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The only hope left is for political reform
#1
Sad 
Prologue: This is a letter that I sent to both California Senators, my district Representative and the Speaker of the house. I've removed personal information and change the name of the insurance company to "The Most Evil Insurance Company" (which I find very fitting). I'm sharing this here for 4 reasons. One I long to be understood. Sometimes I feel like the people closest to me don't understand me, It'd be nice to hear from people in similar situations. Second I'd like to inspire people to contact their government representatives. Plead your case and let them know how the system has failed so many of us. Let's make it an issue and be heard. Lastly if you have any advice please feel free to give it. It's a long read, a sad story but I'm not a bad writer and maybe you're in the mood to hear about someone whose had it pretty bad. Something you can relate to.

Dear Reader,
My name is Yogi Bear, I am now 102 years old, and this is a story about the workman's comp system. Please keep in mind the information I am providing is pertinent to the few questions I will be asking. To start off let me tell you a bit about myself. I was raised in a Christian household with a strong work ethic. My first job was a paper route. I worked in fast food to buy my first car. Then I worked with children with Autism doing educational programming and eventually moved up to a supervisor. Dancing has always been my hobby but I never thought to make a living off of art. By chance I impressed a club owner and was offered a job as an instructor. Over the next 5 years I became the most popular fitness instructor and private dance teacher in my county. This isn't a boast merely for the sake of it, but to show the validity of my dream. Turning my hobby and my love of art into a business. I had financial backers, I was looking at spaces, and I had a TON of fans. I was ready to spread my wings and work for myself. Then my injury happened.
I felt a stabbing pain in my right foot, one that is still there 3.5 years later. Now I could explain what chronic regional pain syndrome is, but i believe it best to leave that up to National Institute of Neurological Disorders and Stroke https://www.ninds.nih.gov/Disorders/Pati...Fact-Sheet (in case you missed it let me point out the ".gov"). The first doctor I was sent to is the kind of doctor with multiple malpractice suits against him, a terrible local reputation, and accepting only workman's comp cases because his patients had no other options. This doctor told me in the first two visits he couldn't diagnose me. He sent me to two specialists who both diagnosed me with C.R.P.S. one being an orthopedic surgeon and the other being a pain specialist. My PTP WC doctor told me he disagreed and sent me to physical therapy. There I saw a physical therapist who admitted he had never worked with someone who had CRPS before but had a "let's just try and see attitude." After our second of 6 sessions he asked me to ride a bike. I begged him not to because I feared what would happen to my foot applying pressure and bending but he chimed in again with his "let's try it attitude." This was the first time my entire leg "died." The only way I can explain it is like when your leg has fallen 100% asleep and as the blood rushes back in. Those 1000's of needles stabbing into your skin. The center of pain in my right foot easily doubled and began sending electric shocks up to my tailbone. I cried uncontrollably for over an hour. My physical therapist lost his "let's just try it attitude" and wrote to my doctor claiming he wasn't equipped to provide treatment. I bring this up because my symptoms still reach all the way up to my tailbone now. Who is to say if it's natural progression of my disorder or the due to the mistreatment of my case.
At this time I reached out to "The Most Evil Insurance Company" and left messages with my adjuster for 2 months. Finally I called her supervisor and said if I didn't get a return call I'd be contacting a lawyer. My adjuster contacted me within 15 minutes... Promises were made to send a list of other doctors in the MPN so I could chose someone else to receive treatment from. They never made good on that offer so I sought out legal representation.

Other than the initial bungling of my treatment I've had two major issues with the workman's comp system:

1. Lyrica is my prescribed medication for CRPS. Normal pain killers such as opioids don't work because this is a neurological disorder. Every time my doctor fills a prescription for Lyrica "The Most Evil Insurance Company" does as medical review (EVERY TIME) and my medication has been approved (EVERY TIME). Now to someone who isn't in my position you may think "great our system works!" Wrong. There is a period of time given to the insurance company to do a third party medical report, but it's only to insure that medical treatments are necessary. Lyrica will always be necessary for me. So why spend money on third party medical reviews? I get an approval, my lawyer get's an approval, and the adjuster get's an approval. Guess who doesn't get an approval? My pharmacist (aka the only person who needs the approval). Now I'm SUPER lucky because my pharmacist is a previous dance student of mine and she loved my classes so she goes above and beyond for me. She calls my adjuster multiple times a day leaving messages multiple weeks in a row. The only way my pharmacist can get the approval from my insurance adjuster is when the planets align or there is some kind of miracle and my adjuster answers the phone. Then she HAS to respond. What this does to me? Lyrica has been limited to a 3 month prescription. The first month my neurological system is "warming up" to it. Similar to how an anti-depressant takes time to work. Then I have two months where I can take one extra step, move one more inch, lift one more pound and slowly retrain my brain that it's safe to use the limb again. It's a long and hard process. Then my meds get shut off for at least a month and once two months. This means withdrawls. This means heightened anxiety, depression and growing PTSD symptoms. This means another piece of my hope dies. Most importantly this means my condition is getting worse. Looking at it from "The Most Evil Insurance Company's" point of view Lyrica is $500 a month. If they can delay my refills 4 times a year (which they do) then they're saving $2000 a year.

2. By removing accountability for emotional distress from insurance companies and removing settlement increase for mental health you have effectively made it impossible to receive mental health treatment. The insurance company won't be held accountable and they don't want to pay for mental health treatment. My lawyer doesn't care about my mental health because it's work he doesn't get paid for (and he has a great local reputation). On top of that the state of California recently lessened the legal weight of a PQME which is a psyche eval from a specially state certified psychiatrist. To be honest it's an absolute mess and due to laws that heavily favor insurance companies. I've had one suicide attempt, been hospitalized, called the suicide hotline numerous times, and called loved ones to leave work and sit with me because I felt unsafe. I've been seen by two psychologists both of which agree I have PTSD/Severe Depression/Anxiety and am considered a "high harm risk." I've had two PQMEs and both agree I have PTSD/Severe Depression/Anxiety I am considered a "high harm risk", I need psychiatric treatment and my mental health deterioration is 100% due to my industrial accident. Still the insurance company doesn't do the right thing and accept my mental health as a body part, and my lawyer never took action because he wouldn't get paid for the time necessary to get it approved. I finally had to report my lawyer to the California State Bar to get him to take legal action and file a court petition. I am now seeing a psychiatrist (many years later) but the insurance company still hasn't accepted responsibility for it (by claiming mental health as a body part on my claim) which means it's a struggle for every visit and every pill. The fight for my mental health is going to be 10 times harder than that of my physical health and it's barely even begun with an initial injury date of of 4 years ago.

So in summation I was an artist. Paid to express myself, channel joy and receive daily applause. I was on track to be a SUCCESSFUL business owner and tax payer (if you knew me, my clientele and my situation you'd know I could have done it). After that I wanted to start a family. I've always wanted to be a father. That dream is dead. My new dream? To live off of social security disability benefits, medi-cal, food stamps, low income housing and hopefully not kill myself today because my life is so pathetic/boring/hopeless/joyless while watching paint dry and stuck in my houde. As for being a father? I can barely get out of bed some days let alone chase around a toddler. I'd want to say this isn't about money. If you told me I could have my old life back with the possibilities, the dreams, the hopes, the joy, the independence or have a billion dollars I would take my old life back in a heartbeat. Just so you know my loss is considered to be worth around $25,000. I don't know about you, but it seems like not only a bad trade but a slap in the face.

I know there is no law you can pass today that will help me or others who are currently in a position similar to mine. We're already in the system and our fates are sealed. I still would like you to think about how the laws you are passing are clearly leaning more and more toward the aid of special interest groups at the cost of the majority. In the spirit of this line of thought I have 3 questions:

1. If a medical review finds a medication to be necessary and I get notified, the insurance get's notified, and my lawyer get's notified then why can't I sign a waiver that allows an approval be sent to my pharmacy? Making the pharmacists rely on the insurance companies (who dodge calls and faxes like the plague) seems like a clear grab at a 25% decrease to the expense column for the insurance. As a representative of the people and for the people can you honestly say that this serves the greater good? People in California are suffering every day for that profit increase.

2. Why don't the medical costs of workman's comp cases reflect what medical professionals are doing? Every treating physician, psychologist, psychiatrist etc has to literally go to war (with paperwork, phone and fax) for every client they have and do it at a lower cost. I have to travel 8 hours round trip to see my pain specialist, 8 hours round trip to see my psychologist and 12 hours round trip to see my psychiatrist. Do you have any idea how difficult it is to find a good doctor that is willing to work with the monster that the workman's comp system has become?

3. I think I have proven that my case was mismanaged by a doctor who was benefiting from an insurance company, my injury was made worse by poor medical care, my disability rating has literally doubled due to the interruptions of approved medical care (which are being allowed under the laws you have written), and my mental state has deteriorated to the point that I'm on 4 anti-depressants. If I can't appeal to your heart then perhaps your wallet is more willing to listen. Imagine I received good medical care (CRPS has a good chance of recovery dependent on early treatment), imagine my depression was properly handled early before it spiraled into a knot that only a psychiatrist can untangle, and imagine I returned to the workforce. For the record every person who is severely injured on the job mourns for their loss of ability and WISHES they could return to work (it is very very very boring to be disabled and poor). So let's say I was on track to be small business owner or a nurse (I went pre-nursing and was eligible for the wait list) either way we're talking middle class. As a partner, a kid, a mini-van, property taxes, and we have happy California Middle Class tax paying household. In spite of my CRPS that was still a POSSIBILITY but now we'll never know and I have to live with that. The reality? Social Security is making monthly payments, California is paying for all of my non-wc medical care, California is paying me food stamps, California is paying for subsidized housing. Now I don't have access to all the numbers but what is the disparity between a middle class household tax vs a single male who is drawing on every government aid offered to the disabled? Now multiply that by all the workman's comp cases for individuals who are permanently disabled. As I've said many wish they were able to work and many share the same stories. Even if 100% of them couldn't have been fixed what percentage could have? I had a chance but it was stolen from me and many share that story. So insurance profit margins increase as the government is hemorrhaging potentially unnecessary funds and losing on potential tax gains at the same time? It's obvious Capitalism is winning this fight at the expense of Democracy and tax payer dollars. At what point does the physical and mental suffering of your people mean less than the whispers of lobbyists?

Sincerely,
Yogi Bear
"Spread love everywhere you go." - Mother Teresa​
I am not a professional and I live in California. I've been in the system 93 months and counting so I've been around the block a couple of times.
 
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Messages In This Thread
The only hope left is for political reform - Buddy1114 - 03-31-2020, 02:20 AM

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