Orthopedic surgeon James Dettling, M.D. specializes in shoulder and knee injuries.\u00a0 About half his patients are injured workers treating under a Nevada workers’ comp claim.\u00a0\u00a0 He and long-time medical assistant, Patrick Boland, and their indispensable office manager, Diane,\u00a0 stopped by my office today to meet my assistants and to chat over lunch. \u00a0I’ve known Dr. Dettling to give straightforward, honest opinions over the years, and I see excellent surgical results \u00a0.\u00a0 I enjoyed having the lunch hour to ask Dr. Dettling about the problems he has treating work comp patients.<\/p>\n
\u00a0We commiserated about the increasing use of retired out-of-state orthopedic doctors hired by insurers to do peer review of treatment requests.\u00a0 (In Nevada, surgeons must request pre-authorization from adjusters for all non-emergency surgeries, for diagnostic tests like MRI’s, and for physical therapy.)\u00a0 Shoulder and knee surgeons aren’t second-guessed as much as the spinal surgeons, but\u00a0 Dr. Dettling noticed that he too was having to deal with\u00a0 denials from\u00a0 doctors who cite outdated treatment guidelines. For example, he told me that\u00a0 according to current orthopedic standards, physicians should be prescribing many more physical therapy visits than the number allowed by industrial insurers following rotator cuff repairs.<\/p>\n
Dr. Dettling and any doctor who actually provides\u00a0 care has a legal\u00a0 doctor\/patient relationship and must adhere to current and real peer treatment guidelines. \u00a0Hired-gun doctors for insurers are not accountable for their\u00a0 judgment errors in denying treatment requests by treating doctors. \u00a0Moreover, under Nevada law, an injured worker cannot sue an industrial insurer for bad faith or negligent claims administration, so it is essential that treating doctors maintain their integrity and continue to request treatment according to their best judgment, regardless of anticipated denials by the insurer. \u00a0An experienced work comp attorney can deal with the denials so long as the treating doctor continues to make the requests for the best treatment.<\/p>\n
Dr. Dettling stressed that with a surgical patient, a successful outcome does not just depend on his skills. \u00a0Equally important is the expertise of the post-surgical physical therapist assigned to rehabilitate the patient. \u00a0 For that reason, he asks for particular therapists to work with his patients. \u00a0I had not realized that, so that is something I can keep an eye on for my clients to make sure that the therapist the doctor wants is approved by the insurer.<\/p>\n
Dr. Dettling and I\u00a0 agreed that the lengthy delays in obtaining necessary MRI’s and surgery approvals on comp claims cost patients more than lost wages. \u00a0He is particularly frustrated when he sees a patient with a bicep tendon rupture that could have been surgically treated if the patient had been referred to him soon after the accident.<\/p>\n
\u00a0Patrick and Dr. Dettling complained about adjusters who don’t sympathize with patients who cannot drive themselves to work after shoulder surgeries.\u00a0 Likewise, he characterized as cruel those employers who want him to substitute a non-narcotic pain medication just so the hurt employee can report for a mindless light duty job just days after surgery.<\/p>\n
We also talked about the power of the third-party administrators and insurers to\u00a0 control their provider lists.\u00a0 He stated that he would support a legislative change that would allow injured workers to treat with any doctor who is willing to accept\u00a0 what the Nevada fee schedule allows.<\/p>\n
Diane, the office administrator, and Dr. Dettling impressed me with their knowledge of what is required to reopen a Nevada claim. \u00a0 They accept cash pay from former clients who need a letter from the doctor documenting a worsening of the industrial injury, and then refund the payment to the patient if the insurer reopens the claim and pays the doctor. \u00a0Thank you,\u00a0 Dr. Dettling, Patrick and Diane for an informative luncheon.<\/p>\n","protected":false},"excerpt":{"rendered":"
Orthopedic surgeon James Dettling, M.D. specializes in shoulder and knee injuries.\u00a0 About half his patients are injured workers treating under a Nevada workers’ comp claim.\u00a0\u00a0 He and long-time medical assistant, Patrick Boland, and their indispensable office manager, Diane,\u00a0 stopped by my office today to meet my assistants and to chat over lunch. \u00a0I’ve known Dr. … Continue reading Dr. Dettling Talks About Shoulder\/Knee Work Injuries<\/span>