DERMATOLOGY PANEL - Southern CA (California)

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DERMATOLOGY PANEL - Southern CA (California)

Postby simplygwents on Mon Mar 24, 2014 10:08 am

Well, we have exhausted any QME's in Northern California because the "default" PQME couldn't timely see patient. Not that I knew any of them anyway. NOW I have a panel of three Dermatologists from Southern CA (I think??) Any opinions and help would be appreciated. This is a SKIN CANCER case for a PEACE OFFICER. The claim has been denied. Exam will be 4060.

Howard Sofen, MD - Westchester CA
Bernard Raskin, MD - Valencia, CA
Michael Borok, MD - North Hills, CA

Any assistance would be greatly appreciated!
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Re: DERMATOLOGY PANEL - Southern CA (California)

Postby chirple on Mon Mar 24, 2014 4:59 pm

Hmmm...denied CANCER for peace officer? I'd be interested to know how that was denied.

I have not used any of these doctors, but if I recall Dr. Sofen, he's not a cancer treater, so I might stay clear of him. Dr. Raskin's reputation is wonderful in the treatment of skin cancers. He has a lot of experience in this area, and has a great CV.
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Re: DERMATOLOGY PANEL - Southern CA (California)

Postby vampireinthenight on Tue Mar 25, 2014 8:06 am

Latency is a common avenue for denial.
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Re: DERMATOLOGY PANEL - Southern CA (California)

Postby simplygwents on Tue Mar 25, 2014 1:51 pm

Thank you so much for your responses! It really helps to have some place to at least start my "strike".

Yes...a peace officer with a denied skin cancer. No...not latency. Just the basic "no medical evidence to support" (before they SDT'd the records). Now I suppose they want a QME to say "Yes. He had melanoma." Sheesh. I only hope there's SOME level of PD for the precautionary "stay out of the sun". We'll see.

Thanks again.
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Re: DERMATOLOGY PANEL - Southern CA (California)

Postby chirple on Tue Mar 25, 2014 5:30 pm

Hmmm...was there a treating doctor record where the patient was diagnosed with melanoma/cancer? Was it submitted with the claim form, or shortly thereafter?

Why wait for the defense to SDT the records. Submit the record with the claim form. The denial for "lack of medical evidence" is weak, if you have submitted some medical evidence.
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Re: DERMATOLOGY PANEL - Southern CA (California)

Postby vampireinthenight on Wed Mar 26, 2014 9:30 am

Sometimes a claim is filed when skin cancer is suspected or a person is warned about the possibility, but it is not yet confirmed.
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Re: DERMATOLOGY PANEL - Southern CA (California)

Postby simplygwents on Wed Mar 26, 2014 9:53 am

Thanks Chirple and Vampire. We did NOT have the records when we amended the CT Application. They were SDT'd and received and it is a little "sciency" with lots of Path reports etc....and I think that is exactly why they haven't accepted yet. SO, here we go to one of these fine QME's (hopefully).
*
Have either of you had experience with WPI based on melanoma? I look at AMA pg. 178, Table 8-2 and even a CLASS 1 has a 0-9% range. Just wondering. The only example of skin cancer given is actually under Class 4 (Example 8-16). Frankly, my client isn't in near as bad of shape as the example.... But, In the past, we have discussed stipping to 0% and just having the employer provide medical treatment. Obviously, if there is any WPI for this - - -it's worth some PD. Thanks again.
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Re: DERMATOLOGY PANEL - Southern CA (California)

Postby simplygwents on Fri Oct 10, 2014 10:29 am

If anyone is interested...we ended up using Dr. Raskin. He (of course) found the cancer industrial (duh!) AND provided for a 10% WPI which rated to 18% PD. He has done well for us on another case also.
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