Workers' Compensation Discussion Forums

Hey everyone. I'm new here but need some advice.

I was working in California. I went on WC due to a lower back injury at work. I have not had any problems with receiving medical care and coverage to this point and the company has worked with me in the past when it came to me requesting a different doctor. I was only ever put on modified duty so my only time off work was for doctor appointments.

Well I have left that job and now moved to Texas. I spoke to my WC agent and he told me that I either have to locate on my own a doctor that knows and will follow what is needed under California's rules or I will have to file to go before a medical panel in California. He did state that they will cover my travel expenses but is this my only options?! The doctors I saw never told me a specific diagnosis and the pain never went away.

By next week he wants me to call him with either a doctor that will take me that can follow California guidelines, submit papers to go before the board in California or close my claim. He said that with going to the board they will determine if i should receive disability and also look to settle my claim. I dont want to settle for a lump some. I would want lifetime medical for this injury if possible since i dont have a diagnosis this could cost me more than what they want to pay me.

I have a hard time believing this is the only options for me but me moving to another state has complicated my search for answers for a situation like this.

Anyone have any advice as to what to do next or if there is something else I am entitled to?

Well, how many doctor's have you called as of now?

Yes, those are your options, and they seem very fair too. You were given 3 options, find a doctor, get treated, submit forms, or just settle your case.

Don't take any options, and your going to watch your case close and nothing happens from there.

So, start looking for a doctor.

Thank You AQA. I will try calling the local field office and see if they can recommend a doctor for my situation along with their listed doctors, looks like there was a couple i didnt have a listing for.

I have been calling doctors and the problem i keep running into is that they wont take me because of the situation of out of state WC. I am sure it is either they just don't know what is required and therefor wont bother or it is extra they don't want to deal with. I still making calls and I have a friend that works at a local hospital and said she would check around for me also to help my search. I know i just have to convince someone it is worth while to take my case. It is just seeming like a local doctor is not going to be able to accommodate my situation and therefor force me into taking the option of traveling cross country to be evaluated. I definitely do not want this to just close out and leave me hanging. The travel causes a lot of headache and difficulties in my home that i rather avoid if i can. I just wanted to see if there was any other options that might be available to me that was not presented to me by the insurer. I just want to make sure I am properly informed and they didn't conveniently leave out something hoping to make it too difficult that i would just give up and they win out on the cheap.

It's not just that. The doctor's in your new State have to work off the medical Fee schedule that applies to the State of California. Many problems aren't even the doctor, it's the Office manager is just too lazy to downlaod the fee schedule, and then simply make changes in the medical charges. It really isn't all that hard. it sucks because you don't get to talk to the doctor about it, but only a Medical staff member that will just be lazy about the whole thing.

unfortunately the rise in medical control systems in comp has made it much more difficult to get care out of state.

if you can't find a texas doctor that will accept california benefits you might have to go to court and have the judge order them to pay regular fees to a texas doctor.
that may delay treatment.
I would discuss the situation with a California I&A officer
http://www.dir.ca.gov/dwc/IandA.html
they can give you more accurate advice based on your particular situation.

We have moved from California to Southeast Texas and have been able to find a few doctors but it was difficult and now it is hard because the doctors here need prior approval to see the patient and the WC adjuster says that he is not obligated to respond to all the "stupid" texas doctors request for authorization every 45 days when we have an appointment.

the adjuster should just send a written notice that the doctor has continuous authorization/approval.
approval every 45 days does seem a bit excessive

1171 Wrote:the adjuster should just send a written notice that the doctor has continuous authorization/approval.
approval every 45 days does seem a bit excessive

My adjuster requires auth/approval for ALL of my meds every time I need a refill each month. It's absolutely ridiculous!

I live in Colorado, but my case fell under California. When I was looking for doctors I would call their offices and only asked them if they accepted WC. They never asked me for what state the WC fell under and I didn't offer up the info freely. They just assumed I meant for CO. I then made an appointment.

When I got to the office for my visit I simply filled out their forms and put the name, address, phone, etc.. of the IC and adjuster. Even though I listed CA, none of the doctors offices I went to ever questioned it. Every single doctor I saw ended up following the CA guidelines and none of them ever told me they wouldn't see me because of it. Maybe try that approach instead of asking them over the phone. They office staff may just think it's too much work and tell you no just for that reason alone.

Good luck!

use the Injured workers Pharmacy, as many have done so from this board in the past.

If you want to get away from a medication nightmare, and having to wait for approvals, I suggest you use this Pharmacy. yes, your going to get your needed medication's without the wait.

http://www.iwpharmacy.com/Default.aspx