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Mileage to pick up narcotic medication denied?
#1
I had a 360 lumbar fusion with 2 artificial discs, in January.
I kept track of my mileage since the first appointment through - 2 follow ups post op in Feb & March 2016.
This included (2) APPROVED pre-op physicals, blood work (had to be at the hospital), the surgery date, to and from, the follow-up visits.
Twice, my husband had to drive 40 miles to the neurosurgeons office to pick up prescription for oxycodone.
Even though I did not have to see the doctor, I would think this is his "treatment" plan for pain, because he found my L-5 never "frayed", so I have permanent nerve damage.
I cannot feel my left big toe and the other toes are numbish, and I cannot bend them. Walking with a cane is all he said I can do. Even then, every 50 feet I have to stop.
Without Gabapentin and the 10mgs of oxycodone TID, I would be a real mess.

I submitted it 2 months ago and I even called her to ask her if she received it. 
She said she did, and she said nothing else. She never spoke a word about denying it nor did I get any letter stating why. 

I called her 6 times in 2 weeks and she never called back. (they have 2 business days to call back in CT if you do not have counsel) 
Finally she picked up and confessed she "confused me with someone else who did not show for an IME, so she cut ME off."
That's rich.....
Now she says, we do not cover mileage to pick up a prescription that "CANNOT be called in, faxed or mailed."
The CT LAWS state that we HAVE to pick it up. 
Usually I picked it up at the follow up. Now he does not need to see me until May which is why we had to do drive to get it.
31-312 in Connecticut has the word "treatment" under the statute.
Plus, back in 2000-2005 a commissioner approved mileage to pick up oxycodone at the pain mgmt clinic I went to.
(notice how long it took me to get surgery from a 1997 work injury?)

Once they set a precedent, don't they have to continue to abide by it?

Talk about cheap skates.
Special place in hell for claim adjusters....just saying~

Thanks for any input if anyone has any.
[color=#181818][size=small][font=Merriweather, Georgia, serif]The greatness of a man is not in how much wealth he acquires, but in his integrity and his ability to affect those around him positively~[/font][/size][/color]
 
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#2
A precedent based on an error/mistake does not have to be repeated.
You can file for penalties for delayed benefits.
If you are on good terms with your employer, you can complain to them. They have more clout with their carrier.
You can also file a written complaint with the claims manager/claims administrator and up their chain of command.
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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#3
(04-26-2016, 12:33 PM)1171 Wrote: A precedent based on an error/mistake does not have to be repeated.
You can file for penalties for delayed benefits.
If you are on good terms with your employer, you can complain to them. They have more clout with their carrier.
You can also file a written complaint with the claims manager/claims administrator and up their chain of command.

Thank you for a reply.
My question is not really answered though.
Why wouldn't a medication I have to take, be considered as "treatment"?
If it is considered that, then I am entitled to bill them for driving 40 miles, to pick up the prescription.
They are trying to manipulate the statute to be what they want.
Nothing in that statute says picking up "narcotic prescriptions" does not apply.
[color=#181818][size=small][font=Merriweather, Georgia, serif]The greatness of a man is not in how much wealth he acquires, but in his integrity and his ability to affect those around him positively~[/font][/size][/color]
 
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#4
you would have to search connecticut case law to find the courts reasoning used to exclude pharmacy mileage.
I found this:
"We also note the claimant offers no authority that traveling to a pharmacy constitutes “medical treatment, examination, laboratory tests, x-rays or other diagnostic procedures” within the scope of § 31-312(a) C.G.S. While the claimant points out “narcotic drug” is a defined term in § 31-275(1)(f) C.G.S., said definition limits eligibility for benefits under certain circumstances and pursuant to § 1-2z C.G.S. this statute cannot be read as to compel the commissioner to award the claimant benefits under § 31-312(a) C.G.S. for traveling to the drugstore."
http://wcc.state.ct.us/crb/2009/5324crb.htm
there may be others that offer more details.
use the search feature here
http://wcc.state.ct.us/search/search.htm
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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#5
Dear Roots Gal:


Apparently your issue is reimbursement for the cost of round trip mileage to get medication your doctor  prescribed to treat your work injury. 

You say carrier denies mileage reimbursement  saying "we do not cover mileage to pick up a prescription that CANNOT be called in, faxed or mailed."  You also say that CT laws require you to pick the medication and that this medication is treatment per Connecticut statute 31-312,

We see a response to your post from user "1171" referring you to a January 2009 case Dellarocco v. Town of Old Saybrook which you can find online at http://wcc.state.ct.us/crb/2009/5324crb.htm.




We read that case. 

In Dellarocco the claimant didn't bother to show up for trial - courts generally don't take kindly to that.

We also see that the Dellarocco opinioon was primarily concerned with a claimant who wanted to be paid for his time to go to the doctor and pick up medication.

The quote User "1171" posted is from a footnote in Dellarocco regarding the mileage issue and seems to indicate that the carrier cannot be compelled to reimburse a claimant for the cost of mileage to pick up a prescription.



Ask yourself -- 


 >Is Dellarocco v. Town of Old Saybrook still good law? 

 >Is the footnote mere dicta?

 >What do the statutes cited in the footnote say?  


Do you think this is complicated and confusing?  You betcha' it is!



Insurance adjusters have eight hours a day to run you ragged on small issues --  small issues which add up.   They are PAID to do that. 



So  -- you can either do further legal research yourself or you can consult a workers' compensation professional -- an attorney -- or see if your state provides the public an information and assistance officer at the workers' compensation court who might be able to answer your question. 

You have obviously done some research already.  Clearly defining and researching your issue will make your time with an attorney more useful - you'll be able to ask clear questions.



In most states you do not pay a workers compensation attorney up front -- he/she is paid a relatively small percentage of your recovery when the case is resolved.



If you really want to fight this issue and other issues that you'll probably encounter in this case, consult an attorney rather than a message board.  



Sorry if that sounds harsh --  but there's a reason people spend years and lots of money to get a legal education -- the law is not simple and you can make serious errors if you treat it as DIY simple.



Although I won't be answering any further questions from you on this please know that I sincerely wish you the very best of luck. Shy


 

 


 

 
Reply
#6
Dear Roots Gal:


Apparently your issue is reimbursement for the cost of round trip mileage to get medication your doctor  prescribed to treat your work injury. 

You say carrier denies mileage reimbursement  saying "we do not cover mileage to pick up a prescription that CANNOT be called in, faxed or mailed."  You also say that CT laws require you to pick the medication and that this medication is treatment per Connecticut statute 31-312,

We see a response to your post from user "1171" referring you to a January 2009 case Dellarocco v. Town of Old Saybrook which you can find online at http://wcc.state.ct.us/crb/2009/5324crb.htm.




We read that case. 

In Dellarocco the claimant didn't bother to show up for trial - courts generally don't take kindly to that.

We also see that the Dellarocco opinioon was primarily concerned with a claimant who wanted to be paid for his time to go to the doctor and pick up medication.

The quote User "1171" posted is from a footnote in Dellarocco regarding the mileage issue and seems to indicate that the carrier cannot be compelled to reimburse a claimant for the cost of mileage to pick up a prescription.



Ask yourself -- 


 >Is Dellarocco v. Town of Old Saybrook still good law? 

 >Is the footnote mere dicta?

 >What do the statutes cited in the footnote say?  


Do you think this is complicated and confusing?  You betcha' it is!



Insurance adjusters have eight hours a day to run you ragged on small issues --  small issues which add up.   They are PAID to do that. 



So  -- you can either do further legal research yourself or you can consult a workers' compensation professional -- an attorney -- or see if your state provides the public an information and assistance officer at the workers' compensation court who might be able to answer your question. 

You have obviously done some research already.  Clearly defining and researching your issue will make your time with an attorney more useful - you'll be able to ask clear questions.



In most states you do not pay a workers compensation attorney up front -- he/she is paid a relatively small percentage of your recovery when the case is resolved.



If you really want to fight this issue and other issues that you'll probably encounter in this case, consult an attorney rather than a message board.  



Sorry if that sounds harsh --  but there's a reason people spend years and lots of money to get a legal education -- the law is not simple and you can make serious errors if you treat it as DIY simple.



Although I won't be answering any further questions from you on this please know that I sincerely wish you the very best of luck. Shy


 

 


 

 
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