frustrated and still confused

[nauticalgurl1]

Been awhile since I checked in with everyone...I had surgery for bilateral carpal tunnel months ago. Went through PT and was still experiencing problems which I voiced to my treating doctor, the physical therapists and my attorney. Got so upset with my doctor that I began to entertain the idea of changing doctors at the suggestion from my attorney. Didn't change doctors but instead had their office send up a request for a 2nd opinion to my employer's rep(my employer is self-insured). My attorney was notified 2 weeks ago that the request has been denied. So this is where I start to get confused....my claims adjuster informed me that I am entitled to a 2nd opinion and I see that also on this website being said from time to time. But while I may be entitled to it....it's going to be something that I'm going to be responsible paying for right? I'm confused about the entitlement thing and who pays for what? I understand that because I am now in the workers comp system everything as far as treatment requires prior approval from my employer's rep(insurance carrier) but if they are going to deny every little thing how am I supposed to get better and back to work? One last thing...and they will probably deny this also...but my doctor has requested an FCE and I'd like to know what does an FCE do for me and them?

[1171]

you didn't share their grounds for the denial but yes you can -at your own expense - get an opinion. you can take the issue to the comp court and ask the judge to order reimbursement. You can also ask your doctor to request a consultation; while it's not exactly the same thing it may give you some additional information.
a functional capacity exam is intended to measure how much recovery there has been in the areas affected by the injury. this can help in developing a treatment plan or determine additional benefits.

[nauticalgurl1]

1171 Wrote:a functional capacity exam is intended to measure how much recovery there has been in the areas affected by the injury. this can help in developing a treatment plan or determine additional benefits.

Okay...with that being known why would the employer's rep(insurance carrier) deny it? They haven't yet to the best of my knowledge but that seems to be the way they are dealing with everything so I am preparing myself for the worst so to speak. My claims adjuster mentioned by chance that every 90 days an IME is supposed to be performed. Knowing that an IME doctor is paid by my employer therefore for the employer it would probably be in my best interest to go get the 2nd opinion or wait to see what gets approved or denied. I'm just wanting to get my continuing issues resolved...being incapacitated from performing my job and dealing with pain is not something I'm enjoying.

[1171]

it could be denied for a number of reasons; too expensive, preamature, not an approved provider, etc.

[Still in Limbo]

You May want to Consider a Consult with an Attorney that Deals in w/c. The Longer You go without Treatment, the Worse Your Injury can get, and You could end Up with Permanent Problems. You have to get to know Your Rights that Your State follows, and Protect them, any way You can. W/C is not in this to Make You 100%, only able to Return to Work at Some Level, and that's why You need to know what You are Entitled to, and if they don't want to Help, and Attorney Surely will! My Best, and Please keep Us Informed!!

[nauticalgurl1]

Still in Limbo Wrote:You May want to Consider a Consult with an Attorney that Deals in w/c. The Longer You go without Treatment, the Worse Your Injury can get, and You could end Up with Permanent Problems. You have to get to know Your Rights that Your State follows, and Protect them, any way You can. W/C is not in this to Make You 100%, only able to Return to Work at Some Level, and that's why You need to know what You are Entitled to, and if they don't want to Help, and Attorney Surely will! My Best, and Please keep Us Informed!!

I have an attorney. Getting in touch with them is an issue. I know it's the holidays and all but a 10 or 15minute callback wouldn't kill them. Last time I spoke with my attorney which was last month...they suggested getting whatever necessary done under my medical insurance while we decided whether or not to file a motion to include my ongoing problems into my workers comp claim. I call the attorney almost every day and I'm still waiting for them to call me back. If I have additional treatment performed I'm afraid my insurance won't pay for it if they know it involves a workers comp claim and I'll get stuck with the bill. I've been using my insurance so far and have had to pay my part also and my insurance is still trying to recoup their money from my employer. This is such a mess!!!

[RNvic]

your insurance should pick up the bill with your letter of refusal from workmans comp.

As for your lawyer not returning your calls, call and try one more time and if you don't get a call back then go and sit in his office until he talks with you and if you still don;t get answers then start calling around to different lawyers until you find one that meets your needs and is willing to return your calls, and change lawyers. Why has you lawyer not done anything about not getting your benefits? Has he filed your claim?

[nauticalgurl1]

RNvic Wrote:your insurance should pick up the bill with your letter of refusal from workmans comp.

As for your lawyer not returning your calls, call and try one more time and if you don't get a call back then go and sit in his office until he talks with you and if you still don;t get answers then start calling around to different lawyers until you find one that meets your needs and is willing to return your calls, and change lawyers. Why has you lawyer not done anything about not getting your benefits? Has he filed your claim?

I was able to speak with my attorney yesterday as luck would have it. Not sure what you mean about me not getting benefits? I am receiving my TTD checks and still going to my scheduled dr. appts. but like I said my other conditions for some reason didn't make it into my claim in the very beginning. It was explained to me by my atty. that they are trying to get additional documentation as it is needed when you file a motion to include additional claims. The dr. needs to be able to relate my ongoing problems with my original problems. I have a repetitive injury to my hands so it's possible that due to that repetitiveness other upper body parts have been affected. The atty. also doesn't think that my employer would deny approval for the FCE but they have not been very "friendly" throughout this whole process...but then again they might surprise me and approve it. I was just hoping that if I got a 2nd opinion that on the off chance it might speed things up alittle.