Reasons for Workers’ Comp Denials

Posted on Monday, October 16th, 2017 at 3:35 pm    

Attorney Joe Miller explains a situations in which your workers’ comp might be denied in a recent interview:

Workers Comp and Social Media

Posted on Wednesday, October 11th, 2017 at 9:29 am    

Should you be concerned about what you put on social media after your injury? Joe Miller addresses workers comp and social media in a recent interview:

Can an employer or insurance company send a nurse with me to my doctors appointment?

Posted on Tuesday, October 3rd, 2017 at 9:16 am    

Attorney Joe Miller answers questions about nurse case managers in a recent interview:

What Types of Doctors are Involved in Workers Compensation Cases?

Posted on Tuesday, September 26th, 2017 at 8:46 am    

Employees can be treated by many different types of doctors depending on how the accident occurred and they type of injuries suffered. Many workers need to see multiple doctors during the course of their recovery process. Some of the doctors who treat injured workers are:

  • Emergency room physician. When an accident occurs, most employees are taken to the hospital emergency room. The ER doctor should be trained in making the initial diagnosis of the workers medical condition and trained to help immediately stabilize the patient’s condition and direct the patient to other doctors when needed. The ER doctor also is the physician who decides if the patient should be admitted to the hospital and whether to pull in consults with numerous other specialties such as orthopedic trauma doctors, or neurosurgeons.  ER doctors often order blood tests, X-Rays, CT scans, MRIs, and other diagnostic tests to evaluate your condition. They also take an oral history and conduct a physical exam. ER doctors are normally trained in life-saving techniques such as cardiac care support and resuscitation.
  • Orthopedic surgeon. For probably 90% of the cases we handle, this is the specialty and the physician who becomes the authorized treating doctor. This doctor diagnoses and treats injuries a worker’s bones and joints or disease of the bones and joints. Some orthopedic doctors specialize in a particular part of the body such as the neck, back, spine, shoulders or back. In addition to diagnosing and treating these injuries, orthopedic doctors can perform surgeries to repair bone and joint disorders. Employees who are involved in an auto accident, fall from a great height or have something fall on them, are involved in an explosion, or injured due to some form of violent condition; often require treatment by an orthopedist. Some orthopedic specialties are hand surgery, shoulder surgery, knee surgery, joint reconstruction, foot and ankle surgery, and spinal surgery.
  • Physiatrist or Osteopathic Physicians. This doctor may work with patients who have had surgery and need rehabilitation, or someone who is trying to avoid surgery by engaging in more conservative treatment first. Physiatrists are not surgeons themselves, although some do perform surgeries.  Physiatrists are also known as physical medicine and rehabilitation (PM & R) specialists. These doctors may do are muscle manipulation, epidural injections, alternative medicine such as acupuncture, and ultrasound-guided procedures. Physiatrists and osteopaths often fill the role of and are often found practicing as pain management physicians. Others care for patients such as quadriplegics or amputees on a long-term basis to assist them with increasing function and coping with their severe, lifelong injuries.
  • Pain management. These physicians typically treat people with chronic pain. They are often anesthesiologists or physiatrists by training, although some are orthopedic surgeons as well. Treatments can include steroid injections, radiofrequency neurotomy (also known as ablation therapy) , nerve blocks, subcutaneous stimulator implants,  and other remedies that can help minimize the pain. Most pain management doctors also prescribe pain medications including opioids. Their role has probably gotten more critical lately. This has come about as surgical physicians seek to transfer care of chronic pain patients out of their practices, out of fear of failure to comply with more stringent regulations and laws passed in Virginia and elsewhere in response to the nationwide epidemic of death from opioid overdose.
  • Neurosurgeon. These physicians diagnose and treat neurological problems of the brain, neck, head, and back. Much of what they do tends to overlap that of the orthopedic physician, with regard to spine surgery. Neurosurgeons often perform spine surgeries, which frequently include multilevel fusions of the spine, using plates and screws, as well as brain surgeries to alleviate subdural hematomas.
  • Neurologist. This doctor treats injuries to the nerves and diseases of the nerves, which may often involve chronic headaches, dizziness, or cognitive deficits, such as memory loss,  after a head injury. He/she does not perform surgeries. Some of the tests a neurologist performs are EEGs, lumbar punctures, CT scans, and MRIs.  He or she may also refer the patient out for neuropsychological testing to gauge a patient’s level of cognitive performance after a brain injury.
  • Psychiatrist. This doctor diagnoses and treats patients with emotional and mental health problems. Treatment usually involves extensive counseling sessions to help identify the source of the patient’s difficulties. Psychiatrists are M.D.’s and therefore can also prescribe medications. Workers treat with psychiatrists to manage the emotional side of dealing with an injury and an inability to return to work, which often includes Post Traumatic Stress Disorder (PTSD). Psychiatrists may sometimes use brain images such as CT scans, MRIs, and PET scans to help determine the cause of a worker’s behavioral and emotional difficulties. Some of the types of specialties psychiatrists have are addiction psychiatry, sleep medicine, geriatric, and clinical neuropsychology. Some psychiatrists see patients infrequently for medication updates, and delegate the psychotherapy role to psychologists or licensed therapists.
  • Psychologists or licensed counselors. This type of doctor treats workers who have behavioral problems such as depression and emotional problems related to their injury. They are also trained in giving the patient mental health tests. Psychologists do not prescribe medications and are not M.D.’s. Some of the categories of psychologists are clinical psychologists, counseling psychologists, and educational psychologists and neuropsychologists. There are also counselors and licensed clinical social workers. Most, but not all psychologists have a PhD, so it is still appropriate to call them “Doctor.” Usually, psychologists use therapy/talk therapy. These sessions are usually hour- long sessions on a regular basis that can last weeks, months, or years. Workers usually get individual therapy. Some psychologists are trained to perform hypnosis.
    Neuropsychologists may administer a battery of tests designed to gauge a worker’s level of cognitive dysfunction after an injury. The evaluation is usually ordered by a neurologist or neurosurgeon which physician is treating the patient for a brain injury.
  • General surgeon. This physician performs many types of surgeries including those that an orthopedist or neurosurgeon would not normally perform, such as to repair damage to internal organs after an injury.
  • Ophthalmologist. This is an eye doctor who can diagnose and medically treat patients who have visual injuries. An ophthalmologist can perform eye surgery such as cataract surgery.
  • Audiologist. An audiologist is a doctor who treats works who lose some or all their hearing in one or both ears. These physicians are also trained to help workers with balance problems and workers who have tinnitus.
  • Pulmonary Physician. these physicians are often seen in the context of asbestos, silicosis, or other work-related lung diseases. Most of the pulmonary doctors who do this are qualified to give something called a “B Reading.”  A “B Reading” is an important standard gauge of lung damage caused by asbestos or silicosis which is recognized by the U.S. Department of Labor. An attorney who is familiar with B-readings can often translate the level of damage into potential recovery for the worker, in accordance with statutory law. In Virginia, this is broken down into First Stage, Second Stage, and Third Stage.
    Occasionally, a pulmonary physician may be utilized for acute exposures to hazardous chemicals to gauge the effects on the lungs via a pulmonary function test.
  • Cardiologist. This is a heart doctor who diagnoses heart disease and risks for heart attacks and heart strokes. He/she prescribes medications such as statins and performs surgeries such as implanting stents and bypass surgery. Some of the tests a cardiologist performs are an echocardiogram which is a soundwave image of the heart’s structure, an ambulatory echocardiogram which is a test to look or abnormal heart rhythms, a stress test to examine a worker’s limitation, and a cardiac catheterization which takes pictures of the heart and helps relieve blockages of the heart.
  • Chiropractor. Some injured employees see chiropractors for diagnosis and treatment of soft-tissue injuries and injuries to the spine. Coverage is limited and not all workers compensation insurance companies will pay for treatment with chiropractors. They are not licensed to perform surgeries or prescribe medicine. They do manipulate and perform adjustments of the spine.  They also treat nerve functions. Workers who treat with chiropractors normally see the chiropractor multiple times.  If warranted, a referral to an orthopedic surgeon may be made by the chiropractor.
  • Independent medical examiners. (IME’s) Often, during the course of treatment, the employer’s insurance company will demand that the worker see an “independent” doctor. This doctor really isn’t neutral. He/she is usually chosen by the employer to try to show that the worker is able to return to work, and/or that the injuries and treatment recommended by the worker’s physicians are not related to the work accident. The good news is that the opinion of the authorized treating doctor is usually followed, not that of the defense IME physician. Your Virginia or North Carolina worker’s compensation lawyer will explain when independent medical examiners can conduct an exam of the employee and what the worker should know about the exam such as what tests and questions the IME doctor is likely to perform or ask and how the worker should best conduct him or herself.

In addition to treating with doctors, injured workers will also treat with the following types of health-care professionals

  • Nurses and Nurse Practitioners (NP’s)
  • Physicians’ Assistants (PA’s)
  • Occupational therapists
  • Speech therapists
  • Vocational counselors
  • Physical therapists

Contact a respected North Carolina or Virginia workers’ compensation lawyer now

Work injury attorney Joe Miller understands which types of doctors injured workers see. He often recommends doctors when the employer recommended doctors aren’t helping. He works with the doctors to determine the full extent of your injuries and to verify your long-term health needs and work restrictions. To speak with an experienced work injury lawyer who has been fighting for employees for more than 25 years, please call attorney Miller Esq. at (888) 694-1671 or use his contact form to schedule an appointment.

Will my company hire a private investigator?

Posted on Monday, September 18th, 2017 at 4:33 pm    

In this recent interview, attorney Joe Miller explains why your company might hire a private investigator:

New Requirements for Prescribing Buprenorphine for Addiction Treatment

Posted on Thursday, September 14th, 2017 at 10:29 am    

The Medical Society of Virginia has new requirements for prescribing Buprenorphine for addiction. These are part of the new Virginia Laws passed in response to the nationwide opioid epidemic and huge uptick in deaths from opioid overdose. Buprenorphine, also prescribed under the brand name Subloxone, is often utilized as a means to treat heroin addiction. While it is a semi-synthetic opioid, and does produce some of the same euphoric effects as heroin and morphine, it is found that at low doses, administration of this drug allows the addict to discontinue heroin or morphine while reducing— and in some cases even eliminating— the severe symptoms of withdrawal that can be so debilitating for addicts.

There are eight steps that physicians should follow before prescribing Buprenorphine:

Step one

Prescriptions should be waivered by the Substance Abuse Mental Health Services Administration (SAMHSA), registered with the Drug Enforcement Agency, and comply with the federal and state laws for prescribing buprenorphine. Nurse practitioners and physician assistants must also be waivered and have a practice agreement with a waivered physician.

Step two

Before buprenorphine can be prescribed for opioid treatment, the physician should conduct and document a patient assessment that covers the following:

  • A complete psychiatric and medical history
  • A substance abuse history
  • A family history review and a review of the patient’s psychological supports
  • A physical examination
  • A urine drug test
  • A pregnancy test for women who are of childbearing age
  • Testing for HIV, Hepatitis B, Hepatitis C, and tuberculosis if clinically indicated

Step three

The physician should query (ask for results of a patient search) from the Prescription Monitoring Program before starting any treatment and during treatment.

Step four

Prepare a treatment plan that includes the following:

  • The reasons for choosing to use medication assistance
  • An education plan for the patient
  • A written informed consent from the patient
  • How counseling of the patient will be achieved
  • A signed agreement that details of both the patient and the physician

Step five

During the induction phase:

Initiate treatment with no more than 8mg of buprenorphine, except when medically indicated if properly documented in the medical record.
The patient should see the doctor once a week

Step six

During the stabilization phase, the prescriber should increase the dosage of buprenorphine in safe and small increments to achieve the lowest dosage without causing intoxication, withdrawal, or significant drug craving.

Step seven

During the course of treatment:

  • Ensure that the patient is getting counseling
  • Limit the strength of the prescription
  • Dosages of more than 16 mg of buprenorphine should be documented in the medical record
  • The prescriber should not prescribe more than 24mg of buprenorphine per day
  • Require that the patient take urine drug tests and serum medication level tests every three months for the first year of treatment and every six months thereafter
  • Incorporate relapse prevention strategies into counseling or make sure they are addressed by a mental health service provider as defined by Virginia Code
  • Take steps to reduce the changes of buprenorphine diversion by:
  • Using the lowest dosage possible
  • Having an appropriate frequency of office visits
  • Counting pills
  • Checking the Prescription Monitoring Program

Step eight

Make sure the medical record includes the following documentation:

  • Records should be legible, timely, accurate, and readily accessible so they can be reviewed
  • The informed consent and treatment plan should be in place
  • The document should meet the state code confidentiality requirements
  • The documentation should comply with the Board of Medicine Regulation

Special Considerations

The prescriber should refer the patient to a mental health service provider as defined by the Virginia Code Section 54-1-2400.1 for counseling or should provide counseling to the patient and document the counseling in the record.

Prescribers should NOT prescribe buprenorphine if the patient is already taking any of the following medications (unless there are extenuating circumstances and a tapering plan to achieve the lowest possible documentation is properly documented):

  • Benzodiazepine
  • Sedative hypnotics
  • Carisoprodol
  • Tramadol

Limitations for prescribing buprenorphine mono-products

  • Buprenorphine should not be prescribed without Naloxone (also known as Narcan—used to reverse the effects of opioids) unless:
    -The patient is pregnant
    -The prescriber is converting the patient from methadone to buprenorphine containing naloxone for not more than seven days
  • Buprenorphine mono-tablets can be prescribed directly to patients in federally approved opioid treatment programs but, with the exception of the above conditions, only the buprenorphine product containing naloxone shall be prescribed or dispensed for use offsite from the program
  • If buprenorphine mono-tablets are prescribed, the evidence for prescribing them should be put into the medical record

How to work with the following special treatment populations

  • Pregnant women. They should be treated with buprenorphine mono-products that have a dosage level of 16 mg or less each day
  • Patients who are less than 16 years of age. Prescribers should not approve the use of buprenorphine for treating addiction unless authorized by the Food and Drug Administration
  • Patients with chronic pain. Assess the progress of patients with chronic pain by “reduction of pain and functional objectives which can be identified, quantified, and independently verified.”
  • Patients with medical comorbidities. Evaluate by taking a patient history, a complete physical exam, take the right laboratory studies, and be aware of how buprenorphine interacts with other prescription medications
  • Patients with psychiatric comorbidities which aren’t stable. Do not undertake buprenorphine treatment. Prescribers should refer the patient for a psychiatric evaluation and treatment before stating any prescription medication treatment program.

Speak with an experienced Virginia workers’ compensation lawyer now
Many workers who are injured are prescribed medications to manage their pain. Attorney Joe Miller works with caring qualified physicians and with the legal community to understand the latest requirements that physicians must follow. He has helped thousands of injured workers get a just recovery. To make an appointment now, please call Joe Miller Esq. by phoning him at (888) 694-1671 or using his contact form.

Denied Claims – What Happens?

Posted on Monday, September 11th, 2017 at 3:41 pm    

Attorney Joe Miller explains what happens if your employer denies your claim:

Will I Get Money At My Hearing?

Posted on Thursday, September 7th, 2017 at 3:36 pm    

Attorney Joe Miller of Joe Miller Law explains the process that follows your final court hearing:

What Is Mediation?

Posted on Tuesday, September 5th, 2017 at 2:22 pm    

Attorney Joe Miller explains what mediation is and how it can be helpful:

Construction Supervisor who fell off a Roof Receives Substantial Six-Figure Settlement

Posted on Friday, September 1st, 2017 at 1:08 pm    

Joe Miller recently negotiated a substantial, six-figure settlement for a construction supervisor who fell off of a roof and lost consciousness. He suffered numerous other injuries which required surgical repair and fixation.

The worker’s compensation insurance company denied the claim, utilizing the willful misconduct defense, surmising that Joe Miller’s client must have been too close to the edge of the roof while performing his work, in violation of OSHA regulations and Company safety rules.

The problem that the defendants had was that the claimant could not recall precisely what had occurred, or how he had even ended up in the area where he had fallen from the roof. In addition, the one potential witness to the incident was no longer available.

Accordingly, insurance company had a difficult problem. In order to block a claim because of a violation of a statute or safety rule, it must be proven that the claimant intentionally violated the statute or rule. Unlike personal injury cases, mere negligence of an employee in performing his duties, even if the negligence is severe, does not bar a workers comp claim. Without a witness to say that the claimant clearly knew he was violating a safety rule and statute at the time of his injury, or that he otherwise intentionally ignored safety regulations, this would be difficult.

These potential problems were brought to the attention of the defense attorney prior to hearing. Approximately two weeks prior to hearing, Joe Miller engaged in negotiations with the defense attorney, which resulted in settlement of the claim for a significant six-figure sum, and in addition an agreement for full payment of all past medical bills related to the claim.

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