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Doctor lied on PR-2 form - CA
#11
(10-04-2016, 11:37 AM)1171 Wrote:
(10-04-2016, 04:20 AM)BB019 Wrote:
(10-03-2016, 08:51 PM)1171 Wrote:
(10-03-2016, 07:35 PM)BB019 Wrote:
(10-02-2016, 07:02 PM)1171 Wrote: talk to the doctor that wrote the erroneous report and  information.
If it,s corrected, it might be a faster way to undo the disability decisions that were based on it.

The doctor knew exactly what she was doing. If you are interested in further details, I can PM them. But she knew perfectly well what she was doing. I tried to only give highlights of the situation so I didn't write a novel.  Rolleyes

you can file a complaint with the medical board or managed health care
http://www.dmhc.ca.gov/
http://www.mbc.ca.gov/

I will do both. Thank you for the links!!

Lying to deny benefits is fraud. Take your evidence to your local district atty or insurance commissioner
http://www.insurance.ca.gov/0300-fraud/0...and-forms/

Thank you again for the link. Somehow I didn't connect the dots that I should be looking in that direction. I read through most of the links, and pass the 'fraud' test for evidence etc. so I'll submit a complaint. Thank you for all your help - it is very much appreciated.
 
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#12
(10-02-2016, 12:32 PM)BB019 Wrote: I have an approved work comp claim and the work comp insurance co my employer had at the time of my date of injury is paying me (PD now, pending settlement - already had trial - now up to judge).

The issue I'm still having is with my private disability insurance through my former employer (they let me go while on leave). Disability has denied benefits for both STD and LTD since last summer. I am supposed to be supplemented to 2/3 of my salary but I am not getting anything and EDD denied me also.

I ordered my claim file and now I understand why. There is a report in my file that I was unaware of, and the report does not state the truth. Not only is the information totally false that is written, but the doctor who wrote it isn't even one of my treating physicians nor is she in the same field / specialty that is required for my injury.

I went over the notes and in doing so, noticed two things. 1. I have an email proving that what was said to me in our appt is not as the doctor stated because I emailed some questions after the visit (this email was omitted from the claim file but I have a copy of it from my medical file and the online hospital system). 2. The notes the doctor recorded in my file PRECEDED my appointment, so the office visit notes were documented and recorded on the system by time stamp, before I ever met this woman. Yet, she felt the need to make up things, lie about a few more things, and then by doing that special PR-2 form (Primary Treating Physician's Progress Report), single handedly cut off my benefits.

I have no idea what avenue to take to get someone's attention on this matter. I have appealed with disability (lost) I have appealed with the hospital (lost) I tried to find an ERISA attorney (didn't go so well-no real money in it, apparently) so does anyone have another suggestion on where I might get some help?

Similarly, upon reading the notes by my private insurance company and as outlined to their 'clinical review team' for recommendation regarding my last appeal, information was misrepresented to the point where I was made out to be, according to their opinion, lying about my injury and not taking my injury serious enough to seek treatment. I'm not even going to bore you with the details on that other than to say, I submitted a five page document outlining all my steps and provided the who what where and when as to being blocked from actually getting treatment, yet the report says there is no evidence to the contrary to their findings of 'lack of intent' on my part. I am out of appeals, as in no more allowed because I lost them all.

I have reached out to some other types of attorneys but not holding my breath since they are not specifically ERISA attorneys. Is there anything I can do to bring attention to this issue?
 
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#13
(10-02-2016, 12:32 PM)BB019 Wrote: I have an approved work comp claim and the work comp insurance co my employer had at the time of my date of injury is paying me (PD now, pending settlement - already had trial - now up to judge).

The issue I'm still having is with my private disability insurance through my former employer (they let me go while on leave). Disability has denied benefits for both STD and LTD since last summer. I am supposed to be supplemented to 2/3 of my salary but I am not getting anything and EDD denied me also.

I ordered my claim file and now I understand why. There is a report in my file that I was unaware of, and the report does not state the truth. Not only is the information totally false that is written, but the doctor who wrote it isn't even one of my treating physicians nor is she in the same field / specialty that is required for my injury.

I went over the notes and in doing so, noticed two things. 1. I have an email proving that what was said to me in our appt is not as the doctor stated because I emailed some questions after the visit (this email was omitted from the claim file but I have a copy of it from my medical file and the online hospital system). 2. The notes the doctor recorded in my file PRECEDED my appointment, so the office visit notes were documented and recorded on the system by time stamp, before I ever met this woman. Yet, she felt the need to make up things, lie about a few more things, and then by doing that special PR-2 form (Primary Treating Physician's Progress Report), single handedly cut off my benefits.

I have no idea what avenue to take to get someone's attention on this matter. I have appealed with disability (lost) I have appealed with the hospital (lost) I tried to find an ERISA attorney (didn't go so well-no real money in it, apparently) so does anyone have another suggestion on where I might get some help?

Similarly, upon reading the notes by my private insurance company and as outlined to their 'clinical review team' for recommendation regarding my last appeal, information was misrepresented to the point where I was made out to be, according to their opinion, lying about my injury and not taking my injury serious enough to seek treatment. I'm not even going to bore you with the details on that other than to say, I submitted a five page document outlining all my steps and provided the who what where and when as to being blocked from actually getting treatment, yet the report says there is no evidence to the contrary to their findings of 'lack of intent' on my part. I am out of appeals, as in no more allowed because I lost them all.

I have reached out to some other types of attorneys but not holding my breath since they are not specifically ERISA attorneys. Is there anything I can do to bring attention to this issue?
File a writ of Mandate with the superior court to have it over turned, it was an administrative action I believe you can petition superior courts to intervene just a suggestion good luck
 
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#14
Civil court will not act on this work comp issue.
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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#15
(06-16-2017, 01:11 AM)1171 Wrote: Civil court will not act on this work comp issue.

Thank you so much for your reply! I am not pursuing anything anymore.  The judge ruled in my favor with my work comp case - on all counts - from my work comp trial, then the insurance company/my former employer decided not to comply with the court order.  The judgement came in January of this year, with specific instructions regarding my need for treatment now and in the future, and I'm still being denied treatment so I would have to take them back to court. 

I had an awareness change, and I don't even care anymore. I moved out of state, and am moving on. I gave them way too much time, energy and attention.

But I sincerely appreciate all of your input, and the many conversations I've had via PM with California_Help...this forum is awesome and a great resource...but for me I am letting it go and am very happy for doing so. I have no desire to continue holding on to my former frustrations...and in fact I now look at them as learning lessons and gifts that have benefited me. I'm lucky for my newfound awareness, and again I thank you and everyone else here so much for your words of wisdom.

Take care!
 
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#16
"The only winning move is not to play"....WarGames 1983
Be well.
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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#17
(06-17-2017, 01:43 PM)1171 Wrote: "The only winning move is not to play"....WarGames 1983
Be well.

I was actually thinking of that movie yesterday! Thank you - you too. I know so many people benefit from your input and the resources you provide. Such a great service to others!!
 
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#18
Every little bit helps.
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
#19
BB019 I am VERY happy to read your comments and SO happy for you. New state, new beginnings...the world is your oyster. What you went through was a learning experience, and not a life sentence. Glad you have such a positive attitude! I wish you the best.
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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