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Confused; Waiting to hear back from attorney
#1
Hello, my wc case is a California case from 1995. Back Injury and lumbar fusion surgery. I live in Northern Nevada and have life time medical. Last year I was told by pain management they would no longer be accepting California WC. “Here’s three months of med’s.” Blah blah blah. Several dr’s offices up here that I have called will not accept it either. I weaned myself off of meds I had been on daily for 9+ years. I am without care, without pain relief with bulging discs, stenosis, herniated disc, and slipped vertebrae. Now, my adjuster tells me I cannot see my original orthopedic doctor in California because he isn’t on “the list.” I’m so tired of all of this, and have been reading forum posts here trying to figure things out. It’s private wc insurance; not state, and I have a disability retirement through my previous employer’s retirement system. (Sorry if this is too much info). My questions are: if (just wondering) I accepted settlement on my life time medical would our private insurance cover any medical related to this injury? Or, would I have to pay it all myself? Also, could someone explain what everyone is talking about with SSDI? I don’t qualify for ssdi, so would this even be a current/future issue for me. I know, it would be nice to hear back from my attorney. It took I don’t know how many calls for the secretary to call me back just to say I need to talk to my attorney and gave me a paralegal’s Voicemail. I just want to get some help for my back and am so frustrated. Thank you for reading this long. ?
 
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#2
Some private insurers do some don’t.
Ask them or have them billed and see how they respond.
Rather then SSDI your issue might be Medicare. Medicare will cover work comp care that has been settled but only after the settlement money has been exhausted. The settlement amount for work comp treatment is called a Medicare set aside.
More on set asides here
https://www.cms.gov/Medicare/Coordinatio...rview.html

If you want to fight for future treatment with work comp, you can select any doctor from their medical provider network. If they can’t provide a doc closer to home, then you are entitled to transportation, meals, lodging for routine treatment. Those benefits may be disputed and have to be litigated.

https://www.dir.ca.gov/dwc/I&A_mileageForm.pdf

P.S. your atty has already gotten a fee and there is little incentive to put in more work unless you are willing to buyout(compromises &release) your future treatment.
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
(01-15-2019, 07:13 AM)seatheeworld Wrote: Hello, my wc case is a California case from 1995. Back Injury and lumbar fusion surgery. I live in Northern Nevada and have life time medical. Last year I was told by pain management they would no longer be accepting California WC. “Here’s three months of med’s.” Blah blah blah. Several dr’s offices up here that I have called will not accept it either. I weaned myself off of meds I had been on daily for 9+ years. I am without care, without pain relief with bulging discs, stenosis, herniated disc, and slipped vertebrae. Now, my adjuster tells me I cannot see my original orthopedic doctor in California because he isn’t on “the list.” I’m so tired of all of this, and have been reading forum posts here trying to figure things out. It’s private wc insurance; not state, and I have a disability retirement through my previous employer’s retirement system. (Sorry if this is too much info). My questions are: if (just wondering) I accepted settlement on my life time medical would our private insurance cover any medical related to this injury? Or, would I have to pay it all myself? Also, could someone explain what everyone is talking about with SSDI? I don’t qualify for ssdi, so would this even be a current/future issue for me. I know, it would be nice to hear back from my attorney. It took I don’t know how many calls for the secretary to call me back just to say I need to talk to my attorney and gave me a paralegal’s Voicemail. I just want to get some help for my back and am so frustrated. Thank you for reading this long. ?

I agree with 1171. You can contact your private insurance and ask if they will provide treatment for your injury. I would make it clear you do not have access to care. This is different than if you just wanted to use your private insurance just because.

It is my understanding Medicare only has to be taken into account if you qualify for it within 30 months of settling, but check this with your attorney.

If you do decide to close out your medical and settle with a compromise and release, I suggest discussing with your attorney any other benefits that you may be receiving like long term disability etc that are affected by the settlement (if you have any).

You should ask for a list of physicians in the medical provider network and see if they have a list for your current state too). You may try to contact doctors in your state that do work comp as you may have a better chance to get them to take wc from outside of the state. California has some strict rules now for doctors requesting treatment in the work comp system. They have to request it on a specific form called an RFA and they should include medical treatment guidelines that are used by the CA wc system as well. This can be a lot to ask from an out of state doctor who is not familiar with this system (JMO).

Your attorney can get additional fees for closing out your medical. I would just make sure you can use your private insurance. Most private insurance will take over treatment for denied treatment or once a claim has been closed, but I would recommend to check with them to make sure this is the case.

Good luck to you.
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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