Disability Case Studies

The claimant had 9 physical therapy visits for cervicalgia and low back pain from 01/12/2017 t0 02/01/2017.

As you know, this case is established for the low back with an average weekly wage of $578.90. The claimant has been classified with a permanent partial disability and payments are continuing to him at the marked rate of $289.45. By Notice of Decision filed on 01/10/2007, Section 15(8)(d) was established in this case.

He stopped working on March 1, 2013, the day of his injury. He has been working at his brother’s lawn mower repair shop. He basically comes and goes as he is able and is always paid $320 a week, regardless of how much time he spends at work. He has collected 26 weeks of Unemployment Insurance Benefits and was approved for Medicaid Disability with a $5,000 deductible every six months. He did not get Worker’s Compensation and has been denied Long Term Disability by his private insurer.

The medical form was not totally in compliance with the “Health Insurance Portability and Accountability Act of 1996 (“HIPAA”), even though the claimant had a written notice there was no effort put forth in order to secure an approved medical authorization and

The patient is very independent in his home and is able to perform all ADLS within the home without any addtional assistance. MSW asked patient if he was interested in any addtional care giving support in the home, but patient declined addtional support at this time. Patinet stated he gets transportation from his neiabors to the store when needed. MSW offered the patient additional transportation services, but the patient declined needing any addtional transportation services at this time.Patient reported falling back in 2004 off the steps and was air lifted to the hospital. Patient reports having diffculty paying doctors and helicoter bills. Patinet's only income is through SS for $847. Patient reported that was the only time he was fallen in his life. Patinet has only been in the hospital two times during his lifetime. MSW offered life alert services, but the patient was not interested. Patient stated his only concern was being able to afford his doctor and helicotor transportion bills. MSW connected AHCCCS and spoke to represtative regarding getting patient signed up for the medicare savings program. Representative stated the patient has already applied for AHCCCS back in

At this time, I also approached the possibility of settling this case pursuant to a compromise and release. As you know, the Stipulations with Request for Award we were ready to accept were for 24% PD paid at a rate of $160.00 per week. The stipulation was for the applicant’s lumbar spine and left knee only. The monetary value of this stipulation would be $15,280.00. I indicated to the applicant’s attorney that I had authority to settle the claim pursuant to a Compromise and Release for $24,000.00. After further discussions, the applicant’s attorney took the Stipulations and indicated he would discuss the Compromise and Release with the applicant.

Client currently receives disability compensation in the amount of $836 each month, along with $64 from SSI.

* The diagnosis can be changed on the next claim, or an adjustment may be made to a prior claim if needed. It is not necessary to cancel any claims already

This 55-year old claimant is filing a DIB claim alleging disability due to cervical strain, left knee strain, cervical disc displacement, and a sprain of ligament as of as of 08/28/2015.

Note: The Claimant said his intentions is to return to work and does not have any intentions to sue or to gain full disability for his medical condition. The Claimant is using Medi-Cal to cover the costs of his

As I anticipated and previously advised you of my prediction on the issue, the Court is allowing the plaintiff to appear for her deposition after the court deadline and has recommended that the parties cooperate with each other. We are taking Lauren Cherny’s deposition tomorrow and Roger Castino is meeting me on March 2 for the inspection. We will incorporate Ms. Cherny’s testimony and Roger’s opinion into our evaluation of the potential damages and the likelihood of a verdict against us. Your insurer, USLI, will use our evaluation as one of several factors considered in determining what to offer in this case, but keep in mind that it prefers to settle cases rather than pay its attorneys to try cases. At this time, I do not know what the

The IHMD, Dr. Maria Tonel works along side the claims examiners on claims with expected disability in excess of six weeks to assure the injured worker’s medical care is properly managed. The IHMD acts as a liaison on behalf of the claim examiners directly communicating with the treating physician with regards to the injured worker’s medical treatment plan, the administration of prescription drugs, and whether the injured worker is a viable candidate to return to the work force. The implementation of the IHMD will positively impact the claims department on multiple levels. (1) the claim’s examiners will have the assurance the injured worker’s medical treatment is appropriate (2) target return to work dates will be more accurate, while also reducing

The QIC also indicated that the documentation submitted did “not include any prior physician progress notes from the billing physician/PCP to substantiate medical necessity for the procedure billed.”

DI 24510.006 indicates the RFC must be based on all of the available medical evidence, including medical history, medical signs and laboratory findings and effects of symptoms including pain that are reasonably attributed to a medically determinable impairment. There is insufficient medical evidence in file to assess the claimant’s current level of function. DI 24515.001B.3 states evidence of a claimant's functional limitation is “sufficient” to permit an assessment of impairment severity when it is both consistent and complete enough to evaluate and assess the function. In this case, the evidence in file is not sufficient to fully assess the claimant’s hand impairment. X-ray imaging of both hands, and knees is needed.

Just looking at this claim form can be a bit intimidating if you have never dealt with them before. But if you were to take a moment to glance over the form and get a feel for what information is pertinent and needed to complete this claim form. This form to me is one of the easiest claim forms that will have to filled out and submitted in the medical office setting. Upon the first time filing this claim form it is important to have all the correct and updated information from the patient, and that the physician or hospital has included all the correct codes and the correct information to be able to file this claim. As with any claim, without the correct information and correct, the claim could be rejected and denied for reimbursement. That not only will delay the payment for services rendered, but will always add more to the medical office administrator work load. With a rejected claim, the medical office administrator will have to go over that claim form again to find the errors and then resubmit the claim. Having to do this, on top of the work load he or she may already have could put them behind on the daily duties already on the