DIAGNOSES: 854 Closed head injury, 784 Headaches, 310.2 Post concussive syndrome, 850.1 Concussion with brief loss of consciousness, 850.9 Head Concussion, 309.81 PTSD, 310.2 Post concussive syndrome, 780.93 Closed Head Injury with amnesia, 921.00 Contusion (left orbit), 750.90 Concussion, 959.01 Head Trauma, 959.01 Cognitive Changes following head trauma, 850.0 Concussion, 959.00 Head Trauma (Contusion x 2) with Impaired Memory, Speech, Balance and Vision, 850-854, 959.01 Somatic/cognitive dysfunction and emotional dysfunction, 310, 310.8, 438 Mild cognitive dysfunction, memory processing,, 850 Mild TBI positive lapse of consciousness, 310.20 Post Concussive Sydrome, 309.28 Mood Disorder secondary to Post Concussive Syndrome, 959.01 Head injury, Lobe Disorders: frontal, parietal, cerebellar dysfunction, motor dysfunction, segmental dysfunctions, Closed Head Injury with Ongoing Sequelae, Psychological sequelae, possibly secondary to industrial injury, 959.01 Closed head injury with cognitive dysfunction and speech dysfunction, 784.00 post traumatic headaches, brain based vision impairements, brain-based vestibular and balance disorders + secondary to head trauma, NECK, BACK, Shoulder PAIN and related ICD-9 codes Reluctantly and hard fought for AUTHORIZED MEDICAL TREATMENT OVER THE COURSE OF approximately 18 months for traumatic brain injury with secondary neck/back/shoulder injuries have included: 14 chiropractic treatments, 17 psychological support sessions, 8 physical therapy treatments.
IS THERE A DOCTOR IN THE HOUSE?? Does this meet ACOEM GUIDELINES OR COMMON SENSE PRACTICES?!! WOULD YOU BE TRIED AND CONVICTED FOR MALPRACTICE IF THIS WAS YOUR COURSE OF ACTION TO TREAT A BRAIN INJURED PATIENT?? IS THERE A DISTRICT ATTORNEY AVAILABLE TO INVESTIGATE WORKERS COMP FRAUD ALLEGATIONS?? Without fear or caution??
MEDICAL EVALUATIONS BY: Orthopedic evaluations were authorized and demanded with 4 different QME Orthopedic Surgeons [FOR A HEAD TRAUMA/BRAIN INJURED WORKER!!]. The injured worker repeated requested a primary treating physician with a brain injury expertise, which was denied, and said denial was supported by the local Workers’ Compensation Information Office. The insurance company repeatedly refused to authorize MEDICALLY APPROPRIATE, ACCORDING TO ACOEM GUIDELINES, EVALUATIONS AND TREATMENTS for head trauma/brain injury/neck/back/shoulder TREATMENTS ALTHOUGH REPEATEDLY REQUESTED BY TREATING DOCTORS.
The insurance company continues to deny medically appropriate treatments, and disputes self-procured medical evaluations from brain experts.
The WORK COMP Gravy Train of doctors/providers the injured worker has been SENT to by various ‘authorities’ , (or was SELF-PROCURED because ‘authorities’ refused to provide reasonable and appropriate medical care) includes evaluations ONLY, no treatment (other than the stated exceptions below over nearly a year and a half from date of injury)…: 1 chiropractor, 1 neuropsychologist, 3 clinical psychologists, 9 MDS (3 family practice, 5 orthopedic surgeons [for brain injury, d’oh!] 2 neurologists, and others: 1 DC with specialty in functional neurology, 1 accupuncturist, 1 EEG neuro-feedback phD (who provided the only EEG, self-procured, unreimbursed), 1 physiatrist, 1 speech therapist (MA, CCC-LS LSP), 1 physical therapist, 1 optometrist, 1 neuro-optometrist, 1 vocational rehabilitation vision specialist, 1 doctor of unknown credentials who repeated tests taken within 30 days, causing ‘practice effect’ in results, and 1 forensic psychiatrist.
All of the doctors provided timely and relatively accurate reports, with some extreme exceptions, requesting a variety of medically necessary treatments, EXCEPT FOR SEVERAL DOCTORS with the STATE QME DESIGNATION. The Neurologist, Forensic Psychiatrist, and Clinical Psychologist WHO DETERMINED THERE WAS EITHER NO INDUSTRIAL INJURY, OR A MIRACULOUS SPONTANEOUS HEALING after receiving a threatening letter from the defense counsel, or a MIRACULOUS SPONTANEOUS HEALING AS A RESULT OF SELF-PROCURED APPROPRIATE MEDICAL CARE WHICH COST THE INJURED WORKER APPROXIMATELY $10,000.00. The three most dangerous “QME” designated evaluating providers opined, without scientific evidence and with slight physical evaluation, that there was or had been NO SIGNIFICANT HEAD TRAUMA, NO CONSEQUENCES OF TBI, CONCUSSION, OR ANY OF THEIR COLLEAGUES’ STATED DIAGNOSIS.
SOMEBODY IS COMMITING FRAUD!!! IS IT THE QME CROWD, OR THE DOCTORS WHO ATTEMPTED TO PROVIDED LEGITIMATE, REASONABLE, APPROPRIATE AND MEDICALLY NECESSARY MEDICAL TREATMENTS AND FURTHER EVALUATIONS???
Exasperated with the sheer evil of the denials of medical care, the injured worker advised defense counsel and insurance company adjuster, in writing, that TBI is known to shorten life-span by 7-8 years, WHEN TREATED, as the brain regulated all body systems. WITHOUT CARE, THE INJURED WORKER’S LIFE SPAN CONTINUES TO BE DIMINISHED. The injured worker further advised that the defense counsel and insurance company adjuster and their firms would most assuredly be named for the CAUSE OF DEATH on the INJURED WORKER’S DEATH CERTIFICATE, sooner rather than later. The injured worker also cited case law indicating, from the Ralph’s case, that insurance company and corporate liability does not end with death of the worker, so be prepared.
DENIED EVALUATIONS AND TREATMENTS INCLUDE BUT ARE NOT LIMITED TO and are convoluted further due to defense counsel’s apparently willful, malicious omission of medical records to skew, confuse and defraud in order to deny, delay, postpone medical treatments (or just real bad record keeping and tracking):
EEG, EEG Neurofeedback, Speech Therapy with Cognitive Remediation, MRI-BRAIN, NECK, BACK (neck authorized approximately 15 months after injury, IW self-procured Brain MRI, Back MRI still pending, Shoulder MRI reluctantly authorized approximately 17 months after injuries), Functional Neurology Assessment and Treatment, Physiatrist Assessment and Treatment, Neuro-Vision Optometry Evaluation and Treatment, Neurologist Consult competent to evaluate the specific clinical issues involved, and where these services are within the scope of the physician’s practice), Occupational Vision Therapy, Physiotherapy/PT (reluctantly authorized approximately 15 months after injury)