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Getting answers when the cause of symptoms is unclear - Printable Version

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Getting answers when the cause of symptoms is unclear - horizon - 06-18-2014

I've been concerned that I hurt myself at work, and I wanted to get it checked out. I felt like I had a muscle injury. To cover my bases, I reported it to my company's worker's compensation department, and they filed a claim and referred me to a local urgent care clinic for an exam.

I went in for the exam, but the doctor didn't think there was anything majorly wrong and gave me a vague diagnosis of muscle pain. Since I wasn't feeling too poorly at the time, I really hoped that it was that simple.

However, since then, my pain has changed and gotten worse, and at this point I'm not entirely sure what's going on. I don't want to dismiss the possibility of an injury, and if a doctor did find an injury, then I'm confident it's work-related. But the pain is odd and I'm worried that there could be something else causing it, or that there's new problem unrelated to the original one. I would like to see another doctor to get a more comprehensive exam to determine what's going on.

I'm not sure what to do at this point, or how I should be involving worker's comp. I'm worried that if I went to my own doctor and an injury was discovered, the worker's comp people would be unhappy with me for seeing a doctor that wasn't approved by them, and my personal health insurance might be unwilling to pay because of the probable work-relatedness. But I don't really want to go through the worker's comp people when I'm unsure about what's going on, and I'm worried that if I go to the doctor under the worker's comp claim, the doctor will focus on finding an injury and won't consider other possibilities, or that I won't be able to have tests done at my own expense/my insurance's expense if necessary. To further frustrate things, I've been trying to get in touch with the people overseeing my claim for a few days now, but have not had any luck. It's delaying me from being able to see a doctor, and I'm frustrated.

What should I do at this point? I don't want to jeopardize the claim prematurely, but I really don't want to risk my health by waiting too long. Thanks for any input you guys have.

RE: Getting answers when the cause of symptoms is unclear - 1171 - 06-18-2014

unfortunately neither you nor the employer get to decide on work comp coverage.
each state has it's own rules about workers comp. getting a second medical opinion varies with each set of rules.
if you are going to challenge the first doctor's opinion you will need another medical opinion.
and that will not necessarily require the carrier to accept it or your claim.
if you can't convince the carrier to let you try again on their dime then your options are limited.
I suggest you contact the first doctor see if they are revising their initial determination.

RE: Getting answers when the cause of symptoms is unclear - horizon - 06-18-2014

It's not so much that I want to challenge the initial doctor's opinion. As far as I can tell, the original doctor didn't even have much of an opinion to begin with. She saw me for around five minutes. When I saw her, the symptoms I was presenting with were a bit different and not as severe, so I think that influenced the diagnosis.

If it's an injury, I would ideally like to have worker's comp cover the expense. But honestly, I'm not that concerned about having a new exam and tests paid for. I'd planned on making an independent appointment with my GP earlier this week and just paying for it normally, but I was worried that making an appointment independently will upset the worker's comp carrier, or that my own insurance wouldn't pay for the exam. At this point, it would almost be a relief to have the claim denied just so I can be free to get help. But I don't want to screw myself over in the event that there is something wrong that's eligible for coverage.

RE: Getting answers when the cause of symptoms is unclear - 1171 - 06-18-2014

since they won't return your calls send them the information in writing and keep a copy.
if they were concerned about your issue they would return your call.
you'll find that being "upset" by either party has little to do with the decisions; the law is about procedures.
even if you get a different opinion it does not change the original doctor's opinion and probably not their decision to cover the injury.
medical opinions are only evidence; the comp court resolves disputed evidence.

RE: Getting answers when the cause of symptoms is unclear - horizon - 06-19-2014

Thanks for the input. I don't know that I have a good, quick way of contacting them in writing (though I could send a letter). I think I'll try calling again and give them a little more time to respond before I make an appointment. But I feel like I need to seek care soon to make sure I don't need urgent treatment.

RE: Getting answers when the cause of symptoms is unclear - jayne - 06-21-2014

second opinions are good and most of the time you pay for your own.The docs will decide if its a work injury or not.get it done for your peace of mind