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Lost in the process
#11
wrong assumption.
litigation slows, delays and lengthens claims activity as everything has to got thru your atty, their atty, and often the judge/court.
until or unless there are issues the process in the beginning is basically a medical one.
every state has a different system and different rules controlling benefits so I can't provide specific information for your case without knowing the state jurisdiction.

because of escalating costs most states instituted gate-keeping functions on treatment.
generally there is little that can be done to bypass necessary communication and approvals that try to limit care.

in many cases doctor fees and procedures can be increased for litigation purposes especially those that are termed "diagnostic".
doctors and lawyers ofter work together closely for their mutual benefit.

"unnecessary" is a subjective term that often depends on who is paying.

yes, the comp system can be frustrating when compared to your health care plan that you pay for.
over the years as costs to employers rose, state legislators- especially those that courted employer/business donations- tightened the spigot.

you definitely need to address the depressive emotional condition that has developed. You need to ask your doctor for a referral for counseling.
prolonged exposure to pain triggers depressive episodes that cannot be self-treated or ignored. if left untreated, this emotional condition can become chronic and can be more disabling then the original injury.
anger, blame, frustration,irritability, social withdrawal, crying, are all standard symptoms of depression that is overwhelming your ability to cope with daily life. seek professional help immediately.
there is information available on the relationship between pain and depression, here's one:
http://www.webmd.com/depression/guide/de...ronic-pain

I'm glad you came back and posted more specific details as to what you were facing with your injury.



Reminder :
........Each state has their own comp system; POST YOUR STATE to get accurate information. Use the search feature to find information from similar questions.
THANKS FOR POSTING.
 
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#12
Thanks again for you help.
I would have been upset if I hired a lawyer to expedite things and they got dragged out further!
As far as the depression goes, they have me fill out a questionnaire every visit asking about it. When I fill it out, it's obvious I'm going through depression, but they never ask or seem to care.
It sucks that you have to be your own advocate when you are impaired physically, mentally, and emotionally.
It also sucks that I gave up four years of my life serving the Govt, giving them my best. And the one time I need help from the Govt they basically crap on me. This whole WC process is demoralizing, demeaning, and inhumane.
I think during my year long ordeal I have spent 8-10 months waiting for approval or treatment. unacceptable!
 
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#13
(01-25-2014, 12:16 PM)1171 Wrote: every state has a different system and different rules controlling benefits so I can't provide specific information for your case without knowing the state jurisdiction.

"PS I'm in California"

The very first post he tells you he's in California! Appreciate your help on CA specific issues 1171.

 
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#14
(01-25-2014, 12:57 AM)A cure for pain Wrote: I guess I'm just assuming that an attorney would expedite the process?
I am sick and tired of waiting 4-10 weeks for approval every step of the way.
my specialist said they have 3-14 days to respond, yeah right!
My specialist even suggested I should see an attorney due to the ridiculous wait times.
I hate lawyers and understand their interest would be financial, but I really am reaching wits end with all the unessecary waiting.
I guess I'm just frustrated in general, lol.
The pain is just horrible and ruins almost every aspect of my life. I have a hard time caring and playing with my two young kids, it's coming between me and my wife. I've been going through depression, anxiety, weight gain. This is ruining my life and I feel like I'm gonna lose it if the pain keeps spreading and I can't find any mid-long term relief. I'm sure this is TMI, but I feel let down. I was always the hardest worker and put in 110% and this is what I get?!?

In my opinion an attorney may help, but it can also make things worse. It depends on your situation.

This is how the system works, or is supposed to:

You see your doctor, he writes a report, that often times has to be transcribed. Depending on how long this doctor's office takes to send the reports to your adjuster, may be a problem. This is unknown at this time, unless you get copies of your doctors reports, and also the proof of service page, that shows when it was sent to your adjuster. Some doctors office's send out the reports within a day or so after the exam, some take a month to send out due to it is sent out to be transcribed. Some adjusters want the doctor's office to send requests directly to Utilization Review, and some adjusters want the request first as they have the power to approve the request OR they have to send to UR. After a request is sent to your adjuster UR has 5 working days to respond. UR can request additional information, which they have 14 days, not business days to give their determination.

Do you see now that this system can lead to delays with treatment, that no attorney could help? It sucks, I know. You would need to get a copy of your doctors requests and proof of service which lists the actual date sent to adjuster to know what is causing the delays. However, if your claims adjuster is illegally delaying sending these requests through UR, then an attorney may be able to help by taking those issues to court, maybe. You should be getting copied on all reports and testing's as you are representing yourself. If you are not being sent this, ask your doctors office to start copying you, and they need to give you your past records.

I don't know what type of doctor you are at, however you do not seem happy with your treatment. If you are stuck at a employer friendly doctor, they may not be looking out for your best interests. An attorney should know what doctors to send a client to in their MPN to avoid this. In my opinion staying away from industrial clinics such as US Healthworks, and Concentra may be in the injured workers best interest. Who picked your doctor you are currently at...was it your claims adjuster or employer? If so, there is a high chance you may be at a defense oriented doctor. Do you know how to access your MPN to look for doctors?

If you are receiving proper treatment currently, without denials, it may benefit you not to get an attorney at this point. It would not hurt to consult with a few though and it is a free consult. Stay away from the large work comp attorney mills and google search your attorney for reviews, and I recommend a work comp specialist. You could also get their opinion on your current doctor, and where they would suggest, just an idea. Calling an I&A officer at your local WCAB can also be helpful when you have questions. You can also go down and meet with one.

Physical therapy does have limits of 24 visits, however I don't know if that is limited to all body parts...this may be something worth asking an I&A officer.

I am not an attorney.Anything I write should not be considered legal advice.I am writing from my own personal experiences,which is not from any sort of legal background. You should consult with an attorney over legal issues. In California, if you cannot get an attorney you can consult with an I&A officer.
 
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#15
I once waited 10 weeks for approval of a 2nd MRI that ultimately turned up my problem. I often wait about a month on average.
As for my doctor, I am only supplied one piece of paper per visit, stating my work status. Every visit he just asks my pain level, has me move my arm two ways, takes a couple notes and asks if I need any refills. Thats it. He never has any helpful advice. He seems to have a new assistant every month. I never picked him myself, how do I change?
Even when I tell him my pain is getting worse, spreading to new areas and causing headaches he barely jots down anything and offers no new meds or treatments.
He seems to just completely differ to the Specialist now.
I did talk to an attorney today to test the waters. He was willing to represent me, but wasn't pushy. He said he couldn't do much to expedite the process exept for forcing them to play by the rules if need be. He said my case had the potential to drag on for another year or more. He could tell I wasn't ready to sign on, and suggested I focus on treatment and call him back when I was ready.
Any suggestions on how to check out his background?
I may talk to a couple for insight since its free, but hold of on hiring anyone for now.
 
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#16
(01-26-2014, 12:35 AM)A cure for pain Wrote: I once waited 10 weeks for approval of a 2nd MRI that ultimately turned up my problem. I often wait about a month on average.
As for my doctor, I am only supplied one piece of paper per visit, stating my work status. Every visit he just asks my pain level, has me move my arm two ways, takes a couple notes and asks if I need any refills. Thats it. He never has any helpful advice. He seems to have a new assistant every month. I never picked him myself, how do I change?
Even when I tell him my pain is getting worse, spreading to new areas and causing headaches he barely jots down anything and offers no new meds or treatments.
He seems to just completely differ to the Specialist now.
I did talk to an attorney today to test the waters. He was willing to represent me, but wasn't pushy. He said he couldn't do much to expedite the process exept for forcing them to play by the rules if need be. He said my case had the potential to drag on for another year or more. He could tell I wasn't ready to sign on, and suggested I focus on treatment and call him back when I was ready.
Any suggestions on how to check out his background?
I may talk to a couple for insight since its free, but hold of on hiring anyone for now.

How to change doctors...you need to find out if your employer (if self insured) or work comp carrier has a MPN (medical provider network). If they have an MPN, then you can go online and search for different doctors. You can ask your claims adjuster for this. If she says she will send you a list of doctors, I would suggest asking for the MPN link as well as an ENTIRE list of MPN doctors. I have heard of adjusters sending a short list of defense/employer friendly doctors. If your employer does not have a MPN, then you can treat with any doctor who takes work comp. Did you ask the attorney you met with what he thinks of your doctor?

Did your HR department or claims adjuster send you to your current doctor? If so, it may benefit you to change.

Contacting the medical unit may help you find IF you have an MPN and HOW to access it. There was a person in charge of MPN's that you could call for assistance, and hopefully there still is, as it has been a while since I called. If you scroll down this link, you can call the medical unit and ask if there is someone to help you with your MPN http://www.dir.ca.gov/dwc/MedicalUnit/imchp.html

You can also get help by calling an I&A officer. Here is a list of number. http://www.dir.ca.gov/dwc/IandA.html

How to check on applicant attorney's. I recommend googleing their name and checking the internet. Check AVVO, and the other attorney reviews. You can do a search on the internet by putting their name and then attorney reviews, or attorney complaints as a search topic. A rating of (6.5) on AVVO does not mean it is a bad attorney, that is normal, but scroll down to see their reviews. The bad mills are large firms that have a LOT of bad reviews. Before hiring an attorney I suggest asking how they like to communicate, e-mail, phone, paralegal AND how long they take to return a call. ONLY call when you REALLY need to know something. I suggest meeting with a few lawyers, and they do not need to know yu are meeting with others.

You should ask your doctors office for a copy of your file/records and also request that you are copied on all of their reports as you are pro-per. Otherwise, you will not know what your doctor is requesting and when it was requested. You also should want to know what he is writing about you...is he being honest or is he minimizing your condition or not listing all injuries, for example. It will also be more difficult for you to appeal something when denied, without your records.

The amount of time you are stating to get authorizations for testing's etc is within the normal time that it takes (IMO). You seem to be getting approvals on your doctors requests, so I don't know if it would benefit you getting an attorney at this point. If you feel you are not receiving proper medical treatment, then I would look into getting a list of the MPN, and then you write a letter to your adjuster that you wish to change doctors, and their name and address. Call those doctors on the MPN first, as some do not take work comp patients, and I would also research the doctor to make sure he is not a defense doctor. Maybe giving that attorney you met with a call and ask him about a few doctors on your MPN would be a good idea before picking one.

These are just some suggestions...

I am not an attorney.Anything I write should not be considered legal advice.I am writing from my own personal experiences,which is not from any sort of legal background. You should consult with an attorney over legal issues. In California, if you cannot get an attorney you can consult with an I&A officer.
 
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#17
Thank you for all the info. I will definately do the research I need regarding switching doctors and possible lawyers.
It is sad to hear the wait times are standard, it seems like forever when you are in pain.
I thank everyone here for their help, and although I may not have gotten any of the answers I wanted to hear, the truth is better.
Wish me luck, and I will check back in with any pertinent information.
 
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#18
I wish you luck.

If you need help with your MPN or changing doctors an I&A officer can assist you, and you can print out a list of doctors. Maybe run the list by an applicant attorney when you meet with him.

It sounds like your treatments are getting approved, and you may not need an attorney at this point. Are you in good terms with your employer? I am going to be honest with you on one thing. Sometimes hiring an attorney does cause a rift between employee and their employer (not always). This is especially true if the employer is self insured. I always say hire an attorney if things get bad. From your posts they may seem bad, but you are getting some treatment, and sometimes attorney's are not the one's t help with that. Having a doctor who looks out for your medical best interests and knows how to write reports and appeal denials is very important.
I am not an attorney.Anything I write should not be considered legal advice.I am writing from my own personal experiences,which is not from any sort of legal background. You should consult with an attorney over legal issues. In California, if you cannot get an attorney you can consult with an I&A officer.
 
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#19
The company I work for is just my boss and I. I felt really bad bailing on him. But after taking three weeks off unpaid trying to heal, and him making me mix and haul concrete by hand right after was just the straw that broke the camels back. I have barely talked to my boss because I feel guilty filing this claim. I know he has replaced me, and it would feel odd for me to return. Honestly my job isn't nearly as big of a concern as my health is to me at this point. I should be using my brain instead working in construction anyways, and maybe this is a sign to do just that...

I will attempt to get ahold of IA person tomorrow regarding MPN network and change of doctor. Again I appreciate your assistance.
 
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