Any ideas...

[FlWC]

I have posted on here before and I know someone else has to be in this situation! I was injured (bulging disc L5 S1 now has turned into a herniated disc w/ 9mm in the thecal sac) June 2006. Since that time I have had 7 injections (now nerve blocks every 2 months) and countless pills, I was scheduled to have fusion surgery on Dec. 20, 2007, but the i/c never approved it until the last day...ie...it was canceled. I don't have the guts to do it now, especially since I was told by my pm that it may or may not work out for the best! I would like to use spinal decompression or acupuncture but the i/c will not pay for that and my doctor said that if I do use outside services w/c could drop me?? My attorney said that was true. I would like to settle this but the only way is I would have to resign....The thing is that the original company where i was hurt is not where I work now...But we use the same payroll leasing company...I can and have proved that we do not use the same w/c company (we have longshoreman's here). The payroll company said it would not be a problem but there attorney will not let them settle and my attorney is a JOKE!! I would like to settle so I can get the proper care!!! It has never been about money! I'm not really asking a question...Just curious if this has happened to anyone else? I just want to get better and I do have personal insurance... My state is Florida.

[jayne]

ok heres the deal...I settled last year...no other insurance company will come in and pick up the bill......unless like me you have champus or medicaid....so saying if you settle you have a 99% chance of paying out of pocket for your entire surgery.......Now I settled without having the lower back surgery simply because I scar alot and the fusion on my cervical failed and I have massive scar tissue....I didnt need a failed back fussion and massive scar tissur there as I would have been in a wheel chair....so weigh your options and yes most settlements are comp and release which is you get a check and quit all the same day.....crappy system but they have all the money so they make the rules.....weigh your options carefully and do whats best for you....

[kate]

You state the doctor says WC can "drop you" if you use outside services. That's not necessarily true, however, they don't have to pay for it and also do not have to abide by any work restrictions, etc. Only the authorized doctor can speak to work status and recommend treatment. Therefore, if you do not see the authorized doctor, you can be "suspended" for medical noncompliance. And if you would have other treatment, you would have to pay. Your own health insurance would most likely not pay as it is work related.

Also, there is absolutely no law (in Florida) that says the IC has to settle. They can keep your claim going as long as they want to. The reason they settle is to reduce their future exposure. They've authorized surgery (even though at the last minute) They have exposure for that and any resulting treatment, meds, etc. Once you decide not to have the surgery, they will probably feel their exposure could be less, therefore, any offer to settle may end up being less.

As for having to resign in order to settle, the reason being is that most companies don't want to risk the possibility that they settle, give you a large sum of money and 2 months later you reinjure yourself and they have the same thing all over again. Or, as I've seen many, many times, the person gets a settlement, goes back to work and tells all of their co-workers and next thing you know, the company has a ton of injuries. They're protecting themselves.

And if your attorney is a "joke", if you feel that way, time to find a new one.

[lfoster21]

VA is a lot like Florida, it seems. I have had 2 surgeries that the i/c waited till the last day to approve and by then the hospital had cancelled because they did not have the approval. But, in VA, if they approved the surgery, even if it is a day prior, and you do not re-schedule, they can say that you are not working to get better and since you are not complying with the Drs. reccomendations, they can drop you for that. As for the outside Drs. appnts., I am pretty sure that in Va, the i/c can drop you for using Drs. that they have not approved. However, they must allow for a 2nd opinion, so you may have that option.

As for the settlement, my lawyer said that they won't offer to settle until they think they can save money by doing that. If there is a procedure that may "fix" you, they'd rather try that 1st. Then they could get you back to work and not have to pay you for the next 15 years etc. So, if Fl. is the same,they are unlikly going to offer a settlement, if they think the fusion could fix your problems. I askd my lawyer about what happens if by doing what they are asking me to do, if that makes me worse or what happens if I have permanent damage because they do not allow my treatment...she said it was unfortunate, but they do not care about my health. They only care about saving themselves as much money as possible. If I get worse, they will just have to keep paying my medical, but will not have to pay me for pain and suffering etc.

As far as your lawyer goes, do you keep in touch with him/her on a regular basis? Also, when you learn things, say from this website or another, do you bring these things up to your lawyer...bassically doing his job for him, but at least getting something done that he may have let pass him by? I know in some states you can not get a new lawyer...or rather you can but many don't want to take the case becasue the fee will have to be split between the 2 lawyers. I don't know how that works in FL. I have also read that if you have proof that your lawyer is not working in your best interest, you can report that to the w/c commission and ask to get a new lawyer and the 1st one would not get paid. You might want to look into that. You could always get an appt. for a free consultation and explain the situation and ask another lawyer if it is possible to change lawyers 1/2 way through and what the consequences would be.

[hurt at work]

if you dont do something with ur back its only going to get worse and you could end up doing more harm than good to the rest of ur back.think long and hard about getting it fixed,my fusion was L-5-S1,L-4,with herniation at L-3 with perm nerve damage.i seen so bill and ur talking over 150,000.thats alot of money for you to have to pay.your health insurance will not pay for a work related injury.....best of luck to you.

[Pooh]

Almost all states allow the injured worker to get a 2nd opinion at their own cost. This will not be covered under your personal health insurance at all. So something that you will have to pay out of pocket in full.

However, any treatment you get, the IC is then entitled to those doctor reports as well. They may not get them right away, but they will get them, either from your attorney at discovery time, or they will send off for them if they have a signed release of medical information for you.

The question then becomes, can you pay for the treatments by a chiropractor? Is the chiropractor really going to be able to help you, or will you need surgery? My understanding is that some chiropractors won't mess with a back if the nerve is already bulging as well. Because if they put it back wrong, you will still need surgery, and they could be liable for it. A catch 22, they can help or they can cause more damage. This could be why the IC is reluctant to allow you to go to a chiro.

Florida, use to allow a 1 time change of doctors, and your attorney will know how to go about that. However, remember when it comes down to rating you, you will not have the option to get a rating from an independent doctor on your own without paying for it. These IME's can range from $500 to $1000 in some cases.

None of us ended up in the WC system for the money, we all just wanted to get better. Or to the place that we are the best that we will get. In my case, I got treatment, but that was after the IC denied my claim. Once they did that, I was able to use my personal health insurance for that. Still 6 yrs later we are still finding things wrong and this is even after going to court on the matter. I am lucky in the fact that even though it relates to the work injury, that my health insurance will still treat me since I have had such a long time without treatment in some cases. That is if you call without treatment, not seeing regular PCP and them giving me the meds that I need to live each day. These have never been covered by the IC for the simple fact that I went outside their approved doctors to seek treatment. Yet because of their denial of the 1st injury, I am able to get treatment. The IC did accept my 2nd injury.

[kate]

Florida still does allow a one time change in physician. That is paid for by WC. However, once you change, that's the only change you get.

FS 440.13(3)(f) states: (f) Upon the written request of the employee, the carrier shall give the employee the opportunity for one change of physician during the course of treatment for any one accident. Upon the granting of a change of physician, the originally authorized physician in the same specialty as the changed physician shall become deauthorized upon written notification by the employer or carrier. The carrier shall authorize an alternative physician who shall not be professionally affiliated with the previous physician within 5 days after receipt of the request. If the carrier fails to provide a change of physician as requested by the employee, the employee may select the physician and such physician shall be considered authorized if the treatment being provided is compensable and medically necessary.

Failure of the carrier to timely comply with this subsection shall be a violation of this chapter and the carrier shall be subject to penalties as provided for in s. 440.525.

You are also entitled to one IME, for any dispute concerning overutilization, medical benefits, compensability, or disability, however, you would have to pay for it and then the IC would reimburse if you prevail at a hearing. Statute 440.12(5) http://www.workerscompensation.com/regul...=22&title=

As far as changing attorneys, it happens all the time here in Florida. The old attorney does have a lien for fees when/if you settle. The old attorney and new attorney usually work that out between themselves. And attorney fees are limited in FL and subject to approval by a judge of compensation claims.