Is there time limit involved? (California)

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Is there time limit involved? (California)

Postby inquiring mind on Wed Nov 04, 2009 4:50 pm

DOI over 5 years old. Stips F&A over a year ago only mentions neck. Claim involved neck injury resulting in discectomy. IW initially treated with personal physician (first 2 months from DOI) who also diagnosed hypertension, but silent on causation. Records showed that IW's pain at that time were severe and initial prescription included muscle relaxants, motrin, vicodin, and eventually a medication for HP. Six months later, she had the surgery. All health records prior to the DOI did not reveal anything that IW complained of high blood pressure or was diagnosed with hypertension. All the WC doctors are aware of the hypertension diagnosis, but were all silent about possible causation.

Is it too late to claim that hypertension is a compensable consequences of the original injury? ANy response will be appreciated.

IM
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Re: Is there time limit involved? (California)

Postby stevepsca on Thu Nov 05, 2009 6:52 am

With a few alterations, you are reading my file...

A compensable consequence (in my case) could be added to the Stipulations/Award... with the AME opine. ie. during surgery rotator cuff torn, DQME confirms, but DA wants AME... Dr AME said. "It's not in the stips, let Medicare take care if this'' (the surgery was about 2 weeks post stipulations) In the same med/legal opinion, additional medication/treatment by Endocrinologist was provided as ''yes, reasonable on an industrial basis"
Also, 8 months treatment for DVT/Deep Vein Thrombosis, due to ''sedate lifestyle'' post-op. Comepensable consequence.

Org DOI/1994, Stips/2002, Dr AME opinion/2006

Is it too late to claim that hypertension is a compensable consequences of the original injury? ANy response will be appreciated.
Got medical evidence, and a good PQME/AME ? IMHO... yes.
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Re: Is there time limit involved? (California)

Postby LoisLane on Thu Nov 05, 2009 10:16 am

Medical treatment is not apportionable. As you have a Stips WITH FM, any comp. conseq that arises out of the injury should be medically treated.
However, it appears you do not have a medical opinion that states whether or not the HBP is a conseq of the injury or the med tx.
Sounds like you need a supplemental report from someone.....

As the disability level will not increase as you are 5 yrs post DOI (unless you have a P2Re-open) , get an opinion on the HBP, so no one has to guess on the causation....

You state that "All the WC doctors are aware of the hypertension diagnosis, but were all silent about possible causation..."

Did anyone ask them about the causation? That may be where the hiccup is. It is in the file, but no one was asked to address the issue of causation.

So, in short, the answer to your question is: You need a medical opinion to state if the HBP is a CC of the injury.

Hope this helps,

Lois
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