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Junior Member
What is the name of your state? Texas
Origional injury Oct. 17, 2003. Hit by a DUI (no insurance) while on patrol.
Saw treating Doctor Oct. 20 through.............return to work Nov. 5, 2003. Still in pain.
Injury to back on duty #2 on Dec. 28, 2003. Still in pain and seeing treating doctor.
Treating doctor orders MRI April 22, 2004. Result L4/5 disc bulge and L5/S1 disc protrusion involving nerve root. Treating doctor sets up appt. with a neurosergeon.
Ins. carrier sends me to TWCC designated doctor for evaluation June 16, 2004. MMI not met.
Aug. 23, 2004 meet with neurosurgeon. Sets up surgery for Oct. 5, 2004
Oct. 2, 2004 Neuro doctor gets a phone call from compensation insurance physician who insisted conservative measures needed to be tried before approval for surgery.
Start theropy Oct. 12, 2004 through Jan. 26, 2005. Very little improvement (pain not shooting all the way down leg only to butt) Set another surgery request. Denied. Needed to try steriod shot first. I decline the shot. Told another 2 weeks of theropy and then to stop. Feeling this was usless, did not go.
July 5, 2005 injury to back fighting suspect. Can hardly walk. Go back for treatment from treatng doctor. Another MRI Aug. 2, 2005. Result another disc protrusion on top of the first two.
Insurance carrier request another visit to TWCC doctor for MMI/IR on Aug.18. 2005. Doctor determines I have reach MMI on Jan. 31, 2005 and IR is set at 26%.
(Try to start new theropy on a DRX-9000. Given the go ahead by carrier. 2 days into treament it is denied and was told she only gave me the go ahead for the free consult, which I had already done the day before I called her to make sure I could do this procedure. Hands tied and needing something done about my back, I paid out of pockett $4000 to start theropy. It is working! I still have a few more session to go and an exit interview with theropy doctor for results.)
Insurance carrier is appauled at the high rating. When I asked where the copies of the peer review and the comp. ins. physician's notes were, I was told in an angry manner " I DON'T KNOW WHAT YOU ARE TALKING ABOUT!" In fact the only thing I have received is the 2 notices to see Twcc doctor and that doctors report for the MMI/IR. This is how I knew that a peer review had been done.
Sept. 13, 2005 receive large check for IIB's. Call ins. carrier to ask about the check. She informs me she is disputing the IR and if this second injury (fight) has an IR of 15% she is going to cut it in half!

Questions that not even the customer service at TWCC can answer me are:
1. Does the carrier need to provide me with the peer review she claims she knows nothing about, but TWCC doc clearly states such statements in report?
2. How many days after MMI can they appeal?
3. If I'm receiving IIB's and she is disputing IR, can she have my IIB's reduced and if they have over paid me, do I owe that money back?
4. I have been told that once a case is closed out (MMI reached) you can not use this original injury for any other injury MMI/IR that happends after. Can the carrier indeed cut the second IR in half and state that the second injury was result of the first?

Thank you for your time,
Ralph Fisher
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