Compensability Of Pqme's Case

Improved Essays
The status of this claim is that the applicant is set to be evaluated by the urology Panel Qualified Medical Evaluator, Dr. Abdo Faddoul on June 14, 2017 and by the neurology Panel Qualified Medical Evaluator, Dr. Steven McIntire on July 13, 2017. If you have not done so already, I recommend you forward the appropriate mileage to the injured worker.

Our office will forward all the medical records in our possession to the both PQME’s. I will also prepare a persuasive cover letter separately to each PQME.

Please recall, originally this was a simple back injury claim. Thanks to our chiropractic Panel Qualified Medical Evaluator, Dr. Douglas Curran, this claim has now been amended to include various other body parts, including cervical spine, thoracic spine, right upper extremity, bilateral lower extremality, headaches, stomach and erectile dysfunction as a compensable consequence.
…show more content…
The latter specialty is to solely discuss the compensability of the alleged erectile dysfunction. As you know, per Labor Code section 4660.1(c)(1), we would not be responsible for any permanent impairment as a result of the erectile dysfunction as this is a post 2013 injury and I do not believe the exception applies here. Nonetheless, we may be on the hook for having to provide treatment and temporary disability benefits. I will ask Dr. Faddoul in my cover letter to specifically address the compensability of the alleged erectile dysfunction in association with the current

Related Documents

  • Improved Essays

    Hsc300 Unit 2 Assignment

    • 626 Words
    • 3 Pages

    The claim was billed with the diagnosis codes 724.2, 722.52, 724.4, and 724.02, which were not one of the recognized diagnoses prescribed in the LCD 30155. The beneficiary was a 65 year old man who complained of lower back pain for one year that was getting progressively worse. He received injections for pain control 10 years before the date of service; he received physical therapy recently that caused him severe pain. He underwent lower back surgery (posterior lumbar interbody fusion [PLIF]) on 03/07/2014. He was taking medications for pain and reported weakness on the left leg; he ambulated with a cane.…

    • 626 Words
    • 3 Pages
    Improved Essays
  • Improved Essays

    Nt1310 Unit 3 Assignment 3

    • 1039 Words
    • 5 Pages

    The evidence shows the claimant has a history of morbid obesity with a BMI as high as 46. A lumbar spine MRI taken on 3/26/14 showed degenerative disc disease with multilevel mild spinal stenosis. Neuroforamina was encroaching at L5 nerve root level on the…

    • 1039 Words
    • 5 Pages
    Improved Essays
  • Decent Essays

    Jon M. Espinoza's Case

    • 408 Words
    • 2 Pages

    Espinoza stated that on the claimant’s LDW 11-25-2015, she was told by Supervisor Navarrete that he had information from the claimant showing that he had a pre-existing industrial back injury. When Ms. Espinoza questioned Mr. Navarrete about the information he allegedly received from the claimant, Mr. Navarrete told her that on 11-25-2015, when the claimant had asked for a day off, he mentioned to him that he needed to see his doctor for an industrial related injury, which occurred when he was employed by a car dealership. The claimant did not specify the name of the car dealership where the injured occurred, but did state that he injured his spine and the discs in the middle of his back (Ms. Espinoza stated that our office needed to interview Mr. Navarrete in regards to the allegations made by the claimant). Ms. Espinoza stated that the claimant completed a safety training, which was presented to him on his DOH. She provided training documentation showing that the claimant’s initial training consisted of information and knowledge of occupational hazards in the workplace, illness and injury prevention plan for working in a safe working environment, to wear all personnel protective equipment required for the claimant, and reporting all injuries immediately to supervisors or through HR (See Attachment #12 for Safety unclear…

    • 408 Words
    • 2 Pages
    Decent Essays
  • Improved Essays

    We represent the self-insured employer, Niskayuna Central School District, and its third-party administrator, Benetech, Inc., in the above reference matter. Please accept this letter as the self-insured employer’s appeal of a Supplemental Decision filed in this matter on 07/13/17, which directs a deposit into the Aggregate Trust Fund. It is respectfully submitted that no deposit into the Aggregate Trust Fund is required of a self-insured employer under Section 27(2) of the Worker’s Compensation Law. At all times since the date of this accident the Niskayuna Central School District has been a self-insured employer and all payments have been made to the claimant by the self-insured employer through its third-party administrator. BACKGROUND…

    • 609 Words
    • 3 Pages
    Improved Essays
  • Improved Essays

    Mr. Chavez recalled the Claimant was involved in a couple of industrial work-related injuries. He recalled one industrial incident when the claimant struck his head against a boom from a crane. He said the Claimant was off from work for about one month after his head injury before the Claimant was released back to full duties. He does not recall the details of the accident as this information is within the claimant’s personnel file with the City’s Human Resources Department. Mr. Chavez said he did not have any records showing any of the claim numbers or documentation for his four past work related…

    • 592 Words
    • 3 Pages
    Improved Essays
  • Improved Essays

    Mr Jetke Case Summary

    • 620 Words
    • 3 Pages

    Mr. Jetke had completed an Independent Medical Evaluation (IME) and a clarification addendum was received by the claims adjuster, Rachel Ryke. Mrs. Ryke has now recommended case management to proceed with closure, as the IME physician does not feel that surgery is related to his work related injury, but rather it is degenerative in nature/aging process of the shoulder. No further treatment is needed pertaining to his work incident. .…

    • 620 Words
    • 3 Pages
    Improved Essays
  • Great Essays

    The physician reviewed the patient’s lab results and inquired about any changes with his erectile dysfunction. Upon examining the patient, the physician observed a slight change in his facial expression. The physician proceeded to teach the FNP student how to perform an accurate neurological exam and what specific signs to look for. The patient was encouraged to delay treatment for erectile dysfunction until the results of the diagnostic test were received. The FNP student reviewed the importance of medication compliance, along with diet modification and exercise.…

    • 1301 Words
    • 6 Pages
    Great Essays
  • Improved Essays

    Ssa 300 Week 4

    • 697 Words
    • 3 Pages

    Group I, Category 30 Insufficient Documentation to Show Conformance to Procedural Requirements When A Disability Determination is Based on Unresolved Work Activity That Could Affect the Decision. ISSUE Step 1 of Sequential Evaluation is not satisfied. The record does not reasonably document if, and when substantial gainful activity (SGA) ended.…

    • 697 Words
    • 3 Pages
    Improved Essays
  • Improved Essays

    Methadone Case Study

    • 545 Words
    • 3 Pages

    I attended a hearing on your behalf in the above matter before Judge Burke in Hudson, New York on 07/18/17. The claimant was not present. His attorney, Paul Lahey, appeared by phone. As you know, this case is established for an injury to the back injury with an average weekly wage of $1,241.00. The claimant has been out of work since 2006.…

    • 545 Words
    • 3 Pages
    Improved Essays
  • Improved Essays

    Patrick Duff Case

    • 413 Words
    • 2 Pages

    The insured’s HR Manager, Emily Lee became knowledgeable of Claimant Patrick Duff’s alleged workers’ compensation injury on 11-24-15 after he voluntarily quit his job as a Dishwasher on 8-8-2015. Ms. Lee said after the claimant had quit she unexpectedly received a phone call from the claimant who wanted to report an injury that he had already reported to General Manager Tom Harbaugh sometime in July 2015. Ms. Lee claimed when the claimant returned the workers’ compensation DWC-1 that was mailed to his residence, the claimant alleged within the DWC-1 that he been treated for Carpal “Tunnel Syndrome and Tendonitis to his right hand and his arm. While at the same of having an inflamed right hand to his wrist and elbow that travelled up to his right shoulder.” Ms. Lee supplemented us with two employee statements from GM Harbaugh and GM Hillman.…

    • 413 Words
    • 2 Pages
    Improved Essays
  • Decent Essays

    CILA Case Summary

    • 478 Words
    • 2 Pages

    This issue necessitates the retention of a medical expert for a more thorough evaluation. At this juncture, it is possible that the delay in medical treatment did cause, or at the least, worsen Elise’s injury. G. Summary of Discovery Responses Relevant to the Medicare Medicaid and SCHIP Extension Act of 2007 (MMSEA). Full Name: Elise A. Wasson Date of Birth: September 8, 1957 SSN: 356-58-8789 Gender: F III. RESOLUTION STRATEGY…

    • 478 Words
    • 2 Pages
    Decent Essays
  • Great Essays

    Nicholas Trauma Case Paper

    • 1263 Words
    • 6 Pages

    As we have previously advised, our client, Nicholas Nehls, sustained severe and permanent injuries as a result of the acts and/or omissions on the part of your insureds, Gerald J. Piazzi, Jr., and Zachary Lommatzsch, in the above-referenced incident. Prior to this occurrence, Nicholas was an active young man that participated in numerous physical activities and was employed in a physically demanding occupation. Due to the multiple severe and permanent injuries that he sustained as a result of your insureds’ conduct, Nicholas’ life has been drastically altered in that he lives with daily pain and discomfort and is no longer able to participate in a physically active life-style. The clear and convincing evidence in this matter leads to the uncontroverted conclusion that your insureds’ negligence is the overwhelming proximate cause of Nicholas’ injuries and related damages.…

    • 1263 Words
    • 6 Pages
    Great Essays
  • Decent Essays

    Wound Case Study

    • 194 Words
    • 1 Pages

    A review of his medical record indicates he continues to go to dialysis three days weekly for his ESRD. He has open wound to left arm that was recently incised and drained. Wound is dressed by Sn from Mihomm home health agency. He suffers from co-morbidities of HTN which is chronic and stable, chronic pain syndrome which is manage by Dr.Glener and Depression which is chronic and stable.…

    • 194 Words
    • 1 Pages
    Decent Essays
  • Improved Essays

    The claimant has a past medical history of depression and anger. He had suicidal thoughts and felt desperate but unable to function. He reported obsessive repetitive thoughts and hopelessness. He had tried Lexapro, but had a negative reaction, including uncontrolled rage and attacking his girlfriend. He was unable to make some follow-up visits and to have psychiatric evaluation due to insufficient funds.…

    • 597 Words
    • 3 Pages
    Improved Essays
  • Decent Essays

    DOI: 10/31/2014. This is a 41-year-old male customer care supervisor who sustained injury to his left quadriceps and knee when he slipped on mud and landed on his knee. As per office noted dated 7/15/16m the patient spoke with Durable Medical Equipment (DME) company last week. It was noted that the patient is still waiting for brace. The patient is doing physical therapy and home exercises.…

    • 187 Words
    • 1 Pages
    Decent Essays