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Thread Title: How would you interpet this.
Created On Tuesday December 30, 2008 4:59 PM

hardluck
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Tuesday December 30, 2008 4:59 PM

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AME report states"Globally, although competitiveness is ceetainly limited, a wide variety of office jobs probably fit within these restrictions." In the Vocational rehab section it reads" There is a very small (nil up to 1 in 10) likelihood that the applicant is feasible for vocational rehabilition." I'm 69 years of age, had a spianl fusion which didn't come out well, had both knees completely replaced and both shoulders repaired. I'm unable to sit for more than 40 to 45 minutes because of back pain. My left knee still will occasionally buckle when an electric shock orginates from the lumbar area and travel to my left knee. I use a "prescribed" Lift Chair at home and never ever sit on an armless chair unless there is a heavy object I can latch on to pull myself up. I use pain pills 24/7 and require sleeping pills to help me make it through the night. Severe leg cramps will wake me up and by the time I work them out I'm wide awake. Sleeping pills help to return me to my sleep mode.

Your thoughts are valued.

STEVEPSCA@YAHOO.COM
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Tuesday December 30, 2008 6:03 PM

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I'm not sure how I'd interpret the AME report, other than to take it at face value, and exactly what it says... you are limited as to what you are/will be able to do in performing a job. No doubt you are precluded fom the type of work, and job description you held pre injury.

But I'd like you to know that as you are Medicare eligible, or currently receiving Medicare benefits, you cannot settle your claim without a WCMSA proposal submitted to CMS/Medicare for a determination for the need of a setaside account, and how much money is required to fund such.

So, as this appears to be an AME evaluation peformed with the intent of a final PD/WPI rating... you should ensure you have signed a SSA release of information so the CA/IC can review your current SSA status and determine if Medicare has made any conditional payments for treatment to your injury that may be reimbursed as well as your SSA/SSDI/Retirement status.

While VR benefits have/will be discontinues as of Jan 01/09, even though you are past 'normal retirement age', you would still be eligible for a SJDV/Supplemental Job Displacement Voucher for any skills honing, and/or placement services you may require in the event your current ER cannot make the 'reasonable acommodation' to bring you back to work.
That voucher would be based on your final PD/WPI rating... averaging from 4K to 10K.
You should not probably expect to be retrained in a totally new occupation through the use of a SJDV...
This could also be subject to a buy out in a C&R settlement to your claim.

gaiassoul1@yahoo.com
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Wednesday December 31, 2008 7:27 AM

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As Steve has pointed out VR hits a demise as of 1/1/09, if you are even eligible for VR, because you did not list your date of injury.

The comments are therefore basically worthless since there is no more VR and the supplemental job displacement benefit is not related to return to work ability but the level of PD.

So bottom line is worthless as related to work comp value, but your employer is now required to participate in interactive discussions as related to FEHA to see if they can accomodate your restrictions should you want to return to work.

-------------------------
Ginger

To know how to say what others only know how to think is what makes men poets or sages; and to dare to say what others only dare to think makes men martyrs or
reformers - or both. Elizabeth Charles

RBaird
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Wednesday December 31, 2008 12:50 PM

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It is difficult to evaluate this AME report. Much may depend on your date of injury. Even under the more favorable "old" rating schedule, I don't think the disability description is clearly consistent with a permanent total. Given the implications of the new "Aguilar" opinion which does appear to limit the LeBouef rule, your probable outcome under the most favorable scenario would be somewhere in the semi-sedentary to sedentary area, possibly with some enhancement. I am sure this is Greek to you and your interest is more practical; "How much money will I get?" The advise you are getting is sound--at your age, any settlement should take into account Medicare. I hope you have an attorney, because some additional discovery requiring specialized knowledge is probably needed here.

hardluck
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Thursday January 01, 2009 12:28 PM

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First & foremost may you all have an excellent New Year and may the flow of traffic always be with you. I sincerly thank you for your responces. They all provide me with some insight as to what I must instruct my attorney to do. I hate using the phase that I must instruct my attorney however he just wants to settle for a lump sum including the future medical. From your responces I realize that I must activily involve Medicare in any settlement proceedings.

I have dual AME reports which contridict each other so I suggested we depo the latest AME. Defence has agreed and will pay for the proceedings. Makes me wonder why they would offer to front the costs. I plan to provide my attorney with a page and line number of each and every contridiction. Hopefully he will ask the AME for the foundation of his conclusions.

I was injured on Jan. 17, 2000. I fell backwards off a stairway which lacked handrails. All depo's of all persons who worked the same area confirm we had all being requesting handrails for at least 8 months as it was a newly built stairway to the loading dock. OSHA did cite the company. A OME P&S me in 2002 in his report however he cites that I will be requiring future surgeries and that I should have periods of TTD. My PTP P&S me in 2005 after the passage of Workers' Comp. reform. I was in limbo for 18 months until I went back to my PTP and told him I was in great pain in the Lumbar area and something was wrong. A MRI confirmed the disks above the fusion were deteriorating and placing pressure on my nerves. I'm soppose to receive pressure point injection and be seen by a pain management doctor however we are still awaiting approval from Insurance co. Sixty two days have gone by and yet we have not had a responce.

I have to sign off as my back is telling me that I need to go lay down and use the wedge pillow to releive some of the pain.

Again, I Thank You.

STEVEPSCA@YAHOO.COM
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Thursday January 01, 2009 1:53 PM

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' I hate using the phase that I must instruct my attorney however he just wants to settle for a lump sum including the future medical. From your responces I realize that I must activily involve Medicare in any settlement proceedings.'

It would be in your AA best interest to take the necessary steps to protect Medicare interests in any settlement that affects your medical benfits...or, he will find his ass in a sling.

'A OME P&S me in 2002 in his report however he cites that I will be requiring future surgeries and that I should have periods of TTD. My PTP P&S me in 2005 after the passage of Workers' Comp. reform.'

That you have a report indicating PD prior to 01/01/2005 is tremendously in your favor here, as you will/should be rated under the 'old' PDRS/schedule. A significant difference in the potential value of your award.

' I'm soppose to receive pressure point injection and be seen by a pain management doctor however we are still awaiting approval from Insurance co. Sixty two days have gone by and yet we have not had a responce.'

What has your AA done regarding the failure to provide benefits here...?
There are UR timelines that provide a MAXIMUM of 14 days to approve/modify/deny a request for treatment, but for few exceptions.
Regardless of the 'few exceptions', you and your AA would be notified of the status of the treatment request an UR timelines.
As there has been no response for such a period/62days... the ER/IC is non-compliant, and this should be pursued.
YOU should also be filing a Audit Unit referral/complaint on the CA/IC on this issue.

'My PTP P&S me in 2005 after the passage of Workers' Comp. reform.'

AH... what happened when you were declared P&S/MMI the first time by the QME, and then the second time by your PTP...?
Were you rated for PD/WPI on those occassions...?
Did you receive PDA/advances on the indemnity... ?

'I have dual AME reports which contridict each other so I suggested we depo the latest AME. Defence has agreed and will pay for the proceedings. Makes me wonder why they would offer to front the costs'

LOL... don't kid yourself...the defense is not 'offering' to front the costs of a deposition of the AME... the law requires the ER/IC to pay for the depositions.

Why do you have TWO AME's here....?

(I wish I could figure out how to use the features of this board...particularly the 'Bold', 'Ital', 'underline', and QUOTE ! Possibly I need a chat with ART...)

hardluck
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Tuesday January 06, 2009 2:37 PM

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Please excuse the delay in responding to your questions. A family situation requires my absence from my home and I didn't want to use their system.

QME P&S me in 2002 with a rating of 60 %.
PTP P&S me in 2005 with a rating of 100%
1st AME P&S me in July 2008 with a rating of 75%. This report was delays for so long that we filed a a hearing to get a new AME. Hearing approved a new AME to be utilized.
AME examined me and rated me at 59%. All three reports cite than I should be restricted to sedentary work.
Voc. rehab. people stated that I was 100% because I was unable to sit for more than 40 to 45 minutes without having to lay down with a triangle pillow. I sincerly attempted too complete the testing sessions however as much as I tried the pain would wear me down.

Judge Baird, I appreciate the feed back and sir it's not really about the money or what is the total sum. I would perfer to be whole again.
Whole as being able to perform useful work, whole to not have to have my wife unload the grocery's all by herself, whole to be able to hold my only one year old grandchild and walk about the garden and explain to him the wonder of plants and flowers and whole to be able to take part in all the family functions without having to continiously having to lay down. I understand age slows us down however I'm lucky to have the fiber which will allows me to push myself. I went 28 years of never missing work because of that moral fiber. I was luckly to have built a portfolio of real estate and other holdings whereas I really don't have to be to concerned about adequate funding.

In closing may I call your attention to the article about the young Arab and the T-shirt which kept him from being allowed to board an airplane. They awared him $240,000.00. You can be 99.5% disabled in workmans' comp. and will maybe see half of that amount in your life time.

Thank you all for taking the time out of your busy day. Perhaps some day there will be solance for such as we who seek a forbidden city that we shall never see. I forget who wrote "The Seeker" but as the lines read" Never the Golden City where radiant people meet but only the Dolorously Town with mourners about the streets". Thats where I currently find myself.

STEVEPSCA@YAHOO.COM
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Tuesday January 06, 2009 5:39 PM

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'... I appreciate the feed back and sir it's not really about the money or what is the total sum. I would perfer to be whole again.'

Your feelings are understandable...and your prose is no doubt appreciated.
But to tell the truth... every IW wants the same thing you are seeking...
The additional truth here is you have suffered an work related injury... could have been a PI claim...could have been a fall off your roof chasing the frisbee you and your grandchild were tossing around...

The end result is, you will eventually be rated to your subsequent PD/WPI for this injury... the further truth is, there will be a settlement of some sort...whether you accept a stipulation w/continuing medical benefits, or a C&R and fully release the ER/IC from all liability for your injury... it will eventually come down to money.

Every benefit you have received, every benefit you stand to receive in the future is about 'money'... that is the basis of everything we hold dear. That you'd like to be 'whole' again is what everyone would gladly accept... that doesn't appear to be in the cards for you, or 1000's of other IW's....

Enjoy your family, children, grandchildren..and friends, the best you possibly can in the best condition you can for as long as you can...

Good luck to you...

postscript2
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Tuesday January 06, 2009 6:19 PM

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Hi Hardluck:

I commend you for your resilience and patience and fortitude to stay afloat in a mess of a system! Great post... I think we all want to be 100% again, but the truth is we have to live with the cards that are dealt us. This isn't my first injury and I'm a C/A of over 20 years. Talk about being jerked around... I think I had it worse at times, because I know the system.

None the less, I feel for you from the bottom of my heart. I can't do some of the simplest of things and it's quite frustrating to say the least! Not being able to drive feels like it took 1/2 of my life away... We all have our own coping skills and yes, you are correct that some of the most frivilous of suits in the civil arena will never, never reach 1/2 or 1/4 the level of compensation in w/c.

I don't know what your injuries entail, but you know--technology gets better every day. Spinal procedures amongst many others have come a long way, baby! Arthroscopic sx's are a miracle considering what they used to be. I'm facing my 10th sx (not all w/c) and I'm not looking forward to it.

Perhaps you may want to consider leaving your FMC open, in hopes of newer technology and that someday, there will be a better remedy for that pain that plagues you! I know what you mean about having to lay down all the time. For me it's very depressing, but it's the only time that "I," personally, am somewhat comfortable.

Maybe you can switch PTP's in the future???

At any rate take care, and hold on to what is dear to you... At least your grandchild is still young enough that they must enjoy you immensely! Children can truly light up your life--they don't see your disability, esp. at this age of 1 year. I'm not trying to write a dissertation here, just hopefully offer you some comfort and insight as to what, as Steve said, 1000's of "us" are going through. "Steve" is also correct that any given one of us could have been injured at home or otherwise. I think the difference is that w/c is a very, very slow process, thus adding "insult to injury..." I've spoken to hundreds of I/W's, if not in the thousands and that is why I enjoyed my job so much. I don't even know if I can return to my former job either.

My pain meds get in the way of my memory, so I can't quote you some of the most powerful things I've read verbatim, but I remember one that goes something like this:

"Therefore by the grace of God go I..." When I see someone in a wheelchair or totally incapacitated, it sort of grounds me.......

At any rate, best wishes for you and hopefully you will obtain some resolution to your claim AND sooner than later!

Sincerely,
LCS

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