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W/C in Ca. Do not know what I can do???
#1
Hello Everybody,

I am new to this site and hope I can get some good advice. I know I am not alone in terms of frustration in dealing with Ca. W/C claims. I have been injured since 2008 and I am just sick and tired of living in constant pain. If you think you can answer my question please do so. I am literally at my wit's end.

So, I was injured while working back in November 2008. After being repeatedly denied an MRI by W/C it came to the point where I could hardly walk. One day at work I was limping through the day and a superior Officer asked me what was wrong with me. I told him about my reported injury and the fact EVERY doctor I had seen to date told me they could not diagnose my problem without an MRI. The superior officer went into his Office, made a phone call and I finally obtained an MRI. This was after MONTHS of denial.

MRI in hand, I went to the Doctor and he told me that I had bulging discs in my L4, L5 and S1 which were affecting my sciatic nerve in my left leg/foot. After wading thru the denial machine and going to see a QME numerous times it was decided that I must medically retire, "because he can no longer perform the duties of his job classification." After 27 years of Service I was made to retire and my lawyer told me that I should take a "Lifetime Medical Award." WHAT A HUGE MISTAKE! WHAT A JOKE!

I retired in 2011 and have been seeing the same Pain Specialist since I was injured. Initially, the insurance carrier paid for my trips to and from my Doctor. Initially, they paid for my pain medication (Oxycodone). They NOW pay for NOTHING. I have brought ALL of this to my lawyer's attention numerous times. I have wasted weeks of my life submitting receipts, travel reimbursement logs for treatment etc. and NEVER received a penny for my troubles. A few weeks ago I brought the subject up again and his reply was give me what you have and I will get you reimbursed. At this point that lemon is not worth the squeeze as he has gone "dark" on me again. ( Will not respond to e-mail, phone messages etc.)

I have tried several times to get treatment from my primary Insurance carrier, Kaiser. They will not touch me, despite the fact I pay $800.00 per month for coverage, stating they cannot do so unless I close my case with W/C.

I told my lawyer I want to close my W/C case. He set a hearing date only to leave me a message the day before we were scheduled to meet to tell me not to bother showing up, "because the County does not have to show up and we will be going to the hearing alone and for nothing." I managed to contact him via phone after several days of constantly calling him. It turns out that he is MAD at me for asking him why he scheduled a hearing if the County did not have to show up. He never answered the obvious question.

I told him I want to close the case so Kaiser can treat me for my injury, which is now far worse than it ever was. I was told that the County that employed me did not have to close my case and further that they did not even have to talk to "us." He went on to tell me that in his estimation Kaiser has to treat me for any medical problems I have since I pay premiums. Two grievances to Kaiser both were answered with, No...Kaiser does not have to treat you and will not until you are free and clear of W/C.

WHAT? What happened to common sense, justice, fairness in America. They do not have to close my case, they do not have to talk to me and I can get no treatment, other than pain medication that I pay for FOREVER. Yet....a person that is here illegally or a person that has never worked a day in their life can walk into any medical facility and get treatment for free. Where did I go wrong? Where did so many working Americans go wrong?

Something is wrong here! It seems to me any large entity ( Alameda County) would welcome closing a case, as it is obviously a liability.

Sorry this is so long, but the obvious question I have is: What do I have to do to get treatment? This entire debacle (joke) has me in constant limbo. Kaiser will not treat me for ANY injury that they feel is related to my lower back injury. The County will not talk to me. My medication is under constant threat of not being filled by a given pharmacy, due to the opioid crisis and the Government's efforts to scare every business that fills a valid opioid prescription.

Does anybody know the remedy for such a ridiculous set of facts? What should I do? I take Oxycodone as prescribed and have literally gone to EVERY pharmacy in my area. The pharmacies fill the prescription for about 3 months and than begin asking if I am being weaned off of Oxy. When I tell them, "No" the pattern has been to no longer fill my prescription. I do not abuse the drug and I am currently on my last pharmacy in the area I live. I point this out because the day is near when my pain med won't even be filled despite having a valid prescription for it.

Is there some course of action I can take so I can get rid of W/C that MY LAWYER has FAILED to tell me about?

Thank you for any advice you can give me.
 
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#2
I read parts of your long post.
For help with kaiser
https://www.dmhc.ca.gov/FileaComplaint.aspx

You might be able to settle/buy out your future medical award.
You might be able to find another atty to negotiate for you

https://www.caaa.org/
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
(12-12-2019, 01:19 PM)1171 Wrote: I read parts of your long post.
For help with kaiser
https://www.dmhc.ca.gov/FileaComplaint.aspx

You might be able to settle/buy out your future medical award.
You might be able to find another atty to negotiate for you

https://www.caaa.org/
 
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#4
(12-12-2019, 03:19 PM)Heater963 Wrote:
(12-12-2019, 01:19 PM)1171 Wrote: I read parts of your long post.
For help with kaiser
https://www.dmhc.ca.gov/FileaComplaint.aspx

You might be able to settle/buy out your future medical award.
You might be able to find another atty to negotiate for you

https://www.caaa.org/
 
Reply
#5
Kaiser seems to be the insurance company who is not providing treatment for those with work comp injuries, but most private insurance companies will treat when there is a denial (for example MRI). You may want to consider going without insurance (I know risky) and pay cash for things like MRI and medications. I would try to work your way up the latter of Kaiser about the denied treatment with work comp.

The insurance carrier does not have to close your claim. You can fire your attorney and represent yourself or start calling other attorney's and try to hire another one stating you want to close your case with a C&R.

Do you send in your mileage to your attorney or directly to the adjuster?
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
(12-13-2019, 11:34 PM)California_Help Wrote: Kaiser seems to be the insurance company who is not providing treatment for those with work comp injuries, but most private insurance companies will treat when there is a denial (for example MRI). You may want to consider going without insurance (I know risky) and pay cash for things like MRI and medications. I would try to work your way up the latter of Kaiser about the denied treatment with work comp.

The insurance carrier does not have to close your claim. You can fire your attorney and represent yourself or start calling other attorney's and try to hire another one stating you want to close your case with a C&R.

Do you send in your mileage to your attorney or directly to the adjuster?
 
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#7
Thanks. I send my mileage to my attorney. I never get reimbursed. It is about 60 miles each way. I currently have a grievance pending against Kaiser with California Managed Health Care. I do not expect much as it is the State of California. I pay for my meds and was contemplating another MRI. Problem is, who do I show it to that can both read it and give me advice. I am simply sick of being in pain all the time. Another thing about W/C is it seems the system is fine with treating adults like children and the sole folks who get treated like adults are the lawyers and adjusters. It is ridiculous. I used to make decisions that had long term effects for those I made them for. Now, I can't seem to make an attorney or any of the involved parties understand how unethical their behavior is. Taking injured workers and walking away from treatment should be illegal in America. I can guarantee that it is not only legal, but acceptable. Ridiculous! Thanks again.
 
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#8
I wonder if your attorney is submitting your mileage to the insurance adjuster? Some have had luck submitting it directly to the adjuster.

I just want to check is the doctor you are seeing in the medical provider network?


You can fire him and represent yourself and then you can communicate with the adjuster. and get help from an information and assistance officer at WCAB, but that help is limited.

Often times doctors are not submitting the info needed bot get treatment requests approved or not doing internal utilization review appeals when more info is needed or inaccurate info.


In my opinion Kaiser should be providing your treatment for denied work comp treatment. Please let me know what happens with Kaiser.

I am so sorry you are going through this.
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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