Worker's Comp - Normal MRI, intractable back pain

[William Sparrow]

Seems like I'm getting more and more of these cases. Intractable low back pain, failed PT, NSAID's, normal MRI, etc. Then when it's time to get released back to work I inevitably get the long message about how their pain is so severe and there's no way they can work, etc etc.

How are you all handling these cases? Ignore them and send them back? Declare them MMI, get an FCE and go with whatever the results say?

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[willabeast]

Seems like I'm getting more and more of these cases. Intractable low back pain, failed PT, NSAID's, normal MRI, etc. Then when it's time to get released back to work I inevitably get the long message about how their pain is so severe and there's no way they can work, etc etc.

How are you all handling these cases? Ignore them and send them back? Declare them MMI, get an FCE and go with whatever the results say?

My department brought in some people from a California agency to talk to us about giving people disability. It was an eye opener for sure. Totally changed my practice. They said they can retrain anyone to work and get them a job. The case I remember best was a quadriplegic who used a computer by hitting keys with a rod in his teeth. After that I basically stopped giving out permanent disability. If I got questioned I would tell them about the agency and how they vowed they could retrain and place almost anyone. Eventually patients stopped asking. Really wish I had known earlier in my career.

 

[cowboydoc]

Seems like I'm getting more and more of these cases. Intractable low back pain, failed PT, NSAID's, normal MRI, etc. Then when it's time to get released back to work I inevitably get the long message about how their pain is so severe and there's no way they can work, etc etc.

How are you all handling these cases? Ignore them and send them back? Declare them MMI, get an FCE and go with whatever the results say?

IMEs are expensive and not necessarily helpful in cases like this. Reasonable CYA, can objectively support your clinical suspicion they are FOS, but also come back with a list of restrictions you may not think are necessary, and you still have to make the decision. I may be getting less sympathetic as get older, but I’m also better at smelling BS.

 

[SSdoc33]

Seems like I'm getting more and more of these cases. Intractable low back pain, failed PT, NSAID's, normal MRI, etc. Then when it's time to get released back to work I inevitably get the long message about how their pain is so severe and there's no way they can work, etc etc.

How are you all handling these cases? Ignore them and send them back? Declare them MMI, get an FCE and go with whatever the results say?

"i dont know why your back still hurts"

you can try to get an FCE, but it never seems to be covered where i am.

i usually refuse to write any long term restrictions without an FCE, and they dont get covered. eventually the patient will stop showing up or you will get a letter from their lawyer asking for more info.

the goal here is to move on from the patient as they are not interested in improving.

 

[Status Sciaticus]

IMEs are expensive and not necessarily helpful in cases like this. Reasonable CYA, can objectively support your clinical suspicion they are FOS, but also come back with a list of restrictions you may not think are necessary, and you still have to make the decision. I may be getting less sympathetic as get older, but I’m also better at smelling BS.

"i dont know why your back still hurts"

you can try to get an FCE, but it never seems to be covered where i am.

i usually refuse to write any long term restrictions without an FCE, and they dont get covered. eventually the patient will stop showing up or you will get a letter from their lawyer asking for more info.

the goal here is to move on from the patient as they are not interested in improving.

IDK man, typing with a rod in your mouth sounds like such a pain. Even from an employer perspective, their throughput would be so low that they wouldnt get anything meaningful done.

 

[willabeast]

IDK man, typing with a rod in your mouth sounds like such a pain. Even from an employer perspective, their throughput would be so low that they wouldnt get anything meaningful done.

The agency people said there are businesses that will hire them. Maybe they get a tax break? If you want to work they can find you a job. Always. (they claim).

 

[BoardingDoc]

or you will get a letter from their lawyer asking for more info.

Can you elaborate on this?

 

[Agast]

Is back pain a contraindication to working? Are they at risk of injuring themselves if they work while they have back pain? The answer to both is No if they have no organic reason for back pain.

 

[SSdoc33]

Can you elaborate on this?

they will ask you to fill out a disability form.

you will say: no. pay me 500 bucks and ill write a letter stating whats up. takes all of 10 minutes

thats usually the end of it, but ill occasionally get a check.