr. shifts at a warehouse, was

> in

>> a MVA, found to have 4 moderately herniated lumbar discs which were

>> asymptomatic prior to accident.

>> The neurosurgeon recommended work hardening rehab.

>> I've treated him successfully with lumbar traction, rehab exercises, spinal

>> adjusting, etc.

>> Now he is med. stat. but will not be able to return to 12 hour shifts

>> lifting freight. I have set him up for a PCE (Physical capacity exam) to

>> demonstrate that he may pass a simple IME but he will become symptomatic

>> with extended effort.

>> The lab wants pre-authorization from the ins. adjuster for payment. These

>> exams can run 2hrs., 4 hrs., 8 hrs. or 3 days! He is set up for a 2-3 hr.

>> exam.

>> The adjuster rather than authorizing payment, set him up for an IME. This

> is

>> so frustrating! He will likely come out of the IME with a clean bill of

>> health. He may then go to the PCE and be found to be disabled.

>> (In tone like the McLoughlin Group)

>> QUESTION: Do I send him to both exams and try to argue the merits of the

>> PCE's opinion risking him losing the accuracy of his current assessment OR

>> does he refuse to attend the IME, thus closing his claim and attend the PCE

>> paying for it out of his pocket.

>> This is absurd! I just want an accurate assessment of his current status

>> which cannot be adequately documented for work purposes with a simple

> office

>> exam. His insurance carrier is effectively halting the process before such

>> an assessment can be made.

>> Any comments?

>> He has an attorney and I will defer to him but as his chiropractor, I can't

>> blindly accept the curve balls that are thrown at him as they will affect

>> his future. --

>> Dr. Abrahamson

>>

>>

>>

>> OregonDCs rules:

>> 1. Keep correspondence professional; the purpose of the listserve is to

> foster communication and collegiality. No personal attacks on listserve

> members will be tolerated.

>> 2. Always sign your e-mails with your first and last name.

>> 3. The listserve is not secure; your e-mail could end up anywhere. However,

> it is against the rules of the listserve to copy, print, forward, or

> otherwise distribute correspondence written by another member without his or

> her consent, unless all personal identifiers have been removed.

>>

>>

[Guest guest]

I'd agree with you Roy, but sometimes attorneys drop the ball. I'll speak

with him and keep ya'll posted.

Why would an adjuster NOT want a PCE at the end of a claim but want an IME?

What will a poorly reasoned IME (Hey! they occasionally happen.) do to his

chances for a clear picture of his condition to the driver who ruined his

low back? An accurate picture is critical for an appropriate settlement...

which will affect his ability to receive future care, thus affecting his

health status.

You and I know things about general health insurance management of

medical/cx. conditions and therefore know that appropriate, ethical damage

awards for future care can make the difference between getting chiropractic

care and not getting care.

For those of you automatically thinking, " ...money for the chiropractors is

the REAL issue " , think in terms of the discussion raging about medication

coverage for the elderly. Now we're talking sacred needs and forget about

pharmaceutical profits. Just some random thoughts.

--

Dr. Abrahamson

> From: Rsteinbergdc@...

> Date: Wed, 3 Apr 2002 19:26:02 EST

> drscott@...,

> Subject: Re: IME's, PCE's, what to do?

>

> This is a matter for the attorney, as it is primarily about his economic

> status, rather than his health status. You're right to push for the PCE to

> document his employability as a result of the accident. Let the attorney

> figure out how to strong-arm the insurers. The greatest impact would be

> economic loss due to loss of earning power, and possible medical costs due to

> work caused aggravations.

>

> Roy Steinberg DC

>

>

> OregonDCs rules:

> 1. Keep correspondence professional; the purpose of the listserve is to foster

> communication and collegiality. No personal attacks on listserve members will

> be tolerated.

> 2. Always sign your e-mails with your first and last name.

> 3. The listserve is not secure; your e-mail could end up anywhere. However, it

> is against the rules of the listserve to copy, print, forward, or otherwise

> distribute correspondence written by another member without his or her

> consent, unless all personal identifiers have been removed.

>

>