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Workers Compensaton as Legalized Fruad)
#1
Just back from my Status Hearing Workers Compensation Board State of California.... Some back ground I suffered a permanent back injury in 2001 settled in 2003, Due to employer negligence (a defective chair) I got dumped on my back again Mar 2016. I tried to work and receive treatment through April 1 2016 then went out on temporary total disability as I couldn't work a full schedule due to pain. (Documented) Jun 3 2026 SCIF denies my case cutting off any benefits (treatment) period... The same week I apply for a hearing, July 28 I receive a hearing date Aug 15 2016. I contacted many (over 20) attorneys during this time none would touch the case!

Final result to be determined by QME Oct 9 2016; SCIF allowed to consider case closed pending QME; Treatment denied pending QME.  

I paid my insurance portion along with my employer, no one rejects the idea I was injured on the job, Services and treatment denied... THIS IS THE LEGAL DEFINATION OF FRUAD!! Why won't any attorney take this CASE?!?!

I am dammed sick and tired of this abuse! and dammed near suicidal with pain, which is only to increase as I run out of pain medication.

Fast running out of options, any help/ideas would be appreciated. . less than 30 days of pain medication left, I'm allergic to opiates so street drugs are not an option.

Last time I'll ask I promise HELP!
Sad  CDC Guideline 2016 Prescribing Opioids for Chronic Pain will be the death of me.
[url=http://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm]http://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm[/url]
 
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#2
TAke your evidence to your local district atty; they are responsible for insurance fraud prosecution.
if your march injury was denied by work comp, you should try your regular health insurance.

you need to find an alternative to work comp
Have you applied for SSDI and/or Medicare?
if you have no other insurance check out the federal health center option
http://www.bphc.hrsa.gov/about/index.html
Your county has services for those who are in need and without other resources.
Contact your church or religious entities; they often can provide emergency relief.
If you have a treating physician, request a referral for counseling. It,s difficult to think clearly  when you are in pain and/or depressed.
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
(08-16-2016, 11:22 PM)Richard+Catz Wrote: Just back from my Status Hearing Workers Compensation Board State of California.... Some back ground I suffered a permanent back injury in 2001 settled in 2003, Due to employer negligence (a defective chair) I got dumped on my back again Mar 2016. I tried to work and receive treatment through April 1 2016 then went out on temporary total disability as I couldn't work a full schedule due to pain. (Documented) Jun 3 2026 SCIF denies my case cutting off any benefits (treatment) period... The same week I apply for a hearing, July 28 I receive a hearing date Aug 15 2016. I contacted many (over 20) attorneys during this time none would touch the case!

Final result to be determined by QME Oct 9 2016; SCIF allowed to consider case closed pending QME; Treatment denied pending QME.  

I paid my insurance portion along with my employer, no one rejects the idea I was injured on the job, Services and treatment denied... THIS IS THE LEGAL DEFINATION OF FRUAD!! Why won't any attorney take this CASE?!?!

I am dammed sick and tired of this abuse! and dammed near suicidal with pain, which is only to increase as I run out of pain medication.

Fast running out of options, any help/ideas would be appreciated. . less than 30 days of pain medication left, I'm allergic to opiates so street drugs are not an option.

Last time I'll ask I promise HELP!

Can you send me a private message of the area you live in California, not the exact city.

Were all of the 20 attorney's you called workers' compensation attorney's?

Have you tried going down to the WCAB your case is located at and ask to sit down with an I&A officer to help you (bring your records)? Sometimes people hire attorney's from just going and sitting in the waiting room and start up a conversation with the IW or attorney next to you. Sometimes I&A officers will give tips on who is a good attorney there and point him out and you  can try to approach him.

You are having difficulties because you claim is denied. Many attorney's do not want denied cases, but some will take them.

Did you pick this QME from requesting a list of 3?

Things you need to do now is make sure you have all of the relevant medical records and testing's reports you want this QME yo have. If there are records you do not have, you can request them from a copy service and I can help walk you through this. The defense is charged with this. You need to send a list of record you want sent to the QME 20 days in advance to the QME appointment to your claims adjuster. You can object to non medicals the adjuster tries to send. I would not recommend listing records that do not benefit you.

I agree with 1171 you should apply for state disability/EDD and use any insurance you have to pay for needed treatment.

Try not to stress out, this QME may be favorable. Make sure you google him.
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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#4
(08-17-2016, 08:26 PM)California_Help Wrote:
(08-16-2016, 11:22 PM)Richard+Catz Wrote: Just back from my Status Hearing Workers Compensation Board State of California.... Some back ground I suffered a permanent back injury in 2001 settled in 2003, Due to employer negligence (a defective chair) I got dumped on my back again Mar 2016. I tried to work and receive treatment through April 1 2016 then went out on temporary total disability as I couldn't work a full schedule due to pain. (Documented) Jun 3 2026 SCIF denies my case cutting off any benefits (treatment) period... The same week I apply for a hearing, July 28 I receive a hearing date Aug 15 2016. I contacted many (over 20) attorneys during this time none would touch the case!

Final result to be determined by QME Oct 9 2016; SCIF allowed to consider case closed pending QME; Treatment denied pending QME.  

I paid my insurance portion along with my employer, no one rejects the idea I was injured on the job, Services and treatment denied... THIS IS THE LEGAL DEFINATION OF FRUAD!! Why won't any attorney take this CASE?!?!

I am dammed sick and tired of this abuse! and dammed near suicidal with pain, which is only to increase as I run out of pain medication.

Fast running out of options, any help/ideas would be appreciated. . less than 30 days of pain medication left, I'm allergic to opiates so street drugs are not an option.

Last time I'll ask I promise HELP!

Can you send me a private message of the area you live in California, not the exact city.

Were all of the 20 attorney's you called workers' compensation attorney's?

Have you tried going down to the WCAB your case is located at and ask to sit down with an I&A officer to help you (bring your records)? Sometimes people hire attorney's from just going and sitting in the waiting room and start up a conversation with the IW or attorney next to you. Sometimes I&A officers will give tips on who is a good attorney there and point him out and you  can try to approach him.

You are having difficulties because you claim is denied. Many attorney's do not want denied cases, but some will take them.

Did you pick this QME from requesting a list of 3?

Things you need to do now is make sure you have all of the relevant medical records and testing's reports you want this QME yo have. If there are records you do not have, you can request them from a copy service and I can help walk you through this. The defense is charged with this. You need to send a list of record you want sent to the QME 20 days in advance to the QME appointment to your claims adjuster. You can object to non medicals the adjuster tries to send. I would not recommend listing records that do not benefit you.

I agree with 1171 you should apply for state disability/EDD and use any insurance you have to pay for needed treatment.

Try not to stress out, this QME may be favorable. Make sure you google him.

I've had an judgement of Lifetime medical for fifteen years. The reason no attorney will help is there is no money to be gained. I have this judgement and I can't get it enforced.
Sad  CDC Guideline 2016 Prescribing Opioids for Chronic Pain will be the death of me.
[url=http://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm]http://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm[/url]
 
Reply
#5
(08-17-2016, 11:52 AM)1171 Wrote: TAke your evidence to your local district atty; they are responsible for insurance fraud prosecution.
if your march injury was denied by work comp, you should try your regular health insurance.

you need to find an alternative to work comp
Have you applied for SSDI and/or Medicare?
if you have no other insurance check out the federal health center option
http://www.bphc.hrsa.gov/about/index.html
Your county has services for those who are in need and without other resources.
Contact your church or religious entities; they often can provide emergency relief.
If you have a treating physician, request a referral for counseling. It,s difficult to think clearly  when you are in pain and/or depressed.

My health insurance will not touch chronic pain.. for a decade they keep sending me back to my original W/C carrier. So far disability SSI tells me I have to be sleeping under a bridge before they will consider helping. I allegedly have Psych in my  lifetime medical. Haven't tried D/A as yet well nothing to lose I guess.
Sad  CDC Guideline 2016 Prescribing Opioids for Chronic Pain will be the death of me.
[url=http://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm]http://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm[/url]
 
Reply
#6
So it not just comp that has failed you since your injury?
Your normal health insurance;
Federal SSDI;
Attys;
Employer;
QME?
SCIF;
Comp court?

Reminds me of the guy driving on a freeway at night into all the oncoming headlights wondering why everyone is going the wrong way.....

Your failure to understand does not make a them wrong and you right.
When you are continually running into walls and deadends you need to change your strategy.
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
#7
(11-30-2016, 02:10 PM)Richard+Catz Wrote:
(08-17-2016, 11:52 AM)1171 Wrote: TAke your evidence to your local district atty; they are responsible for insurance fraud prosecution.
if your march injury was denied by work comp, you should try your regular health insurance.

you need to find an alternative to work comp
Have you applied for SSDI and/or Medicare?
if you have no other insurance check out the federal health center option
http://www.bphc.hrsa.gov/about/index.html
Your county has services for those who are in need and without other resources.
Contact your church or religious entities; they often can provide emergency relief.
If you have a treating physician, request a referral for counseling. It,s difficult to think clearly  when you are in pain and/or depressed.

My health insurance will not touch chronic pain.. for a decade they keep sending me back to my original W/C carrier. So far disability SSI tells me I have to be sleeping under a bridge before they will consider helping. I allegedly have Psych in my  lifetime medical. Haven't tried D/A as yet well nothing to lose I guess.

 

I offered to try to help you but never received a message from you.
 
I agree with 1171, about changing strategy.

Is it your health insurance or your doctor with private insurance who will not help you? Usually if you are denied treatment with work comp you can treat with private insurance, but you have to let your doctors office know. 1171 it sounds like he is denied and not covered under work comp, if the QME states it is not industrial could he just get a new doctor under his private insurance and not mention work comp?

I have never heard of health insurance not treating chronic pain. It sounds like you may be seeing the wrong doctors in your health insurance who do not treat chronic pain. Do you have an HMO or PPO and have you been seen by pain management doctors? Usually general physician doctors/internists do not like to prescribe pain medications especially opioids.

Have you tried calling your private insurance and request to be transferred to a nurse manager to discuss these issues? These are different than nurse case managers in work comp.
Or have you tried talking to your private insurance customer service rep or ask for a supervisor and let them know you do not have coverage for your work related injury as it is being denied and will they treat you and ask for their assistance? If they state no I would ask for a copy of their policy that states they will not treat patients with denied workers compensation claims.

Did you apply to state disability through EED this is different than SSI and you can get the form online?
SSI does have high threshold, however if your doctor feels you may be out of work for a 12 month period you can apply for SSDI too.

Many are mislead when they hear they get lifetime medical with work comp. This does not mean whatever your doctor requests will be supplied and his requests are subject to UR and IMR. It sounds like the WC IC us denying your claim which is another issue. 

There may be money for an attorney if the QME rules in your favor and if you want to compromise and release your claim. 

Another idea is to contact a nurse case manager from PAF.
http://patientadvocate.org/
They do not help those who have work related injuries, but you have a denied work related injury and I hope the nurse will knw the difference. She may be able to help you get treatment by intervening with your private insurance company. They help those who have chronic debilitating or life threatening injuries and illnesses who are having problems obtaining treatment either due to being underinsured or not insured or with having treatment denials or obstacles with their private insurance. Again, I think your situation would fall under what they do but only if they understand you have a denied work comp injury so in essence you are not covered by workers compensation but your private insurance is also not covering you. The nurse manager will have you fill out an intake form.

Another idea is if you do not get any help from your private insurance you can try calling the California State Department of Insurance and see if they can help you with your private insurance who is refusing to treat you even though you are not covered by work comp. I think that may be illegal.

When you call these places including your private insurance I recommend writing down the names of people you talked to and the date.

I know this is a lot, and may take a few days to do but I hope somewhere along the line you will get some help. How you eat an elephant is one bite at a time.
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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