Workers' comp second opinion · Regenerative care · St. Louis

Hurt at work and told you need surgery?
Get a workers’ comp second opinion

Before you agree to surgery for a work injury, get a workers’ comp second opinion that confirms what is causing your pain and why it has not healed. Surgery cannot be undone. At Regen.MD in St. Louis, care your adjuster authorizes is billed to the work comp claim, and appropriate care the claim denies is pursued through the claim by your attorney.

Schedule Now Call (314) 295-3000

Surgery is irreversible. Your job is not.

A work injury tends to reach a surgeon by the same road. First a clinic visit, then light duty, physical therapy, a steroid shot, then a referral. By then the options that got approved fastest are used up. An operation looks like the next box on the form.

If you work with your hands, your body is your paycheck. Weeks or months off for an operation means weeks or months of a smaller check. And you go back to the same loads afterward. That is why the order matters. Confirm the source, treat it, and keep surgery for last.

Picture the other side of it. A fused level does not unfuse. Removed tissue does not grow back. You may go back to the same job, lifting the same loads, in a spine or a shoulder that has been changed for good. If the result disappoints, can you live with that?

And the plainer question: has anyone offered you the alternatives?

Why did it fail when your coworkers’ did not?

A claim file records the lift, the fall and your duty status. It rarely asks why one disc or tendon gave out under a load your coworkers handle every day. Often the answer sits outside the hurt tissue.

Insulin resistance and low-grade inflammation slow every repair the body makes. Rotating and night shifts break sleep. Broken sleep shows up in blood sugar and in pain signals. Years of the same motion load the same tissue the same way. What night shift work does to your metabolism shows the pattern.

Your body creates the healing; we are merely the catalyst. Send the same body back to the same duty without fixing the terrain, and the next failure gets written up as a new injury. So we measure the terrain first. Then we treat it alongside the injured structure.

Who picks your doctor in Missouri and Illinois?

Missouri. Under RSMo 287.140, the employer provides the medical and surgical treatment reasonably required for the injury, which in practice means the employer or its insurer chooses the doctors. You have the right to choose your own physician or surgeon, but at your own expense. If your life, health or recovery is endangered by the care being furnished, the Division of Workers’ Compensation or the Commission can order a change of physician. Illinois. Under 820 ILCS 305/8(a), you may choose your own physician at the employer’s expense. The law covers two choices of provider, plus the doctors each of those providers refers you to. After that, the employer selects unless it agrees otherwise. If your employer runs an approved preferred provider program, different rules apply, and you can decline that program in writing.

Which state’s law covers your claim is not always the state you live in. Ask your attorney early.

Not yet is not the same as no

Missouri law lets the Division or Commission deny compensation for disability caused or made worse by an unreasonable refusal of treatment or an operation, when it judges the risk small compared with the injury (RSMo 287.140). That is a reason to be careful, and it is also a reason a second opinion helps. A decision made after a documented evaluation, with the alternatives written down, is a reasoned decision. Talk with your attorney before you decline anything in writing.

What does a regenerative second opinion look for?

An MRI shows wear in most working adults, including many with no pain at all. Our job is to find which structure causes your pain now. We use an exam read against your imaging. We also use diagnostic blocks that test one target at a time.

Once the source is confirmed, there are options before surgery. They include image-guided platelet-rich plasma, and bone marrow concentrate or microfragmented fat where the tissue has lost more ground. They include prolotherapy for loose ligaments. They include radiofrequency neurolysis when a block confirms a specific nerve. Every needle is guided by ultrasound or fluoroscopy. How orthobiologics are matched to the tissue explains why that matters.

Then comes the return to work. Load is the treatment, and a shot cannot supply it. So the plan is built around your real duties: lifting, climbing, overhead work, and long shifts on your feet.

How regenerative care is billed on a work injury

Your adjuster authorizes it. When the adjuster refers you to Regen.MD or approves the visit, it is authorized care, and it is billed to the workers’ comp claim. Ask for the authorization in writing.
Work comp denies appropriate care. The care is still billable to workers’ comp. Your attorney pursues it through the claim. Missouri’s medical lien law does not apply to people covered by workers’ compensation (RSMo 430.230), which is exactly why denied care goes back through the work comp claim with your attorney instead of onto a lien.
A physician you choose outside the claim. In Missouri, you may pick your own doctor at your own expense and pay at the time of service. That is an option you can choose. It is not what happens when care is denied.

If you were hurt in Illinois, say so on the first call. In our practice an Illinois work injury is handled much closer to a standard medical lien than a Missouri one. It changes the paperwork, not the treatment.

Whichever route applies, the care is billed. The route decides when it is paid and by whom, never whether it is owed.

When surgery is the right call

Worsening weakness, loss of bladder or bowel control, numbness in the groin and unstable fractures go to an emergency room the same day. Report the injury to your employer as your state requires.

Dr. Padda is a licensed physician and surgeon who does image-guided procedures in our clinic. When an operation is right, we say so. Then you go into it with a named, confirmed diagnosis.

Not sure this is your problem? Take the 60-second candidacy check: am I a candidate?. Related: Second opinion before surgery after an injury.

Questions patients ask

Can my adjuster send me to Regen.MD?

Yes. When the adjuster refers you or approves the visit, it is authorized care billed to the work comp claim. Get the approval in writing and bring your claim number.

Will saying no to surgery cost me my benefits?

In Missouri, an unreasonable refusal of low-risk treatment can affect compensation. A documented second opinion is how you show your decision is reasoned. Ask your attorney before declining anything. Learn more: questions to ask before surgery.

Workers’ comp denied my treatment. Now what?

Appropriate care that work comp denies is still billable to work comp, and your attorney pursues it through the claim. Call us and we explain the route for your state.

Is this only for back injuries?

No. Shoulders, knees, elbows, wrists, necks and backs all reach the surgery consult by the same road. Learn more: is surgery really your only option for a herniated disc.

Where is Regen.MD?

Regen.MD is at 4477 Woodson Rd, Suite 103, St. Louis, MO 63134, and sees injured workers from across the St. Louis region in Missouri and Illinois. Call (314) 295-3000 or text (314) 886-5902.

Watch and read next

Sources

Revised Statutes of Missouri, section 287.140 (medical treatment under workers’ compensation). revisor.mo.gov
Illinois Workers’ Compensation Act, 820 ILCS 305/8(a). ilga.gov
Revised Statutes of Missouri, section 430.230 (lien not valid against anyone under workers’ compensation). revisor.mo.gov
Brinjikji W, Luetmer PH, Comstock B, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015. doi:10.3174/ajnr.A4173 (PMID 25430861)