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Not Ready to Return to Work / Stress (New to Forum)
#1
Hello,

Not sure what would have yielded the best results in search mode regarding my question. I am in California presently TTD due to stress related injuries. Although I have gone through physical therapy for chronic neck pain and headaches, and my physical symptoms have improved, I don't feel that I am ready to return to work. I have asked for but so far have been denied access to a mental health professional and do not have health insurance.

Is there a different approach that I can take? I do have a w/c attorney and they do not have any options as there are not any counselors that will take a patient on a lien basis. 

I hope that makes sense. I thank you for your time in answering this question.
 
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#2
You didn,t give the reason for the denial.
Who made the denial--treating Doctor?carrier?utilization Review?psyche?judge?
You can treat with anyone in the MPN.
Have you contacted doctors on your own?
Have you  tried changing treating docs to one that will make a referral?
Refusal to authorize care is grounds for an expedited hearing with the comp court. You'll need medical evidence that you need a referral for your comp injury, your own feelings will not be sufficient.
You can get a consultation/second opinion at your own expense at any time.

If there are no legal options left to get what you want, you can try settling your claim with a lump sum buyout and provide for the care yourself.

If you can't afford your own medical care, you can contact your county social services. In emergency situations they might allow at least a consultation.
Also look into public assistance and medi-cal for non-comp covered treatment.

You can also Check with the feds
http://findahealthcenter.hrsa.gov/index.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.
 
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#3
Dear 1171,

First of all, thank you for investing your time to this forum. I have read a lot of the threads and you have given so much. Thank you.

Secondly, the denial was made at the insurance level. Your insight is very helpful and I will use it to push forward. Kindest Regards to you.
 
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#4
You can challenge the carrier denial depending on the reason.
Glad I could help, if only a little.
Keep options open and push in multiple directions simultaneously.
A solution will appear.

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.
 
Reply
#5
(11-28-2016, 10:17 AM)jjjccefbr Wrote: Hello,

Not sure what would have yielded the best results in search mode regarding my question. I am in California presently TTD due to stress related injuries. Although I have gone through physical therapy for chronic neck pain and headaches, and my physical symptoms have improved, I don't feel that I am ready to return to work. I have asked for but so far have been denied access to a mental health professional and do not have health insurance.

Is there a different approach that I can take? I do have a w/c attorney and they do not have any options as there are not any counselors that will take a patient on a lien basis. 

I hope that makes sense. I thank you for your time in answering this question.


Who has denied you access to a mental health professional at insurance level was it utilization review or was it the work comp insurance company denying the psych portion of your injury? If the insurance company is denying your psych claim the next step would be for your attorney to request a QME and the QME would evaluate you and state if psych is work related or not. If you received a UR denial for psych consult your primary doctor had a short window to appeal through UR internal appeals process and then you had 30 days to request an IMR. If IMR denied it that means it is denied for 12 months unless you have a change in condition.

If your injury was after 1/1/2013 and psych is secondary to your other injuries they no longer pay permanent disability payments for this but they do provide treatment for accepted injuries. Your attorney gets paid by PD rating and why some are not helpful for those in your situation.
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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#6
(11-28-2016, 02:34 PM)1171 Wrote: You can challenge the carrier denial depending on the reason.
Glad I could help, if only a little.
Keep options open and push in multiple directions simultaneously.
A solution will appear.

Be well.

Dear 1171,

I'm starting to feel a bit anxious as the PCP that I have been seeing is only seeing me one last time since the insuance company is continuing to deny my claim. What are my options? 

I am currently in an intensive outpatient treatment program for depression that I have advocated on my behalf with my own insurance. I was able to finally get insurance due to the mental health disability which was exacerbated by the employment conditions.

My attorney at one time indicated that they would push for the mental health / depression injury claim as I am thinking about looking into permanent disability. Please note that I do not know much about the permanent disability and it is only just a consideration at this point. I am more worried about continuing on with my mental health needs, not having to worry about income via CA state disability, and having the appropriate certifications that the state is looking for while getting the care that I need.  I'm not even really sure what my question is at this point. I have often wondered what the chronology of events are to be if the claim continues to be denied. I am hard pressed to ask my attorney, because, and I'm sure you know this in general, he is a very busy attny with little time for questions that  I'm not sure how to formulate.

I hope that this makes sense. As always, I'm am grateful for your's and others responses that have had experience in this area.
 
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#7
Appeal the denial to the comp court. Your atty needs to file for a hearing.
You either get the judge to rule on whether your mental health issue is covered or not or you settle the issue for $$$.
Permanent impairment /disability is not your choice; it's a medical determination.
An atty with no time for you is not helpful or worth the fee.
Talk to other attys: search at caaa.org.
Read the guidebook for basic information
http://www.dir.ca.gov/InjuredWorkerGuide...ebook.html
Also review additional information on the state website
http://www.dir.ca.gov/dwc/WCFaqIW.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.
 
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#8
Thank you! Have a fantastic weekend!
 
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#9
You are welcome. Hope the information helps.
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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