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scoobydee71 · 07-09-2012, 12:03 PM

WE really need help now ...I don't know what to do.... as of july 6th we got a letter stating that hubby was going to start getting TIB's...yeah and then on the 7th we actually got a check.. yeah... well we also got a certified letter notice on the 7th but after the post office closed so i had to wait till today. I just went and got the certified letter and i just had to open it... bad idea ..ruined my day.. well it is a letter from hubby's workman's comp ins. company and they are saying :

We are disputing entitlement of medical for alleged repetitive motion conditions Because :
Carrier admits the claimant suffered a lumbar strain on 06/13/12, However carrier disputes the employee sustained an injury/ occupational illness or repetitive trauma while in the course and scope of employment to include or extend to the neck,right shoulder/arm /hand,right foot, left hand/fingers, and bilateral knees. The claimants alleged occupational disease is a disease of life to which the general public is exposed outside of employment with the employer. The computational injury is limited to the lumbar strain/sprain. The claimant has the right to request a benefit review conference.

Okay this is really poopy of them and i think it is the dr's fault for not putting it on the progress reports the last two times ... like i said he did not even really look at his arm until after the ppe machine testing. and the only thing listed on the nature of injury is a strain ... i am mad now because how do they know for sure it's a strain if they only have x-rays>? He has to go in today for the first time for rehab ...

1171 · 07-09-2012, 02:00 PM

(07-09-2012 12:03 PM)scoobydee71 Wrote: WE really need help now ...I don't know what to do.... as of july 6th we got a letter stating that hubby was going to start getting TIB's...yeah and then on the 7th we actually got a check.. yeah... well we also got a certified letter notice on the 7th but after the post office closed so i had to wait till today. I just went and got the certified letter and i just had to open it... bad idea ..ruined my day.. well it is a letter from hubby's workman's comp ins. company and they are saying :

We are disputing entitlement of medical for alleged repetitive motion conditions Because :
Carrier admits the claimant suffered a lumbar strain on 06/13/12, However carrier disputes the employee sustained an injury/ occupational illness or repetitive trauma while in the course and scope of employment to include or extend to the neck,right shoulder/arm /hand,right foot, left hand/fingers, and bilateral knees. The claimants alleged occupational disease is a disease of life to which the general public is exposed outside of employment with the employer. The computational injury is limited to the lumbar strain/sprain. The claimant has the right to request a benefit review conference.

Okay this is really poopy of them and i think it is the dr's fault for not putting it on the progress reports the last two times ... like i said he did not even really look at his arm until after the ppe machine testing. and the only thing listed on the nature of injury is a strain ... i am mad now because how do they know for sure it's a strain if they only have x-rays>? He has to go in today for the first time for rehab ...

file for a benefit review conference. make sure you have medical report from his doctor that ties the aggravated disputed conditions to the job duties.

kwhite48 · 07-09-2012, 02:01 PM

i used a place called Elite Healthcare on bridge street in fort worth. They got Chiro, p.t. and a medical doctor comes once a week.

I'm not saying they are perfect, but they are definately there for the patient. That's how they make their money. Some of these appointments are going to take a while. If you are dealing with a wc insurer, they are going to deny and delay as much as possible. Patience is key. They hope that you will go away, or die before you get anything out of them. The few people who have tried to screw the system have made it very difficult for honest people.

Give you an example: some of the initial tests that I had done from Wallmart injury. There were 2 tests that you can just take. Right after I did them. I was told that they do not let you take any tests until you appeal the decision twice. And really every time they stall they are probably saving millions, or at least slowing down the drain.

(07-02-2012 11:08 PM)scoobydee71 Wrote: Hi from Texas.. here is what is going on. Sorry so long
My hubby (35) got hurt at work after being there for 13 years 11 months on 06/13/12 he is a scale technician in which he installs, services and maintains all types and sizes of scales ranging from small deli style scales to food production scales to grain silo ones all the way up to truck and train scales. He uses weights all day every day from one 50lb weight to many and he may slide, carry, crawl or any number of different ways to move these to get them to where the scale is. This was how he hurt his right shoulder, arm hand and knee and his left hand and knee.
Well the day it was done his job sent him to the only place near them in Dallas they could find to take W/C he was a chiropractor and hubby liked him he did x-rays on his shoulder and was going to send him near his office for a MRI , but he was too far from our home and since they picked him we looked closer to our home.
I found a dr and a clinic just down the road from us that seemed liked a good choice. So we made an appt. The first bad feeling i had was that they made us fill out the 041-form then and there or they would not be able to see my hubby. Not sure what that was about but we did it. We go see the dr he asks what hurts and how bad..mind you my hubby has a high tolerance of pain and he is hurting. He physically checks him out not a major check but of some of the areas he stated.
We had the x rays from the chiro with us and gave them to the nurse when we got there so the Dr had them and kinda looked at one of them while we were there,next he writes something down on his file and then says we need more X rays and schedules an appt for that and then something on there appointment sheet called PPE. He then gives him a Rx for tramadol and muscle relaxers. and we get our Dr status report and on our way they send us.
We go to the x ray appt,, no x ray on shoulder mind you.. and then two days later to the PPE which about killed him the next day, they used a machine and had him push, pull,lean against it, the another dr came in and measured him i think it was for range of motion cause he had him try to touch his toes and measured him at the neck and waist and bend forward and backward then we waited and then saw dr. he said the testing showed something to the extent that it was not good.
Well we knew that. We did have to have him change the tramadol cause it caused hubby to have rapid heart beat and sweating and it was not easing the pain. He at least did that..That is when he actually physically examined hubby's shoulder and had him grab and hold his fingers as he pulled and hubby's right hand could not hold on much at all. He is right handed and was very strong, not anymore.
Next he just gave us Rx for new pain med and said we will see you on 07/11. I am thinking WHAT??? no pt or anything being scheduled?

We have been to this dr our choice of treating dr twice as of 06/27/12 and I am questioning what he is going to do to help hubby I say this because as of this visit I realize he may not still understand how difficult hubbys job position is most of the time.

Again I say this because after taking more x-rays and having him do the PPE he said that the test said he apparently has problems. Then he finally actually paid attention to his right shoulder problems and pain. Only now has he looked at and figured out he had lost and was still losing strength in his hand and whole arm. This was written down on all forms with all the other original effected parts but only now being addressed.
I am questioning him because as of the last visit on 06/27/12 he only made a future appt. for 2 weeks from the then for the 11 Th of July, no mention of any physical therapy at this time,we did ask about getting an MRI for the shoulder because the chiro that his job sent me to first said that is what he needed to make sure there were no underlying issues that an x-ray could not tell him. This Dr said well we will have to wait because WC will not agree right now even though there might be a possible surgery needed???. And this I believe is just putting hubby off from getting the help needed to get back work.
HELP>>HELP ..HELP
So what can I do about seeking a MRI for more information on the injuries?
Can I get him to send hubby somewhere else?

scoobydee71 · 07-12-2012, 06:18 PM

We went to dr again yesterday.. he is an idiot, i have determined. I need to know again about the elite health care place or any dr near south fort worth that actually took care of you while there?

I need to change hubby's Dr after yesterday. I asked why hubby's right arm and shoulder and knee were not listed on the first work status report and he said because my hubby did not say it he had pain in it but we did and it is listed on all the forms. He only asked what is hurting the most every time we have been in and my hubby has said his back then his shoulder and knee so we did mention it he chose not to hear it..but the ppe showed that there was a problem with it ..?
he did not like that i asked why it was not on there.

Then Dr said well they are not going to do anything for those areas and if you could get a lawyer since most wont do w/c any more he prob could not do anything for you anyway,,
but then he says i will give you a lawyers name we work with and you can see if he will help you... well that pushed my last nerve... this time i took notes and wrote all this down,including him saying my husband is depressed while he might be stressing and not sleeping well because of that he is not depressed .. yet at least.. so he gave him a sleeping pill Rx and then he asked about the pain meds after telling him he was not sleeping well and said that he was only going to give him the hydrocodone refill one more time because he has prob already built up an immunity to them.. hell he is only taking one a day so that he can actually sleep when he does cause they actually give him energy instead of making him sleepy.

so now this dr is taking away the only control of pain from him ...really?
oh and about the 9 appts of rehab they are still good and even though they did the first one his rt shoulder and the dr said they will still work on it and just not put it in the paperwork.. little fishy to me..

hubby went today for the second appt and they only did his back ..therapist said they wrote it down wrong ...hah ..and now even though he mentioned a possible surgery on hubby's rt arm and/or shoulder he isn't even going to help us get it... he gave up or in to the W/C ..I/C . So i really need help finding a new dr that will care and help hubby get better and back to the job he wants to go back to .

brneyedgirl40 · 07-13-2012, 12:09 AM

Sorry you are having so many issues.I also go to Elite Healthcare in Ft.Worth.My lawyer actually referred me to the doctor there since I was having a hard time finding a treating doctor in my area.I have to drive 3 hours to see him but it is well worth it.He is a patient advocate for WC patients and completely on your side.He and his staff are experts in finding solutions to all of the issues that come up in this process They actually care about you and want to help.The address is 1100 Bridgewood Drive Suite 108 Ft.Worth Tx.If you have any further questions let me know.Hang in there and take care!!

(07-12-2012 06:18 PM)scoobydee71 Wrote: We went to dr again yesterday.. he is an idiot, i have determined. I need to know again about the elite health care place or any dr near south fort worth that actually took care of you while there?

I need to change hubby's Dr after yesterday. I asked why hubby's right arm and shoulder and knee were not listed on the first work status report and he said because my hubby did not say it he had pain in it but we did and it is listed on all the forms. He only asked what is hurting the most every time we have been in and my hubby has said his back then his shoulder and knee so we did mention it he chose not to hear it..but the ppe showed that there was a problem with it ..?
he did not like that i asked why it was not on there.

Then Dr said well they are not going to do anything for those areas and if you could get a lawyer since most wont do w/c any more he prob could not do anything for you anyway,,
but then he says i will give you a lawyers name we work with and you can see if he will help you... well that pushed my last nerve... this time i took notes and wrote all this down,including him saying my husband is depressed while he might be stressing and not sleeping well because of that he is not depressed .. yet at least.. so he gave him a sleeping pill Rx and then he asked about the pain meds after telling him he was not sleeping well and said that he was only going to give him the hydrocodone refill one more time because he has prob already built up an immunity to them.. hell he is only taking one a day so that he can actually sleep when he does cause they actually give him energy instead of making him sleepy.

so now this dr is taking away the only control of pain from him ...really?
oh and about the 9 appts of rehab they are still good and even though they did the first one his rt shoulder and the dr said they will still work on it and just not put it in the paperwork.. little fishy to me..

hubby went today for the second appt and they only did his back ..therapist said they wrote it down wrong ...hah ..and now even though he mentioned a possible surgery on hubby's rt arm and/or shoulder he isn't even going to help us get it... he gave up or in to the W/C ..I/C . So i really need help finding a new dr that will care and help hubby get better and back to the job he wants to go back to .

UndercovrAngel · (This post was last modified: 07-13-2012 11:52 AM by UndercovrAngel.)

OMG !!! If you tell me that the Dr's name is Dr. M!tch3ll.... this is just to much of a coincidence. As that is exactly who I used during 08--10 with my WC injury to my right shoulder. I looked up the addy as it looked familiar to me, and it is the same as the one I was going to in the end of my injury (the had an office elsewhere when I first started going to see him) and I was also referred to him by my attorney. He saw me from the very start when no WC Dr here in the Falls would touch me because my employer and the IC were denying my claim. He finally got paid in August of 09 when the insurance settled with me and accepted the claim. No thanks to their stupid IRE Dr.

I have to agree with you about the staff there. They are a fantastic group to work with and actually care about every person that walks through their door. From the receptonist, to the front office staff, to the therapists, to the Dr's as well as the people they have come in to do the different tests such as FCE's to EMG/NCV's. I only met the medical Dr once, but he over saw my case along with Dr M, who would consult with him every time I had an office visit.

Angel ^j^

(07-13-2012 12:09 AM)brneyedgirl40 Wrote: Sorry you are having so many issues.I also go to Elite Healthcare in Ft.Worth.My lawyer actually referred me to the doctor there since I was having a hard time finding a treating doctor in my area.I have to drive 3 hours to see him but it is well worth it.He is a patient advocate for WC patients and completely on your side.He and his staff are experts in finding solutions to all of the issues that come up in this process They actually care about you and want to help.The address is 1100 Bridgewood Drive Suite 108 Ft.Worth Tx.If you have any further questions let me know.Hang in there and take care!!

Scoobydee71,

I have to concur with Brneyedgirl. Elite Healthcare in Ft Worth is a very caring office. Dr M will do all that he can to help your husband get his life back on track and will fight with the IC to get the treatment he needs for ALL of his injuries, not just his back. My injury was also caused due to repetitive motion and was denied almost from the get go. I fought tooth and nail and Dr M took my case knowing he might not get one dime for all the work/testing he did with me.

In the state of TX, you are allowed a one time change of treating Dr's. I suggest you at least make an appointment and go talk to the staff and Dr's at Elite and see what they have to say. The staff will give you the appropriate paperwork to fill out for the change as well as help to get it approved if you decide you want to stay with them and be treated. The office is an easy on/easy off drive on I-820 and I rarely met with any traffic issues when driving the 2.5 hours from my home. Not exactly sure where you are located, but it is definitely worth a little bit of a drive to use the Dr as well as the facilities ... they have their own in house therapy so that would save you from having to go to another location for that.

You can also contact me through PM's here on the forum, or find my email addy on my profile if you would like to talk in private.

Angel ^j^

[quote='scoobydee71' pid='145427' dateline='1342131516']
We went to dr again yesterday.. he is an idiot, i have determined. I need to know again about the elite health care place or any dr near south fort worth that actually took care of you while there?

I need to change hubby's Dr after yesterday. I asked why hubby's right arm and shoulder and knee were not listed on the first work status report and he said because my hubby did not say it he had pain in it but we did and it is listed on all the forms. He only asked what is hurting the most every time we have been in and my hubby has said his back then his shoulder and knee so we did mention it he chose not to hear it..but the ppe showed that there was a problem with it ..?
he did not like that i asked why it was not on there.

Then Dr said well they are not going to do anything for those areas and if you could get a lawyer since most wont do w/c any more he prob could not do anything for you anyway,,
but then he says i will give you a lawyers name we work with and you can see if he will help you... well that pushed my last nerve... this time i took notes and wrote all this down,including him saying my husband is depressed while he might be stressing and not sleeping well because of that he is not depressed .. yet at least.. so he gave him a sleeping pill Rx and then he asked about the pain meds after telling him he was not sleeping well and said that he was only going to give him the hydrocodone refill one more time because he has prob already built up an immunity to them.. hell he is only taking one a day so that he can actually sleep when he does cause they actually give him energy instead of making him sleepy.

so now this dr is taking away the only control of pain from him ...really?
oh and about the 9 appts of rehab they are still good and even though they did the first one his rt shoulder and the dr said they will still work on it and just not put it in the paperwork.. little fishy to me..

hubby went today for the second appt and they only did his back ..therapist said they wrote it down wrong ...hah ..and now even though he mentioned a possible surgery on hubby's rt arm and/or shoulder he isn't even going to help us get it... he gave up or in to the W/C ..I/C . So i really need help finding a new dr that will care and help hubby get better and back to the job he wants to go back to .

scoobydee71 · 07-16-2012, 02:15 AM

well sat we got a notice for an RME in the mail,,sure that is not good. what do they actually do in these things ? hubby is going to be talking with his boss and the case worker tomorrow if we can get a hold of both of them to make sure the case worker has more info on his multiple job descriptions.Hopefully this will give her a better idea of what he actually does and that these injuries are in the course and scope of his employment.

hurt back · (This post was last modified: 07-16-2012 11:48 AM by hurt back.)

(07-12-2012 06:18 PM)scoobydee71 Wrote: this time i took notes and wrote all this down,including him saying my husband is depressed while he might be stressing and not sleeping well because of that he is not depressed .. yet at least.. so he gave him a sleeping pill Rx and then he asked about the pain meds after telling him he was not sleeping well and said that he was only going to give him the hydrocodone refill one more time because he has prob already built up an immunity to them.. hell he is only taking one a day so that he can actually sleep when he does cause they actually give him energy instead of making him sleepy.

so now this dr is taking away the only control of pain from him ...really?

I don't know a/b your state but in TN they can only prescribe a "narcotic" for 3 months, then you have to go to Pain Management, from what I've heard they write a prescription down for you and "drug test" you to ensure you are taking the medicine and not selling it.. ( This is due to all the abusers and drugies in our world.)

But also YES narcotics can be addictive as well.. My dr switched mine up every other month but they never did anything but take the edge off of the pain..

So I would ask the dr if there is a "pain management" program in your state and if so does W/C pay for it.. I know they do in TN..

Also as far as switching Dr's check your states guidelines, here in TN you can change Dr's once, but only under the statement that you do not agree with a diagnosis. But after that once that's it unless you pay out of pocket. So check into that as well.. The I/C company can also do the same have another opinion by another Dr as well, I'm not sure if they are limited though ( since they are paying for the care ).

Good luck

(07-16-2012 02:15 AM)scoobydee71 Wrote: well sat we got a notice for an RME in the mail,,sure that is not good. what do they actually do in these things ? hubby is going to be talking with his boss and the case worker tomorrow if we can get a hold of both of them to make sure the case worker has more info on his multiple job descriptions.Hopefully this will give her a better idea of what he actually does and that these injuries are in the course and scope of his employment.

The RME is a medical evaluation.. I'm not sure what they do, but from what I've read here, some people are there 5 minutes, and others there 1 1/2 hrs... Its performed by another Dr outside your treating..

As far as calling his boss and case worker, his boss should have already given the case worker his "daily" detailed duties.. The case workers normally go off of medical facts not working facts... That being said... You can be a manager ( office job ) and get hurt helping a fellow co-worker ( like your husband ) lifting something which is outside of your job description but that doesn't count it as not covered.. Thats why you always give a Report Of Injury ( ROI ), which gives the case worker the facts a/b injury, then thats when they ask his boss of daily duties, etc.. The call may or may not help but keep in mind, you do not want to angry the case worker as for they are the one that is approving his benefits and if you angry them and they find the smallest gap in a story they will cancel treatment and then you have to appeal which can take a while....

I wish I could tell you a "magic" answer but there isn't one.. Good luck

scoobydee71 · 07-29-2012, 06:29 AM

Well sorry for not updating more but there wasn't much to say... until now ...

hubby's next visit with Dr is not until august 8th (3 weeks) from the July 11th one... we did manage to get all but 2 of the approved 9 visits of therapy in at least by the 23rd.
and the new meds for depression and sleep he prescribed ,well it is hit and miss especially with the sleep one ,,if and when it starts to make him at best yawn it is 4 hrs after taking it, only once after taking both and being up almost 24 hours did it actually make him as he put it "feel like i have no control" which he very quickly was falling asleep and i had to put his chair in here by the couch and fix him a way to sleep where i could watch him .. he was afraid that something might happen since he has never had to take any kind of meds...

We did finally get a hold of work and and the adjuster on the same day and the adjuster, she got back to his work last Monday the 20th and said that she would get back to them again after her supervisor looked it over.

Well the 22nd the supervisor called his work back and said the injuries were not in the scope or course of his job as previous stated and that he could get a BRC or pay out of pocket for a second opinion himself but they would not pay for one.

Well hubby's work did not like their answer either..they have only had one other W/C case in over 20 years and they did not have as many problems with their ins then. Work as i said is mad that the W/C ins is not doing much for my hubby.. like i said before this co. is small and family owned with 15 employee's and they are very tight nit with all the employee's.

So that said the husband and wife owners asked to meet with us on Monday to get a better feeling of how he is feeling and i am guessing maybe try to see what they can do to help more.. we shall see what they can do this was on Thursday.

Well on Friday the 27th the dr's office clinic called and said that hubby's therapy was extended until august 3rd ...I'm thinking what ??? you could not have done this like 2 weeks ago so he could have spaced them out ... but no.. so he has 2 days left of therapy and will finish that up this week...

oh and i had not mentioned that on the second to last day he went which was Friday the 20th while they had him walking on the treadmill (for his back) he had to stop because he had a major pain appear in his left groin area .. at least the therapist stopped what he was doing and got him off the treadmill and then when he iced his back he also iced his groin ...great I'm thinking now they have caused something else to happen...

Also have not gotten to the chiro Dr yet had too much therapy and work to head that way(it's in north Dallas and you got to go at just the right time so as not to hit a major traffic jam) .. but we will go Monday after the lunch meeting with his owners..since it is closer to the chiro's office..

I am going to wait on changing his Dr until at least after Monday maybe until after the Dr visit...

Oh and i was asking if anyone had heard of a place i just didn't have the name of yet .. well it is called Trinity orthopedic in Hurst TX- Dr kilguard? my sis went there when she was on W/C and she said he was great to her with her rotators cuff which was bad, she had 3 tears in it and they had to do surgery on it and he was the one that figured out she was worse that previous thought..not sure yet if i have to have a referral to go there or that they just take w/c she was referred from care now (her treating Dr) to him.
thanks all
well i think that is everything caught up until Monday