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physician choice
#1
Hello: My brother in law is mentally challenged. He is and always has been mainstreamed, he works hard and does his job, he drives, he does not write or read well at all though, he still lives at home and will never be able to live completely alone.
Here is the situation : He fell at work, he is a clean up man at a pork plant, the floors are covered in fat. When he fell a wooden pallate fell on top of him hurting his shoulder (not sure from the fall or the pallate or both). After complaining for a week, his work sent him to a physician/surgeon, who then ordered a CT of his shoulder...all of this being done without any of his family there to explain things to him and his employer knows without a doubt that he his mentally challenged, we are certain the medical professionals that saw him, ran the tests, had him sign consent forms could tell he is mentally challenged, but no on notifed his parents (who he lives with and are listed on his application as person and number to call in case of emergency or injury, so there is one question, how could they treat, scan him without his complete and sound consent?

Next question, he kept all of the Dr. visit and Scan to himself before he told my husband that he had to have surgery, so we started questioning him and his mother went to the next dr.s apt. with him.

I am a registered nurse and I know the specialist/surgeon well, he is not a good surgeon, he should not even be practicing medicine in my opinion.

The Dx is rotator cuff tear. He wants to do this surgery on my brother in law and I have told his parents he needs to be seen and if need be treated by the same orthopedic surgeon that did his hip replacement, who is an excellant surgeon and my brother in law feels comfortable with him, I would feel allot more comfortable with a surgeon that is respected in the medical community.

His work told his mother that they tell you what Doctor to go to and you have to go to that certain Dr and then what surgeon.

I find this impossible to believe, but she said they told her that was "workmans comp laws

Is this true and if so is there any way we can get him to the doctor we want, could we see this surgeon they have listed and ask him to refer my brother in law to the surgeon we want?

How can they tell you specifically what doctor to see? Even the worst insurance companies give you a choice of at least two or three, as in an HMO.

thank you for any help given.
 
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#2
Smile
you were right to realize things a different and to try and get better information
workers comp is not health insurance and does not work the same; don't compare them.
It's not your brother-in-law's claim; it the employer's.
It's not your brother-in-law's doctor; it's the employers.
It's not your brother-in-law's insurance; it's the employers.
these facts complicate the decision process; there are strict limitations on what can and can't be done and how it's done.
Rolleyes
what option or choices your brother-in-law has depends on the work comp laws in your brother-in-law's state.
In some states the employer is given strict control over treatment; others give the workers some say.
tell us what state and we can point you in the right direction.
Shy
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
1171 Wrote:workers comp is not health insurance and works very differently.
It's not your brother-in-law's claim; it the employer's.
It's not your brother-in-law's doctor; it's the employers.

what option or choices your brother-in-law has depends on the work comp laws in your brother-in-law's state.
In some states the employer is given strict control over treatment; others give the workers some say.
tell us what state and we can point you in the right direction.

He lives in the state of Iowa, which is where the phycisian, scan, surgeon is also, the surgeon that we want to look at his shoulder and treat of necessary is in Omaha, Nebraska.

As a nurse and knowing what I know about this surgeon, I just can't bear the thought of him operating on my brother in law, he already has enough problems you know? Currently this surgeon has numerous laws suits against him just for FYI.
 
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#4
"The employer provides medical care reasonably suited to treat the employee’s injury, and has the right to choose the medical care. If the employee is dissatisfied with the care offered, the employee should discuss the problem with the employer or insurance carrier. In certain situations the employee may wish to request alternate care. If the employer, or insurance carrier, does not allow alternate care, the employee (through appropriate proceedings) may apply to the workers' compensation commissioner for alternate medical care. (85.27)"

http://www.iowaworkforce.org/wc/faq.htm#chooses

It's going to be difficult for your brother-in-law and you to wrest control of the treatment from the employer/carrier unless they are willing to cooperate.
If you don't have power of atty or any other agreement giving you legal standing to speak or act for him, they may not even be willing to discuss his case with you.
Of course, contact the carrier and try to arrange a change of physican or at least a consult.
Barring that, hooking him up with an atty who will deal with you both might be the best you can hope for.
http://www.iowabar.org/information.nsf/2...enDocument
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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#5
get a lawyer now!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! if your brother in law has a known medical problem(mental retardation) and has his parents as guardians then they cant treat him without their consent just as they couldnt treat a child under 18.......he needs a lawyer to get him a second opinion he is intitled to it(he may have to pay for it) but he needs a lawyer now to protect him you can bet WC wont do anything or go anywhere without their lawyers.....get a good WC lawyer....PM Timothy Belt on here and see if he knows one in your state he is a lawyer.
........I love cats, I just cant eat a whole one by myself......







 
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#6
HEy Pam 1171 is correct on the laws .. Im from Ia
ASk to speak to adjuster .. IF you or someone has legal consent ....
Keep going to appouintments with him ask that it be taped .. since he might need to rehear it .. (ggod excuse ) He has rights to copies of all reports but you have to go to each place of treatment and ask for them .... Sign papers .....
Are they treating him ok so far ??Does everything seem to be going the right way ...
!st consult with lawyers are most of the time free ... stay away from the Tv ones ...
ASk the big question >>> what are your fees ....... Have seen some who want % plus cost of expenses ...
Please Pm if you need more .... I do know a few lawyers ...
 
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#7
[/size][size=medium]Has everyone forgotten the one time doctor change that is allowed in most states?? HELLO?? If I am not wrong you have a change allowed so you can get your brother-in-law to another surgeon. It maynot be the one that did his hip but you can ask the IC either for a choice of 3-5 other docs in the ortho surgery field OR you pick a name you have heard or know by reputation and ask the IC if he is in their provider network. I did the latter and LO AND BEHOLD he was. It wasn't as difficult as everyone else is claiming it to be. Good Luck and also check the laws in your state by going online, typing in states name government statutes and look for WC Laws. I had to..it was tedious but worth it and REMEMBER WC is not going to help you navigate the way through..you saw how they treated him w/out parents knowledge.Get an attorney soon.
RSD..no CURE....but there is HOPE! Go Georgia Bulldogs..RUFF, RUFF, RUFF
 
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#8
Pam,

I want to welcome you to the forum; you will find lots of good info here; good avenues to explore; wonderful support; and be sure to check out the off topic area if you just need to vent or want to join in our crazy fun.

you have already gotten good direction; far better than i could give from our esteemed 1171 and jayne re: your brother-in-law's situation; BTW we want jayne to run for president (much better choice than that other woman running) Smile

hopefully your brother-in-law will make a speedy complete recovery. that is the important thing. I am sorry that this has happened to him; even though the family was not in the loop to begin with it is good that you will now help him negotiate this landmined field known as worker's comp.

One of the things that really struck me having worked over 25 years with no injury was that I didn't really know what w/c could/would do for ME.
It seems as if everything is slanted toward the employer and 1171 makes an excellent point that is is NOT health insurance; it is the EMPLOYER'S insurance--------while the employee is entitled to reasonable medical care, etc. (and I do feel that we can use those terms loosely!); delay and denial seem to be the order of the day. As an injured worker I have rec'd in my opinion substandard treatment which was delayed at every juncture. While private insurance does now require pre-certs, prior authorizations, etc. that system still moves faster than w/c.............If I had injured myself off the job I firmly believe that I would have 1) been treated sooner 2) rec'd more courteous treatment and not been treated like a liar, criminal or slacker and 3) rec'd better treatment but I will stop turning this into the "me
show because I want to focus on your brother in law

I absolutely think you need to consult with attorneys (usually the consult will be free of charge); if there is not already a POA in place for medical perhaps this can be put into place for any further treatment. How long has he been working at his place of employment? I think they probably conveniently "overlooked" his mental disability at the time of the accident and when he was sent for treatment as did the medical professionals.

As a registered nurse myself, I personally feel that the health care personnel dropped the ball if his disability is obvious-you and I know that it is our job to determine if a patient is able to give his/her informed consent and to question about who to contact in emergency, etc. Please cotinue to be a vigorous advocate for your brother-in-law------you know as well as I do that being firmly persistent and polite while not giving an inch is often required in these situations.

It's scary as someone who has the inside track to see a friend or loved one being "sentenced" to a doctor you KNOW you wouldn't let treat a stray dog. A rotator cuff tear is not usually an "emergency" surgery although it can be "urgent" as well as "elective". Hit the ground running learning what his rights are and good luck and again WELCOME!!!!!!!
nurse83

"After all, tomorrow is another day." Wishing you a better tomorrow!
 
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#9
BulldawgOnFire Wrote:[/size][size=medium]Has everyone forgotten the one time doctor change that is allowed in most states?? HELLO?? If I am not wrong you have a change allowed so you can get your brother-in-law to another surgeon. It maynot be the one that did his hip but you can ask the IC either for a choice of 3-5 other docs in the ortho surgery field OR you pick a name you have heard or know by reputation and ask the IC if he is in their provider network. I did the latter and LO AND BEHOLD he was. It wasn't as difficult as everyone else is claiming it to be. Good Luck and also check the laws in your state by going online, typing in states name government statutes and look for WC Laws. I had to..it was tedious but worth it and REMEMBER WC is not going to help you navigate the way through..you saw how they treated him w/out parents knowledge.Get an attorney soon.

hey there GA-------I lived in Atlanta and loved it!!!!!!!!!!!!!!!!!!
but my dgt would never forgive me if I didn't say
"GO, GA dawgs, GO; LSU TIGERS ARE ROARING!; ya hear 'em right? SmileSmileSmile

PS--------you gave Pam great advice!!!!!!!!!!!
nurse83

"After all, tomorrow is another day." Wishing you a better tomorrow!
 
Reply
#10
BulldawgOnFire Wrote:[/size][size=medium]Has everyone forgotten the one time doctor change that is allowed in most states?? HELLO?? If I am not wrong you have a change allowed so you can get your brother-in-law to another surgeon. It maynot be the one that did his hip but you can ask the IC either for a choice of 3-5 other docs in the ortho surgery field OR you pick a name you have heard or know by reputation and ask the IC if he is in their provider network. I did the latter and LO AND BEHOLD he was. It wasn't as difficult as everyone else is claiming it to be. Good Luck and also check the laws in your state by going online, typing in states name government statutes and look for WC Laws. I had to..it was tedious but worth it and REMEMBER WC is not going to help you navigate the way through..you saw how they treated him w/out parents knowledge.Get an attorney soon.

hey there GA-------I lived in Atlanta and loved it!!!!!!!!!!!!!!!!!!
but my dgt would never forgive me if I didn't say
"GO, GA dawgs, GO; LSU TIGERS ARE ROARING!; ya hear 'em right? SmileSmileSmile

PS--------you gave Pam great advice!!!!!!!!!!!
nurse83

"After all, tomorrow is another day." Wishing you a better tomorrow!
 
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