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Future medical issues
(10-03-2016, 02:13 PM)Richard+Catz Wrote: More to the point, I have a settlement for lifetime medical.. It's pretty useless as I can't find anyway to enforce it. My lawyer bailed on me four years ago. Ever since I've been trying to represent myself with very little in the way of results. In March I got reinjured on another job and the SCIF has had a field day finding ways to not allow treatment, this aided by the fact I have found no legal assistance in seven months now. I tried a hearing, no result and have a QME in two weeks. This will be the final discussion point. I have pretty much blown thru my accumulated sick leave, vacation, and other means SCI is a bad joke unless I can sell my home quick and live in my car. November is make or break either we get help or just suicide I've had it SEVEN months of pain little sleep and games!

Hope things go better for you.

There is no longer anything that can be enforced as far as treatment even if you have a QME or AME report that stated you are to receive x,y,z in the future because all treatment requests are subject to UR and IMR and can be denied.

Is the carrier denying your injury or denying treatment through UR and IMR? It sounds like they are not paying you TTD due to denial. If this is the case you can apply for 3 things (unless not enough time on job) first state disability through EDD (SDI) and if your doctor believes you will be out at least 12 months you can apply for social security disability SSDI (at social security office). You can also apply for SSI (supplemental security income) at the social security department. You may also qualify for cal fresh (formerly food stamps).

Is your work comp doctor appealing your UR denials by internal UR appeal process with the UR company? If not you can try and I can give you some recommendations on how to appeal the UR denial. There are strict time limits to appeal depended upon the UR company usually 5-10 days from the denial date.

If you cannot get help from an attorney I recommend bringing your records down to the work comp board and ask an information and assistance officer to help you with things like filing for and preparing for hearing, sending cover letter and documents to QME doctor and also assist you with any UR denials. They are there to help you. I do not recommend not sending in a cover letter to the QME and allow your adjuster to just send her letter and list of records. Review the list and make sure relevant records that would help you are included. You can send your own cover letter and records to the QME as long as you copy the adjuster at least 20 days in advance.
Another reason why it may help you to go down to the work comp board as you may be able to find an attorney to represent you there. I know several injured workers who were successful this way.

Good luck and try not to let this work comp BS get you down. This is all just temporary. The hardships we face in life is what ultimately strengthens you. It is that strength that God gives us to make it through these things we encounter in life. May it be a divorce, a death, medical problem, chronic pain a financial crisis... anything that is important to you is important to God. What you are experiencing today is temporary.

If you cannot get help from an attorney or I&A officer come back to this site and I will do my best to help you . I am very good at appealing UR denials, and have taught my system to a few doctors offices and applicant attorney's. I will do my best to help you with this issue or preparing for upcoming QME appointment. I am offering my help. You are not alone.
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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