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primary care faciolity denies service
#1
hi everybody, i'm Dave from (and currently in) Texas. i was hurt on the job in Texas in Feb of 2007. My employer had worker's comp. insurance through Cambridge. immediately after the injury i called my employers and they took me to an emergency clinic, where i was xrayed and diagnosed with back strain, given tramadol and celebrex, and told to report back weekly, which i did.

the pain, which was quite sever, did not get any better for months, finally i was given an MRI and diagnosed with a herniated disk, and sent to a neurologist who did an electrical nerve test and diagnosed me with radio culpathy (pinched nerves) which was a result of the disk herniation.

i was sent to a pain specialist, and when i requested something that would ease the pain better than the tramadol and celebrex, while waiting the several weeks untill the injection date, was accused of wanting narcotics. I told the insurance people the accusation was true, that in fact i did want narcotics, as the tramadol was not addressing the pain, and giving me terrible heartburn, which i still have, even though i stopped taking the tramadol and celebrex months ago.

so i found another pain specialist, told the insurance people, who contacted my primary care doctor, and a referral was arranged. it was decided that steroidal injections were the solution, and even though i explained the tramadol and celebrex wasn't working, and in fact adding to my pain (via the terrible heart burn) was given the strong ibuprofen tablets, and tramadol, and celebrex.

it took several weeks before the injections were administered, this some 5 to 6 months after the injury, and by that time the paralyzing pain had diminished greatly, but there was still a lot of discomfort.

so the injections, a series of two separate events, did not really relieve any pain, yet i can not know that if they had been administered sooner after the injury would, or would not have. it would have been a God send if the agony of those several months could have been relieved, but i do not know that it could have, simply because nothing tangible as far as pain management occurred when the pain was at its most intense.

interestingly enough, the pain doctor, upon my final visit with him before being released told me to NEVER take celebrex and ibuprofen together. I thought this odd since it was his staff who prescribed me the ibuprophen and celebrex together, adamantly refusing to give me anything that would actualy relieve my pain. I jus find it odd, that all the time, and complicated procedures, and hours of paper work and phone calls to insurance people and accountants, and lawyers did not help the situation at all, and that i could have been spared months of quiet sever agony by being prescribed hydrocodone and cyclobenzaprine, not to mention a ton of money, and their time could have been saved.

during this time, being very frustrated, and by some miracle, i managed to find an attorney who took the (my) workman's comp case. also i reapplied for social security disability (which i had applied for in 2004 with no success).

The main reason i got the attorney was because in all correspondence with the work comp insurance people, they were determined to call my injury a "strain" and not a "herniation". since it was defined a "lost time accident" i received an approximately $100 check weekly. once the injections occurred, the insurance people stopped these lost time checks. the attorney arranged for me to see a state certified (texas) doctor to evaluate me, and after two separate visits with him, it was determined that the injury was due to the job, and i was awarded 5% disability. which resulted in the insurance people giving me a $1500 settlement.

in the mean time i was approved for social security disability, from which the work comp money was deducted. but the work comp insurance company said they would always be liable for any treatment (pain management) my condition would require.

my condition gives me constant pain, but all the doctors stopped authorizing the tramadol, celebrex, and ibuprofen prescriptions. and since the added, terrible heart burn that started soon after i started the tramadol and celebrex was no help, i simply did with out any medication. while the herniation and degenerated disks are a constant discomfort, it was tolerable and i managed it with over the counter medications.

the other morning (6 or so days ago) i woke up and when i tried to get out of bed, the pain was intense, and debilitating. i am on social security disability, but the medicare doesn't start till august (three more months). I went a couple days hoping it would get better, but it did not, and hasn't.

I went to my primary care doctor, and they said i was not entitled to further care from the work comp insurance. However, the work comp insurance people say they will always be liable for the treatment of this injury.

being at a loss for options, and desperate, i went to the emergency room of a local hospital and was given an injection and a prescription which has relived my pain wonderfully. however, now, i am liable for the cost of this treatment and the medications.

the sad thing is, in a few weeks my medicare insurance starts and i will have access to a doctor, this current situation though is pretty bad, i have many things to do, and need to be able to do them, and the pain in my back simply wont let me. thankfully the doctor at the emergency room saw and had mercy, and gave me what i needed to function adequately.

ok, that's basically the background, I am just wandering what the law actually is, is the worker's compensation insurance company actually liable for the cost of whatever treatment the condition requires or not?

frankly, i do not want to rely on worker's comp, because the treatment they give involves mostly paper work, and vague diagnoses, and most doctors don't want to mess with it, simply because the trouble is much more than the benefits. however, since they told me they were liable for my injury's treatment, i feel as if at the very least the primary care doctor they gave me should treat me when i need it.

Does anyone understand?

thanks,
Davey
 
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Messages In This Thread
primary care faciolity denies service - daveybaby52 - 05-21-2009, 08:34 PM

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