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Newbie to forum - Chronic Pain - C&R - celenr02 - 08-13-2015

Hello everyone,
I;m from California. I apologize if this is already posted somewhere in this forum. I am at the end of my workers comp case and I need help. I got rid of my attorney for reason I choose not to discuss at the moment. I have been given a 25% rating. Since I became P&S, I have not seen the WC doctor and my pain management doctor has been treating me through Kaiser. After 6 years of dealing with chronic pain and then changing my pain mgmt doctor as well, this new doctor has determined i suffer from myofascial pain syndrome. I do not know how to start getting treatment for this using the WC doctors. The treatment for this is very long and it needs a lot of therapy, massage, medicine, etc for relief.
Kaiser does not cover massage and or chiropractors. 
The attorneys for the insurance company want to know if I am interested in settling using Compromise and release for all future medical. Because I know this is going to be a very long recovery, how do I put an amount on that? Where can I possibly go to determine an amount? 
Because I am still undecided in getting a new attorney, I am hoping that someone here can enlighten me on what my options are. any and all help will be greatly appreciated.
Thank you  Big Grin

RE: Newbie to forum - Chronic Pain - C&R - California_Help - 08-13-2015


In my opinion determining the amount of what is fair for you to C&R is something that an attorney is best at determining. I have not seen any resource that has this information.

If you are not treating in the work comp system you are not costing the work comp insurer any money. In my opinion this may not be the best strategy to get a C&R. I would recommend consulting with some attorney's.

Can I ask why you are not treating with work comp for pain management and is your private insurance and doctor aware they are treating you for a work related injury? Just because you have been C&R does not mean you cannot continue treatment or see a pain management doctor through work comp.Some private insurance allows it if the injured worker is being denied treatment. I have also read some private insurance companies have gone after the injured worker for the bills if they cannot be reimbursed by the work comp carrier.If you still need treatment for your work comp injury, why not get it through work comp?

If you need message and chiropractic and your private insurance is not covering, I suggest reviewing your work comp MPN (medical provider network) and pick a pain management doctor. I also recommend calling the doctors office to make sure he takes work comp patients. He can refer you out for chiro etc but there are limits and caps for this. After you pick a doctor from the MPN you just send a letter to your claims adjuster stating you chose Dr x as your new primary treating doctor and please send a letter of authorization to treat and a complete copy of your medical records to this doctor. I also suggest printing the page from the MPN that shows the doctor you picked is in the MPN and attach to your letter. I would send this certified mail return receipt to your claims adjuster and keep a copy for yourself. If you have any questions let me know.

It sounds like you have a new diagnosis of miofacial pain, so I recommend requesting a copy of your records from your pain management doctor and provide a copy to your new doctor.

If you need assistance with getting a work comp doctor I would contact and I&A officer where your case is located or you can go in and talk to one in person.

Best of luck to you.

RE: Newbie to forum - Chronic Pain - C&R - 1171 - 08-13-2015

if your health insurance doctor is in the carrier's Medical Provider Network, they can submit their billings and reports and treatment recommendations directly to the carrier. workers comp will review them for compliance with utilization review guidelines and either approve them or not. there is an appeal process for your physician.
if you are eligible-- or will be shortly-- for medicare CMS will require a set-aside account and will have to approve the future medical component.

settlement is difficult when you choose represent yourself and you are not experienced.

to cost out medical treatment you should review the carriers paid costs. request an itemized payment record from the carrier. this will give you some idea of the costs of various treatments in your area.
then you will have to have a discussion with your doctor as to types of treatment and frequency.
you can also pay to have a health professional prepare a life care plan.
you can find such service with any internet search.

RE: Newbie to forum - Chronic Pain - C&R - celenr02 - 08-13-2015

Wow thanks guys!!!! This really helps me out. I am going to look for an attorney then. I am also going to have to go to my pain mgmt doctor and ask him for the types of treatment and frequency.
I started going to my pain doctor before I filed for WC. Later it was determined that my job was responsible for my injuries. Since the WC doctor stated I was P&S, he no longer saw me. I sent emails to his office, but I never got any reply back, that is why I continued to go to my regular doctor. I signed a medical records release for the attorney I had, so I don't even know what he received if he even got documents from the hospital. There are several years of billings I'm sure Kaiser would like to get paid for. I guess I assumed that my lawyer was taking care of this part of the paperwork.
Can I request the attorney for my file?
I am in constant pain, I have tried to work and I can't. The pain is too much to be sitting all day.
My claim also has a psychological evaluation and an ortho evaluation. Both AME doctors claim it was job related injury. Thank you guys so much, I will have a lot of things to clear up. Smile

RE: Newbie to forum - Chronic Pain - C&R - California_Help - 08-13-2015

Yes, you should send a letter to your former attorney and request your file. You can also call and set up a time to pick it up but if they do not respond, I would send a letter. You own that file, not your former attorney.

If you returned to work and could not tolerate it did your doctor release you from work and are you receiving TTD payments? I do not know if this would be considered a new injury or now, but you should REALLY hire an attorney to help you. I recommend hiring an attorney who does most of not all of his business with work comp claims, and google him and read reviews to ensure you have a good attorney. I would mention your new diagnosis and that it has not been rated or reviewed. Can I ask if you are on medical leave or have you quit your job?

I recommend calling your claims adjuster and ask for a link for their MPN (medical provider network) and the rest I replied above. You can wait until you hire another attorney (if another attorney will take your case) and ask the attorney for assistance with finding a pain management doctor on your MPN.

 Have you settled your case with open medical as you mentioned your case is 6 years old?