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Can W/C start issuing IIBs without telling you
#1

.jpg   zurich form 001.jpg (Size: 442.97 KB / Downloads: 9) OK long Story and I will try to make it short as I can ....
I inserted this letter from the W/C carrier look at Dates
I was injured 0n 1/17/2011 . I ended up having back surgery in June 2011. Here in the State of Texas
My doctor was wanting to do another back surgery. Butttt W/C sent me to the MMI Dr. and the post DRME Dr. in the same week which was on 2-14-2012. They both said I was at MMI and gave me a IR of 5% , which is fine ok what ever tired of fighting these people . But my issue is ! W/C just sent me a letter yesterday 3/17/2012 stating the post drme and MMI Dr both put me on MMI on or about 12/19/2011 . And started IIBs which will end on 4/02/2012. I have yet to receive nothing but TIBs checks to current date . Further more W/C just sent me this letter yesterday
Not one check has stated IIBs . So I feel like they are screwing me over due to the fact I am basically done with tibs and with no job sense my employer fired me on march 12th 2012 . But here is the kicker If they have told me I could have been looking for a job . But sense I waited for the doctor report for over a month I couldnt , because if I had found a job and W/C found out about it they would have made me pay all the money back . stating I wasnt released yet . But now the doctor put me at MMI 2 moths prior to the MMI eval . So basically as I am taking this I was burning up my IR checks without ANY notification of even receiving them until 3/17/2012 . My question is can they doi this and is there any thing I can do sense they have not even given proper notices what so ever ?
 
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#2
I don't believe there is anything you can do.

If you disagree with the rating of 5%. You can dispute that, but keep in mind that there is a time frame for that.
8-05, Micro laminectomy/disectomy. 10-05 lumbar fusion L5-S1. 2-07 exploritory surgery. 12-07 medical implant, Spinal Cord Stimulator. now receiving SSDI. After going back to school, I received my degree as a mechanical engineer. What can I say, it was the only way I had to beat the system. 
 
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#3
It states right on the letter that if you disagree, you have a 90 day period from date of letter to disagree and file an appeal. It sounds to me as if it is time for you to talk to a few attorneys and see what they have to say. Also, double check your check stubs and make sure that they state they are for TIBs and not IIBs. If they state TIBs, then you have as of yet to start receiving those benefits.

Also, medical in the state of TX is for lifetime, regardless of being found MMI. If your Dr can convince the IC that the surgery is necessary, they can still approve it and it will be paid for by the IC. I would talk to your Dr about this and have him submit his request and the reasons why he feels this surgery is necessary. It will go through a UR and may/may not be approved, but you can still fight to get it the same way you would have fought for treatment if your claim would have been denied in the beginning. So don't give up totally as of yet.

Angel ^j^
I've always been crazy, but it keeps me from going insane.
************
Happiness comes through doors you didn't even know you left open
 
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#4
(03-19-2012, 11:17 AM)UndercovrAngel Wrote: It states right on the letter that if you disagree, you have a 90 day period from date of letter to disagree and file an appeal. It sounds to me as if it is time for you to talk to a few attorneys and see what they have to say. Also, double check your check stubs and make sure that they state they are for TIBs and not IIBs. If they state TIBs, then you have as of yet to start receiving those benefits.

Also, medical in the state of TX is for lifetime, regardless of being found MMI. If your Dr can convince the IC that the surgery is necessary, they can still approve it and it will be paid for by the IC. I would talk to your Dr about this and have him submit his request and the reasons why he feels this surgery is necessary. It will go through a UR and may/may not be approved, but you can still fight to get it the same way you would have fought for treatment if your claim would have been denied in the beginning. So don't give up totally as of yet.

Angel ^j^

Yea I did , I talked to W/C attorney today they said the MMI Dr. and set MMI at an earlier date and what was paid to you already is a credit . So in theory If i were to look for a job before they put me at mmi I will have to pay it all back if they caught me doing so , But they have no problem taking money from me sense I waited and the DR saying I was mmi 2 months prior . W/C = There for the employer not the employee .
I have had nothing but drama with them trying to get any procedure done . In a way I am giving up because I am tired of fighting them to fix my back
 
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