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.

 

[pmrmd]

I have many signs taped to the glass window on my office. One of them says:

Do Not Mention Disability Unless I Do First.

Set the tone at the outset.

 

[Ducttape]

i dont "write" for short term disability to start and do not "write" for long term.

when patients come in, they are told that and that the purpose of treatment is to get them to work, and thus i am not going to write for them not to.

i do give out info on resources for job retraining (if appropriate).

Welcome to ACCES-VR

ACCES-VR assists individuals with disabilities to achieve and maintain employment and to support independent living through training, education, rehabilitation, and career development.

www.acces.nysed.gov

 

[clubdeac]

I've been seeing a lot of patient's who I start treating who've already taken themselves out of work b/c the pain was debilitating. They ask me to then fill out their work FMLA paperwork backdating to the date they had left work. I typically won't do it but sometimes it's hard when I get the MRI and they have a huge disc. Even with a large disc, I often am torn on how sympathetic I should be especially when the ask that I back date the restrictions to the time they decide to leave work. It's super annoying

 

[Agast]

FMLA is to protect someone from losing their job. Most of these blue collar workers are not getting paid time off when they miss that much work, it’s not vacation free time. You are preserving their ability to return to work once you have finished treating them. It’s reasonable to say someone with an acute disc herniation should not be climbing ladders.

 

[drusso]

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?

Are they tender to palpation over the iliac crest near the distribution of the cluneal nerves?

 

[cowboydoc]

FMLA is to protect someone from losing their job. Most of these blue collar workers are not getting paid time off when they miss that much work, it’s not vacation free time. You are preserving their ability to return to work once you have finished treating them. It’s reasonable to say someone with an acute disc herniation should not be climbing ladders.

100%. this is completely different than “giving them disability.” They don’t get a nickel for this, so there’s not nearly the perverse incentives that exist with disability and work comp, where some try to sit around and collect a check.

 

[powermd]

Are they tender to palpation over the iliac crest near the distribution of the cluneal nerves?

 

[clubdeac]

FMLA is to protect someone from losing their job. Most of these blue collar workers are not getting paid time off when they miss that much work, it’s not vacation free time. You are preserving their ability to return to work once you have finished treating them. It’s reasonable to say someone with an acute disc herniation should not be climbing ladders.

I get that but I had one yesterday that wanted me to back date him being out of work the last two months. No MRI. Would you fill that out?

 

[Agast]

I get that but I had one yesterday that wanted me to back date him being out of work the last two months. No MRI. Would you fill that out?

Is there reason to believe the inciting event did not occur 2 months ago?

 

[Malayil]

I tell people I care about your medical side. Disability is done by lawyers and judges. They can use my notes.

 

[mohandess]

Do any of you actually provide "disability"? I tell them I'm not the one that can determine if you're actually disabled or not.

My patients ask all the time, I usually just direct them to the state disability office or to disability lawyer.

 

[clubdeac]

Is there reason to believe the inciting event did not occur 2 months ago?

No, but also no objective reason to believe he has an anatomical problem necessitating him to be out of work for 2 months

 

[Ducttape]

I get that but I had one yesterday that wanted me to back date him being out of work the last two months. No MRI. Would you fill that out?

i dont generally fill out FLMA paperwork, except very generically if the patient has no PCP to do so.


but i would not back date. you are setting yourself up to try to defend your actions prior to actually establishing a relationship with them.

 

[clubdeac]

i dont generally fill out FLMA paperwork, except very generically if the patient has no PCP to do so.


but i would not back date. you are setting yourself up to try to defend your actions prior to actually establishing a relationship with them.

Agree!

 

[William Sparrow]

Are they tender to palpation over the iliac crest near the distribution of the cluneal nerves?

I'll make sure to check if the pain persists after the bilateral SIJ fusion. There's an epidemic, you know.

 

[painfree23]

Why don’t you just refuse to fill this paperwork out? Who’s forcing you to do this? I don’t do FCE so I tell patients I don’t write for ltd. Most I’ll do is work accommodation for temporary time. FMLA is another issue but generally avoid that as well

 

[William Sparrow]

Why don’t you just refuse to fill this paperwork out? Who’s forcing you to do this? I don’t do FCE so I tell patients I don’t write for ltd. Most I’ll do is work accommodation for temporary time. FMLA is another issue but generally avoid that as well

I almost never declare anyone disabled. I'm specifically talking about worker's comp cases where there is inevitably some form of paperwork that they want to either clear their employee to return to work in a full capacity, or with restrictions. I don't think I could get away with refusing to do that paperwork unless I quit seeing worker's comp all together. I try to limit how much I take on as is, but I don't mind seeing a little.

 

[Darkside_]

Not filling out FMLA paperwork IMHO is unnecessarily malignant. PCPs are already inundated with paperwork.

I do, however, fill it out with the patient during a visit (in person or telemedicine) so that we agree on dates, etc. and there is no back and forth, and I can charge for my time. Often I'll fill in the part that requires any brain cells and then the MA will fill in demographics, etc.

 

[BobBarker]

Yes, I always fill out fmla as part of an office visit.