RE: 2 PI Questions for Listmates and our Attorney friends on the Listserve

[Guest guest]

Should you treat: there is an increased risk they will request a medical exam and an increased risk they’ll send the claim over to the special investigations unit (SIU), aka the fraud unit.  I once represented an LMT who treated with his girlfriend who was also an LMT, and that got him sent over to the SIU.  If the case ever gets tried, there will be an accusation of bias.  If you decide to treat, I would suggest being more careful than normal about documentation and making referrals (CYA), and aiming for an earlier than usual end of treatment. Wage loss: sounds bogus to me.  Submit your work release to them anyway and see what they do.  With no other expert opinion in the file, it increases the pressure on the adjuster if they want to deny the wage loss. T. Hill, PC520 SW Sixth Avenue, Suite 1250Portland, OR  97204(503) 227-4330chill@...http://www.portlandinjurylaw.com From: [mailto: ] On Behalf Of bluepearl2001@...Sent: Tuesday, February 21, 2012 8:59 AM Subject: 2 PI Questions for Listmates and our Attorney friends on the Listserve Good morning, ListmatesMy office manager was rear-ended Saturday evening. She really want me to treat her--more convenient and she is somewhat new to PDX, doesn't want to find 'another DC'.Is there any reason, if we are up front with insurance, that I should NOT be the treating physician??God knows, she'll get first rate care... LOLSecondly,When she was called by the 3rd party insurance adjuster, he asked if she had lost time from work.She said, " Not yet " ...not knowing how she would fare when she returned to work today.He told her that they would not reimburse for lost wages if a DC was the one who took her off work.Really??Would appreciate your thoughts, knowledge on these two issues.Many thanks.Ann DC

[Guest guest]

Ann,

I suggest a co-treat scenario. Does your employee have a PCP? IF so, have her see them now, at the onset of care. See if the PCP agrees with your treatment plan. Work together as a team. Do as suggests with respect to charting. Send her to someone (another DC) nearby for re-exams at intervals. No every interval, but perhaps mid treatment and at end of care. You can choose doctors with experience in expert testimony and PIP exam work near your office, so it won't be geographically inconvenient for your patient. That's no different than you would do for any other patient. However, do expect some extra scrutiny. This should not be taken as adversarial even tho it may feel so. Consider it a normal effect of past fraud cases that now alerts insurance companies to watch for 'trends in fraud'. Don't take the scrutiny personally, just be pro-active in your treatment approach. I do this on the east Portland side, Vern works on the west side with this type of work. I'm sure there are others as well.

Also be aware that any treatment plan now will require a review of 'past care'. This is a good reason to document all care given to employees no matter what the etiology. One of the first questions that may be asked is "Does the doctor treat you without charting?" or "Did you receive care in your employers/ doctor's office prior to this auto accident?" Be prepared to give this information.

Minga Guerrero DC

abowoman@...

2 PI Questions for Listmates and our Attorney friends on the Listserve

Good morning, Listmates

My office manager was rear-ended Saturday evening.

She really want me to treat her--more convenient and she is somewhat new to PDX, doesn't want to find 'another DC'.

Is there any reason, if we are up front with insurance, that I should NOT be the treating physician??

God knows, she'll get first rate care... LOL

Secondly,

When she was called by the 3rd party insurance adjuster, he asked if she had lost time from work.

She said, "Not yet"...not knowing how she would fare when she returned to work today.

He told her that they would not reimburse for lost wages if a DC was the one who took her off work.

Really??

Would appreciate your thoughts, knowledge on these two issues.

Many thanks.

Ann DC