9/4/2010 6:18:11 AM

This is a non-network claim.
This is a network claim. 

I am transmitting the above support documents via:

Email to: SendTo@FOL.com
FOL Dallas Metroplex Service Representative to Retrieve
Fax to: (512) 479-5319
Overnight Mail to: FOL, 504 Lavaca, STE 1000 Austin, Texas 78701

PLEASE NOTE: Questions regarding medical treatment may not be asked of a post-DD RME and may not be asked in cases where the claimant is in a network. Similarly, questions directed to the post-DD RME must be with respect to issues for which the DD was appointed. FOL will review the questions and ensure that only questions allowed by the statute and rules are presented to the RME.

Has the treatment to date been reasonable, necessary, and related to the compensable injury?

With respect to the compensable injury as accepted by the carrier, please provide a treatment plan consistent with evidenced-based medicine?

Regardless of compensability issues, please provide a treatment plan consistent with evidenced-based medicine?

Is the proposed service (list specific service; i.e., surgery, etc.) reasonable and necessary?

In your opinion, what is the claimant’s diagnosis as related to the compensable injury?

Does the claimant have any non-work-related condition that would cause any of the problems of which the claimant is currently complaining, and if so, what?

For those diagnosis you believe are unrelated to the compensable injury, please explain why you believe them to be unrelated?

Do the objective findings appear consistent with the claimant’s subjective complaints?

In your medical opinion, and based upon reasonable medical probability, is the designated doctor’s opinion with respect to the extent of injury overcome by the preponderance of the other medical evidence?

If you disagree with the designated doctor with respect to the extent of injury, does your disagreement reflect merely a difference of medical opinion or a fundamental error in the designated doctor’s evaluation? If the latter, please explain the error.

Can the claimant return to work with or without restrictions? If so, what would reasonable return-to-work restrictions be (please complete a DWC-73?

In your medical opinion, and based upon reasonable medical probability, is the designated doctor’s opinion with respect to the ability of the claimant to work overcome by the preponderance of the other medical evidence?

If you disagree with the designated doctor with respect to the ability of the claimant to work, does your disagreement reflect merely a difference of medical opinion or a fundamental error in the designated doctor’s evaluation? If the latter, please explain the error.

Please provide a DWC-69 certifying the claimant with the impairment rating and date of MMI you believe to be correct.

In your medical opinion, and based upon reasonable medical probability, is the designated doctor’s assignment of maximum medical improvement and award of impairment rating overcome by the preponderance of the other medical evidence?

If you disagree with the designated doctor with respect to either the date of maximum medical improvement or the impairment rating, does your disagreement reflect a difference of medical opinion, differences in the claimant’s presentation that may fluctuate on a daily basis, but not necessarily rise to the level of any error in the opinion of the designated doctor, or a fundamental error in the designated doctor’s evaluation? If the latter, please explain the error.

Please note the caveat bolded above before submitting any additional questions.

Brian Lam Flahive, Ogden & Latson DDR@FOL.com - 512.435.2200

Flahive, Ogden & Latson
Phone No: 512/435-2299
P.O. Box 13367 , Austin , TX 78711
Fax No: 512/479-5319
Email: ddr@fol.com