Sexual Problems May Be Related to Spinal Cord Injury
Many injured workers with severe spinal cord injuries are reluctant to mention to their treating physician that they have had sexual dysfunction since their work accident in Nevada. Males in particular are embarrassed to bring up this topic with their doctors. Unless the doctor initiates the discussion and directly asks about any sexual problems, the problem isn't noted in the dictated reporting, and isn't treated. And if the problem is permanent, the injured worker isn't properly evaluated for impairment.
It is very important that if you have had a serious spinal injury that you tell your treating physician about any loss of control of the bladder and/or bowels (involuntarily urinating or soiling yourself), any loss of sensation to your genitals and surrounding area, and any inability to engage in usual sexual activity.
Orthopedic surgeons, neurosurgeons, and physiatrists are busy doctors, and your appointment may already seem rushed without you bringing up an embarrassing problem . However, you should not delay in asking the doctor about these symptoms. If there is a nurse case manager that is present at doctors' visits, you might want to ask the nurse to allow you to speak to the doctor privately about a symptom that is bothering you. You have the right to see the doctor alone. Unless you speak up and tell your doctor who is treating your spinal injury about theses problems, nothing Will be done to investigate and find the right treatment.
Once you do discuss the problem, your spine doctor may want to refer you to a urologist for testing, or to your own primary care doctor to rule out other possible non-industrial causes for your complaints. Adjusters will usually pay for consultations to determine the cause of the problem if your spine doctor makes the request for a consultation. If it's found that the spinal cord injury isn't the cause, at least you will know what you need to do to treat the problem.
If there is a direct causal connection between your work injury and loss of bladder or bowel control, or sexual dysfunction, your permanent partial disability (PPD) award could be significantly increased when you are rated under the AMA Guides to Evaluation of Impairment, Fifth edition. The injured worker must be vigilant about having these impairments included in the rating.
5 Huge Mistakes Injured Workers Make
1. Going along with bad medical care
You don't have to accept substandard medical care just because you were injured at work. It is hard to correct a botched surgery. If you feel reluctant or have a gut feeling that the surgeon the insurer has assigned to you isn't very good or isn't listening to you, change doctors. You have the absolute right within the first 90 days of your claim to change to a different doctor on the insurer's provider list. And even after the first 90 days, you may still request a different doctor. Make your request for the provider list in writing, and make your request to change doctors in writing.
2. Getting unreliable information about the claims process
Instead of relying on friends and co-workers to educate yourself about the Nevada claims process, why not read the blog posts I've written on almost every topic concerning Nevada workers' compensation claims? If you want to research the law yourself, in addition to reading the statutes (NRS 616 and 617), and the regulations (NAC 616-617), you must be familiar with Nevada Supreme Court decisions interpreting the law. You must also know about the actual practice of the hearings and appeals officers to have some idea of what appeals officers, the district court judges, and Nevada Supreme Court justices are likely to do in your case. Take advantage of a free consultation with a reputable attorney.
3. Accepting a PPD award when you want more medical treatment
Even if you don't elect to receive your permanent partial disability (PPD) award in a lump sum, and the insurer is paying your PPD award in installments, you must appeal claim closure if you want more medical treatment. First ask the adjuster whether he or she will allow you to return to the last treating doctor for more treatment. If not, then go to any rating exam the insurer schedules so that your benefits aren't suspended. Also, you must file an appeal. You will have to get a report from your private physician to show the hearings officer that you need treatment. Don't wait, thinking that you can easily reopen your claim later. It's hard to reopen claims.
4. Waiting to add other injured body parts
Remember that you can't reopen a claim to get treatment for an injured body part if it was never accepted before the claim was closed. If your claim acceptance letter only references some of your injuries, notify the adjuster in writing. Ask the adjuster to at least allow your doctor to examine your other injuries before the adjuster outright denies these injuries to other body parts. File an appeal on time (within 70 days) of any letter the adjuster sends denying injuries to other body parts. You may also need to go to your own doctor using your health insurance if other injured body parts are denied.
5. Not planning for your vocational future
Be realistic and honest with yourself and your doctor when discussing whether you are going to be able to return to your job at a later date. If you know or think you might not be able to return to your usual occupation, try to find out now whether your employer is likely to offer you a permanent modified job or not. If you or a family member is dependent on the health insurance your employer provides, then you must start being creative and persistent now in persuading your employer to keep you despite any permanent physical work restrictions. Your employer does not have to find you permanent light duty work. Alternatively, start thinking about retraining programs and start visiting schools that have 9 to 18-month vocational programs.
Delays in Getting Medical Care on Your Nevada Work Comp Claim
Delays in getting medical care authorized are the reason most injured workers contact me for help on their claim. Here is some additional information about treatment delays and what you can do to get proper medical care on time on your Nevada workers' compensation claim.
- An insurer won't authorize expensive tests like MRI's or EMG/nerve conduction studies until the insurer decides to accept your claim. The adjuster has 30 days to accept or deny the claim. If the claim is denied, no tests or further treatment will be authorized.
- Prior authorization must be sent by your treating doctor to the adjuster for diagnostic tests (other than in-office x-rays), physical therapy, consultations with other doctors, or for surgical procedures.
- The adjuster has 5 working days to respond to a doctor's request for authorization pursuant to NRS 616.157.
- Insurers can delay treatment or tests by scheduling an injured worker for a consultation or an independent medical exam with a doctor chosen by the adjuster. The adjuster can suspend your benefits for non-cooperation if you don't attend this appointment. NRS 616C.140.
- The insurer can delay authorizing treatment or diagnostic testing until the requesting doctor provides the adjuster with his dictated medical report.
- The insurer might have a medical review done of the request.
- An adjuster should copy you on any denial of the requested treatment or test. and give appeal rights instead of just notifying the doctor of the denial. NAC 616C.091(3).
- If you moved outside of Nevada, the insurer won't authorize medical care with an out-of-state doctor until the insurer is sure that the doctor will accept what the Nevada medical fee schedule allows for office visits and treatment.
- What you can do:
- Make sure that your doctor faxed the request for prior authorization to the adjuster.
- If the adjuster hasn't acted within 5 working days, and doesn't give you a reason for the delay, you may file a complaint with the DIR, with a copy to the adjuster. Some adjusters will then respond, not wanting to deal with a DIR investigation. See NAC 616C.092.
- File an appeal if you have requested a transfer of doctors or some particular treatment. File appeals of any medical review doctor's opinion denying the requested treatment or test. You may appeal an insurer's failure to respond to your written request after 30 days.
- You may ask your doctor for help by having him talk to the adjuster to explain why treatment or testing is necessary.
- Make sure that your out-of-state doctor will accept the Nevada fee schedule before you ask the adjuster to allow treatment with that doctor.
- Get legal help if there are delays that prevent you from getting the medical care you need now for all of your injuries. Most attorneys do not charge for an initial consultation.
Should You Get a Second Opinion Before Having a Spinal Fusion?
Most industrial insurers will schedule injured workers for a second opinion before authorizing an orthopedic surgeon or a neurosurgeon's request to do a spinal fusion. It is a good idea, even if the insurer isn't requiring it, to get a second opinion on whether a spinal fusion is the best treatment for you. Many injured workers immediately agree with their treating physician's recommendation for a fusion because they are still in pain after physical therapy and a course of medication, or because injections didn't work. A fusion surgery is not something that should be done simply because a patient is still in pain and the doctor doesn't know else to do. It should be done only after careful consideration of all treatment options and only if there are clear-cut objective indications for this surgery.
Some injured workers mistakenly believe that that their benefits will be terminated if they don't agree to have surgery. An adjuster cannot terminate benefits solely because a claimant decides not to have a surgery. The adjuster may close a claim because the doctor has exhausted all treatment options. The adjuster will not let a claim remain open indefinitely while a claimant takes months to decide whether to have surgery or not. However, most adjusters will agree to allow a second opinion if the adjuster hasn't already decided to get one.
If you feel that you are being pressured into making a rushed decision on having a spinal fusion by your treating doctor, discuss this with the adjuster and request that he schedule a second surgical consultation. Remember that you may request a copy of the insurer's provider list to see what other spine surgeons are on the the insurer's provider list. Do some research so that you are informed about the surgeons before you request a particular one, or before the insurer chooses a second opinion physician for you.
