Hello There, Guest! Login Register
Index    |     Search    |     Members    |     Help

Thread Rating:
  • 0 Vote(s) - 0 Average
  • 1
  • 2
  • 3
  • 4
  • 5
WC or Private Insurance?
#1
I'm hoping for some advice.  I'm in Texas and injured my knee (meniscus tear) on the job in October 2013.  I had surgery to repair the tear in January 2014 and many months of physical therapy until WC finally said that's enough.  I was no where near healed since they allowed my quad to completely atrophy.  Because of this my knee was not functioning properly and hasn't functioned right since.  On my own or through chiropractors I've tried to rebuild my quad and get back to normal.  I've paid for this treatment out of my own pocket since WC was extremely difficult at best.   Well here I am a year and a half post op and I am still having issues.  Recently I started having sharp pain in the same knee and I need to have it looked at.  Sad

The thought of dealing with WC again makes my blood pressure rise, but I am 34 and want to continue to my very active lifestyle that I had previously.

Ideally I'd like to go through my own insurance for future treatment, but will I be rejected?

I was never sent for my MMI and my WC case is still technically open unless they are allowed to close it without that?

I don't care about the money.  I want good treatment and I want my knee back to normal.  Anyone have any advice on what my next course of action should be?  Any opinions would be greatly welcomed.

-Rachel
 
Reply
#2
I would check with your private insurance to make sure you can use it for a work related injury.

I am no expert, but my first thought would be this may get you in some hot water. I have read about people using their private insurance for treatments workers compensation has denied, but un your case there is no denial.

My suggestion would be to try and get the treatment through work comp and if denied, then ask your private insurance if they will cover it. You can also ask if they would cover it now, but I would recommend getting something in writing as you do not want to be stuck with the bills.

My opinion on chiropractic treatment is that it is limited. You really need physical therapy or pool therapy by a actual physical therapist which is different than a chiropractor who does some physical therapy for his patients (JMO).

Have you been given home exercises by a physical therapist in the past? Exercises on land or in the pool and walking is the only way to prevent atrophy. I found a great link for exercises listed by injury, I will try to find it but check with your doctor first especially since you are having some pain.
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.
 
Reply
#3
if the recent uptick in your knee symptoms is due to an aggravation outside of your work duties, then your regular health insurance should take care of it.
these are decisions based on medical evidence so coverage will follow the evidence/opinions.
what cause does your doctor support--work or not?
your choice or opinion is not the determining factor.
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.
 
Reply
#4
California_HelpI would check with your private insurance to make sure you can use it for a work related injury.

I am no expert, but my first thought would be this may get you in some hot water. I have read about people using their private insurance for treatments workers compensation has denied, but un your case there is no denial.

My suggestion would be to try and get the treatment through work comp and if denied, then ask your private insurance if they will cover it. You can also ask if they would cover it now, but I would recommend getting something in writing as you do not want to be stuck with the bills.

My opinion on chiropractic treatment is that it is limited. You really need physical therapy or pool therapy by a actual physical therapist which is different than a chiropractor who does some physical therapy for his patients (JMO).

Have you been given home exercises by a physical therapist in the past? Exercises on land or in the pool and walking is the only way to prevent atrophy. I found a great link for exercises listed by injury, I will try to find it but check with your doctor first especially since you are having some pain.


I was in formal physical therapy for about 8 months post op and 3 months pre-op.  They did little for my quad and instead were focused on getting the swelling to go down and restoring ROM.


The chiropractor is also a sports medicine doc and he got my quad almost back to normal.  But I'm still having pain.  I want to go see a doctor again to make sure nothing else is going on.  I just don't know which avenue I should take.  WC or go ahead and close the WC claim and go through my own insurance.
 
Reply
#5
(07-29-2015, 12:52 PM)1171 Wrote: if the recent uptick in your knee symptoms is due to an aggravation outside of your work duties, then your regular health insurance should take care of it.
these are decisions based on medical evidence so coverage will follow the evidence/opinions.
what cause does your doctor support--work or not?
your choice or opinion is not the determining factor.

Will my regular insurance cover it even if the WC claim is still open?  I can't explain the recent issues with my knee.  I've been abck to the gym, working on building my quad and I haven't had any injury or painful event.  I just can't go any further without pain.  I want my knee back to fully functional.........so I don't know if I should go back to WC or my insurance.
 
Reply
#6
No one on this site would be able to answer your question on would your private insurance cover an injury if you have an open work comp claim as all polices are different. You can call your private insurance or ask for your policy and review it. I personally would want to see something in writing (JMHO).

1171 wrote some good information that a doctor will need to determine if this is work related or not. You can make an apt with your private insurance doctor and see what his opinion is. Has your chiropractor given any opinions on your injury and how to move forward, if not I would recommend asking his opinion if you are still treating with him? If you have a work comp attorney U would recommend to also get his advice.


Best of luck to you.
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.
 
Reply
#7
(07-29-2015, 03:33 PM)California_Help Wrote: No one on this site would be able to answer your question on would your private insurance cover an injury if you have an open work comp claim as all polices are different. You can call your private insurance or ask for your policy and review it. I personally would want to see something in writing (JMHO).

1171 wrote some good information that a doctor will need to determine if this is work related or not. You can make an apt with your private insurance doctor and see what his opinion is. Has your chiropractor given any opinions on your injury and how to move forward, if not I would recommend asking his opinion if you are still treating with him? If you have a work comp attorney U would recommend to also get his advice.


Best of luck to you.

Thanks for the advice.  I saw my chiropractor this morning.  He thinks I need another MRI which is my reason for trying to figure out who to go to.   I don't want to screw myself and I don't want to do anything illegal.  This is complicated.

I don't have a WC attorney.  I was told this was a simple surgery and everything would be all good in 6 months.  Live and learn I guess.
 
Reply
#8
(07-29-2015, 03:37 PM)rrenfrow Wrote:
(07-29-2015, 03:33 PM)California_Help Wrote: No one on this site would be able to answer your question on would your private insurance cover an injury if you have an open work comp claim as all polices are different. You can call your private insurance or ask for your policy and review it. I personally would want to see something in writing (JMHO).

1171 wrote some good information that a doctor will need to determine if this is work related or not. You can make an apt with your private insurance doctor and see what his opinion is. Has your chiropractor given any opinions on your injury and how to move forward, if not I would recommend asking his opinion if you are still treating with him? If you have a work comp attorney U would recommend to also get his advice.


Best of luck to you.

Thanks for the advice.  I saw my chiropractor this morning.  He thinks I need another MRI which is my reason for trying to figure out who to go to.   I don't want to screw myself and I don't want to do anything illegal.  This is complicated.

I don't have a WC attorney.  I was told this was a simple surgery and everything would be all good in 6 months.  Live and learn I guess.

I understand you are trying to do the right thing.


Best of luck.
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.
 
Reply
#9
Will my regular insurance cover it even if the WC claim is still open?  I can't explain the recent issues with my knee.  I've been abck to the gym, working on building my quad and I haven't had any injury or painful event.  I just can't go any further without pain.  I want my knee back to fully functional.........so I don't know if I should go back to WC or my insurance.




do you know if additional recovery is realistic and possible? if there has not been an aggravation, then the original injury is still liable.
sounds like you need to revisit the prior comp doctor or ask the carrier for a second opinion before coming to the conclusion that additional improvement/treatment is possible.
you can always seek additional treatment on your own if comp is unwilling to provide it-- or even appeal their denial.
if you did not like the original doctor you can file form 53 to request another.
http://www.tdi.texas.gov/wc/employee/medicalben.html
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.
 
Reply
#10
(07-29-2015, 11:57 AM)rrenfrow Wrote: I'm hoping for some advice.  I'm in Texas and injured my knee (meniscus tear) on the job in October 2013.  I had surgery to repair the tear in January 2014 and many months of physical therapy until WC finally said that's enough.  I was no where near healed since they allowed my quad to completely atrophy.  Because of this my knee was not functioning properly and hasn't functioned right since.  On my own or through chiropractors I've tried to rebuild my quad and get back to normal.  I've paid for this treatment out of my own pocket since WC was extremely difficult at best.   Well here I am a year and a half post op and I am still having issues.  Recently I started having sharp pain in the same knee and I need to have it looked at.  Sad

The thought of dealing with WC again makes my blood pressure rise, but I am 34 and want to continue to my very active lifestyle that I had previously.

Ideally I'd like to go through my own insurance for future treatment, but will I be rejected?

I was never sent for my MMI and my WC case is still technically open unless they are allowed to close it without that?

I don't care about the money.  I want good treatment and I want my knee back to normal.  Anyone have any advice on what my next course of action should be?  Any opinions would be greatly welcomed.

-Rachel

Your case is still open. You should have complained about the PT you received to your treating provider. If I were you I would request a Designated Doctor exam for MMI or at least request that exam from your treating doctor. You have a right to this exam by law.

Also if you sustained new degenerative problems as a result of the PT that can be considered a WC injury in Texas.
And could result in impairment and or disability.
 
Reply
  


Possibly Related Threads...
Thread Author Replies Views Last Post
  private mediation Gabriel's Dad 12 1,395 01-28-2020, 09:11 PM
Last Post: 1171
  cannot send private messages California_Help 1 478 03-24-2019, 05:12 PM
Last Post: 1171
Question 1st Time Private Business Claim - Need Advice/Info Pacman 6 1,755 05-23-2018, 12:28 AM
Last Post: path62
  C and R, then need lumbar surgery -is private insurance strict? kmecdd 2 3,181 08-12-2016, 10:48 PM
Last Post: California_Help
Question looking for advice about federal workers' comp, and working in the private sector. shabanski 1 2,993 08-26-2014, 01:55 PM
Last Post: 1171
  WC and Private Insurance mickeyluvr63 8 9,558 11-23-2011, 06:04 PM
Last Post: 1171
  private insurance and work comp meyea 7 11,161 10-03-2011, 03:18 PM
Last Post: gba2011
  Private Mediation Cookiecrum 9 9,463 02-01-2010, 04:27 PM
Last Post: Cookiecrum
  Private Insurance? lostinthesystem 6 7,490 01-10-2008, 08:44 AM
Last Post: Lilly
  Private Investigators chrischris 34 32,691 06-24-2007, 04:26 AM
Last Post: snowbear

Forum Jump:


Browsing: 1 Guest(s)