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Back injury
03-16-2012, 06:29 PM
Post: #1
Toungue Back injury
I currently have a w/c claim in Tx.I fell at work and have been diagnosed with two bulging discs,one herniated disc and narrowing foramen with sciatica.I was told I needed surgery.I was referred to a neurosurgeon.Without even doing any exam or anything the nurse practioner said I was wasting their time since I havent even had physical therapy yet.They gave me a referral for 6 weeks of pt and told me to call for an appt when it is complete.I also needed refills on medicine that I have been on for 3 months which they denied.My injuries are now alot worse.The treating doctor wont help me due once they refer you to a specialist they are done and the neurosurgeon's office wont even return my calls.At this point I cant even get out of bed much less go to physical therapy.I explained the situation to my adjustor and she just stated if I dont go to pt they will drop me.Any advice on what I should do would be appreciated.
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03-16-2012, 07:24 PM (This post was last modified: 03-16-2012 07:27 PM by 1171.)
Post: #2
RE: Back injury
I assume the employer has comp insurance since there is an adjuster.
if the employer uses a medical network, request a change of doctors thru them; put it in writing.
if no network is in use,file for the change thru the DWC.
forms and information on medical benefits under Texas workers comp are here:

http://www.tdi.texas.gov/wc/employee/medicalben.html
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03-16-2012, 08:47 PM
Post: #3
RE: Back injury
(03-16-2012 07:24 PM)1171 Wrote:  I assume the employer has comp insurance since there is an adjuster.
if the employer uses a medical network, request a change of doctors thru them; put it in writing.
if no network is in use,file for the change thru the DWC.
forms and information on medical benefits under Texas workers comp are here:

http://www.tdi.texas.gov/wc/employee/medicalben.html

Thank you for your help.No network is in use so I appreciate the link to the form.I did request a different neurosurgeon at first due to the one I was referred to was two hours away.I was told by the adjuster that I didnt have a choice.Hopefully she is wrong.I will request the change immediately.Thanks again!
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03-17-2012, 12:19 AM
Post: #4
RE: Back injury
I to am in Texas. Your adjuster is wrong!!! follow 1171 advise. Some of the rules, regs. and laws have change in the Texas WC. system since I was first injured. I know I changed drs. shortly after being injured and there was no medical network. I had to file out a form and fax it to my adjuster. I had an appointment with the new dr. that afternoon.

Take Care

8-05, Micro laminectomy/disectomy. 10-05 lumbar fusion L5-S1. 2-07 exploritory surgery. 12-07 medical implant, Spinal Cord Stimulator. now receiving SSDI. Jesus died for our sins. Soilders died for our freedom.
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03-17-2012, 12:49 AM
Post: #5
RE: Back injury
(03-17-2012 12:19 AM)AQA Wrote:  I to am in Texas. Your adjuster is wrong!!! follow 1171 advise. Some of the rules, regs. and laws have change in the Texas WC. system since I was first injured. I know I changed drs. shortly after being injured and there was no medical network. I had to file out a form and fax it to my adjuster. I had an appointment with the new dr. that afternoon.

Take Care

Thats good news that I do have an option to change doctors. Maybe I can find someone closer that will actually help me.I will fill the form out immediately and fax it.Thank you for replying to my post!
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03-17-2012, 06:39 PM
Post: #6
RE: Back injury
im in florida so i dont know if its the same but when i went to the surgeon it was to see what course to take the surgeon said pt is always first to see if it helps and his paperwork to the adjuster states pt then evaluation in 4-6 weeks thats when the adjuster schedules pt for you ive got 2 herniated 1 bulging so i assume its the same and the adjuster goes on that to make decision, good luck
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03-18-2012, 03:02 PM
Post: #7
RE: Back injury
1171 is correct in telling you that you have a 1 time choice of changing Dr's here in TX. I was injured at work in 08 and the only Dr I saw to begin with was in the ER. Although the IC denied my claim for over 13 months, at the beginning they stated that if I were to be seen, it would have to be by the 1st dr, in the ER. How does one make an appointment with an ER dr for treatment??

After hiring an attorney, she sent me to a Dr and he gave me the forms to change Dr's. The IC fought the change, but it was granted through DWC for the above reason. One can not be treated continually by an ER dr. However, with my claim being denied, all my Dr could do was see me once a month and report on where my injury was progressing (he did take x-rays the 1st visit) and schedule the next monthly visit. He got fed up with the IC's games and took me out of work in August of 08, and finally ordered a computer generated FCE in Jan 09, which showed I had lost 13% use of my right arm (dominate) which got through to the IC and they allowed me to have an MRI in Feb. 09. The IC finally accepted my claim in April 09 but promptly sent me for a DME who claimed my injury was pre-existing osteo-arthritis (although the MRI showed none) and I was declared MMI.

Because this was a denied claim right up to the end, I ended up on short term disability due to a surgery I had on my right foot in Oct 07. I never received a dime of TIB's from the IC. And it was never figured into my IIB's when the IC finally settled with me in Aug. 09. I was also due over $1400 in travel for which I was paid a measely $350 and told to accept it as the time period for collecting the remaining travel pay had expired, even though I had turned it in within the one year time period. It sat on my adjustors desk for 6 months, but that didn't matter.

I hope that you are able to find a Dr that will treat you as a human and not just a number and give you the care that you deserve as an IW.

Angel ^j^

I've always been crazy, but it keeps me from going insane.
************
Happiness comes through doors you didn't even know you left open
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03-18-2012, 04:52 PM
Post: #8
RE: Back injury
I thought I had it bad.After reading your issues I feel like I am pretty lucky.I am so sorry for what you went through and how you were treated.I am surprised your attorney wasnt able to help more.They also tried denying my claim for a couple of months.At first they stated they didnt have WC insurance.I called the local WC office and told them the situation.They told me my company did have coverage and gave me the number to file a claim. Then after my Mri they said that my injuries were pre-existing but luckily my treating doctor stated it was related to my work injury.My teating doctor was great but like I said once they refer you they are done.Also she stated she could only see WC patients for 3 visits and thats it.I will quit complaining about my minor issues after seeing what you went through.Its so unfair that they can get away with not giving you the medical treatment and lost wages that you definitely deserved.
(03-18-2012 03:02 PM)UndercovrAngel Wrote:  1171 is correct in telling you that you [/b]have a 1 time choice of changing Dr's here in TX. I was injured at work in 08 and the only Dr I saw to begin with was in the ER. Although the IC denied my claim for over 13 months, at the beginning they stated that if I were to be seen, it would have to be by the 1st dr, in the ER. How does one make an appointment with an ER dr for treatment??

After hiring an attorney, she sent me to a Dr and he gave me the forms to change Dr's. The IC fought the change, but it was granted through DWC for the above reason. One can not be treated continually by an ER dr. However, with my claim being denied, all my Dr could do was see me once a month and report on where my injury was progressing (he did take x-rays the 1st visit) and schedule the next monthly visit. He got fed up with the IC's games and took me out of work in August of 08, and finally ordered a computer generated FCE in Jan 09, which showed I had lost 13% use of my right arm (dominate) which got through to the IC and they allowed me to have an MRI in Feb. 09. The IC finally accepted my claim in April 09 but promptly sent me for a DME who claimed my injury was pre-existing osteo-arthritis (although the MRI showed none) and I was declared MMI.

Because this was a denied claim right up to the end, I ended up on short term disability due to a surgery I had on my right foot in Oct 07. I never received a dime of TIB's from the IC. And it was never figured into my IIB's when the IC finally settled with me in Aug. 09. I was also due over $1400 in travel for which I was paid a measely $350 and told to accept it as the time period for collecting the remaining travel pay had expired, even though I had turned it in within the one year time period. It sat on my adjustors desk for 6 months, but that didn't matter.

I hope that you are able to find a Dr that will treat you as a human and not just a number and give you the care that you deserve as an IW.

Angel ^j^
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