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Old 09-16-2007, 06:01 AM   #1
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cashmoni HB User
Question Just learning about comp...need help

Hi all,

I'm just finding out how favorable w/c law is to insurance co. and how our rights are disregarded.Big brother following the $ also I suppose .

Although my journey has just begun I did,according to alot of ppl get off to a good start.My employer had not refused claim(yet)and I have seen my first payment,thank god.My problems are arising out of the corperate doctors and my rights.I've never filed a claim before and am comtemplating hiring an attorney.I know i have the right to see a doctor of my choice and everyone i want to see,needs a referral and the w/c doctor won't provide me one.It's like they'll only authorize me to see a doctor in thier network.I don't want a doctor in thier network for obvious reasons.This is a very slick way of denying my rights,but I do understand the independant doctors concern,they also want to get paid and not have to wait around for years of litigation.


So here's my question....How does one go about finding a doctor of thier choice w/out referral?Do I go thru my personal insurance?Wouldn't that muddy up the claim process?Explain to me how hiring an attorney would allow me to see a doctor of my choice?I know there are variances among state laws but someone has to know what i'm talking about?


Thanks for any and all help,
cash

 
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Old 09-16-2007, 11:01 AM   #2
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deltaelise HB User
Re: Just learning about comp...need help

I do know that a lawyer is necessary to fight W/C.
Both myself and my husband had to go through it all and it was just plain awful.
My advice to you is to not let them get you down. W/C people are mean and heartless and will surely take advantage of you without a lawyer.
I don't know if hiring a lawyer would h elp you get a dr of your own choice as both sides, W/C and your lawyer send you to their drs. Ofcourse the W/C drs will say you are fine and the lawyers drs will say you are not so it all eventually boils down to is your word against theirs in a crooked court system.
I always had my own dr during my W/C ordeal but it really doesn't matter much what they say.
When the W/C dr found out my husband had been there many years earlier when he was almost killed at work, he kicked me out thinking I was just trying to get something for nothing when it was my boss who injured me and stated so in all the records. It's one crazy ride and I wish you the best in your journey through this.

 
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Old 09-16-2007, 11:41 AM   #3
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MAMMYBOJAMMY HB User
Re: Just learning about comp...need help

Quote:
Originally Posted by cashmoni View Post
Hi all,

I'm just finding out how favorable w/c law is to insurance co. and how our rights are disregarded.Big brother following the $ also I suppose .

Although my journey has just begun I did,according to alot of ppl get off to a good start.My employer had not refused claim(yet)and I have seen my first payment,thank god.My problems are arising out of the corperate doctors and my rights.I've never filed a claim before and am comtemplating hiring an attorney.I know i have the right to see a doctor of my choice and everyone i want to see,needs a referral and the w/c doctor won't provide me one.It's like they'll only authorize me to see a doctor in thier network.I don't want a doctor in thier network for obvious reasons.This is a very slick way of denying my rights,but I do understand the independant doctors concern,they also want to get paid and not have to wait around for years of litigation.


So here's my question....How does one go about finding a doctor of thier choice w/out referral?Do I go thru my personal insurance?Wouldn't that muddy up the claim process?Explain to me how hiring an attorney would allow me to see a doctor of my choice?I know there are variances among state laws but someone has to know what i'm talking about?


Thanks for any and all help,
cash
Hi again Cash. When I first got hurt on my job, I went to my Family Dr. first.

He then sent me to an Ortho. After going to him for a while, he sent me to a Neuro.

The Neuro sent me back to my family Dr. Then WC ppl sent me to "their" dr. Then they yanked me off WC payments because their Dr. said I ws ok to do clerical type work...not what I had been doing which was physical labor of lifting up to70lb packages. I got so yanked around it wasn't funny. Then I got myself an Attorney and all that nonsense stopped and I started getting the proper treatment.


If I were you, I would go to my family dr., and ask him/her to refer me to a dr. that accepts WC. Give your Dr. the name of who you would like to go to if you have already chosen a new one that you want to go to. Your family dr. should know what needs to be done to deal with WC.

It is really funny that having WC Insurance is mandatory for all Employers, yet we as the Employees have no choice in a lot of matters. So, why do they make them carry insurance on us in the first place if we aren't going to be the ones making our own medical decisions.

I would definitely get a WC Attorney NOW. I have read a lot of your posts and it seems to me you are being jacked around.

Get a lawyer, and let all of them have to go through your attorney for all matters.

It is not necessiarily that having an attorney allows you to see the dr. of your choice, but that he will make sure your rights are not being swept under a rug, which right now they seem to be doing just that to you..

If they know you have a lawyer, it seems that things start running a lot smoother for people.

There also should be a WC Ombudsman for your State. If you will go to the WC handbook for your State, it should tell you how to contact the Ombudsman.

I had to do that last year with my case mgr. She was a new one for me and was trying to dick me around, when the office had lost all of my medical records from 1987 up to 2003. She was trying to deny treatment because she didn't have any paperwork showing I had neck injury, in addition to my back!

Thank God I had copies of all my Medical records from the date of injury so I scanned and emailed the initial report of incidence to her, which clearly showed my neck injury. They will do everything they can to try and starve you out, and make you settle with them prematurely....DON"T!!!

If you plan on suing them, and you certainly should, a lawyer will file the necessary papers to get a lawsuit started. You only have a certain period of time to start a lawsuit..I think maybe a year from the date of injury. Even if you do not plan on suing them, you still need an attorney. he/she will get all of them on the ball.

In my State, WC Dr. bills have to be paid within 30 days of the visit, so WC has no say so as to how long they can wait to make payment. It is a law they are paid in 30 days. This keeps the Dr.'s from worrying about having to wait a year to get paid for their services.

Are you the one who told me you had found the WC Handbook online for your STATE and downloaded it so you could refer to it??. If you are, I would do some reading now and if you aren't the one who said that to me, then if I was you, I would try to find it online and save it so you can go back and read a little at a time.

Good Luck and hope I said something that will help you.
Take care, Mammy

 
Old 09-16-2007, 09:55 PM   #4
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cashmoni HB User
Re: Just learning about comp...need help

Quote:
Originally Posted by MAMMYBOJAMMY View Post
Hi again Cash. When I first got hurt on my job, I went to my Family Dr. first.
Wish I did,but was afraid they say it was BS I went to work to ask my boss for a few more days off w.out reprecussions.I felt obligated to see him and when he seen me,he said he couldn't let me work in that condition and made me go to clinic

He then sent me to an Ortho. After going to him for a while, he sent me to a Neuro.

The Neuro sent me back to my family Dr. Then WC ppl sent me to "their" dr. Then they yanked me off WC payments because their Dr. said I ws ok to do clerical type work...not what I had been doing which was physical labor of lifting up to70lb packages. I got so yanked around it wasn't funny. Then I got myself an Attorney and all that nonsense stopped and I started getting the proper treatment.


If I were you, I would go to my family dr., and ask him/her to refer me to a dr. that accepts WC. Give your Dr. the name of who you would like to go to if you have already chosen a new one that you want to go to. Your family dr. should know what needs to be done to deal with WC.

I don't go to doctors(stubborn/stupid?ask my wife,lol) but maybe every other year when I get migraines.I usually tell them it's a life long thing and let them know the scripts I was last on and they fill em.When migraines go,so do I.I am getting migraines now so I think I will find one and get some help and see if they could help me.What I did do though is my wife has a friend who worked for a chiro,(i know,i know he's no ortho/nuero)she see's him every week(herniated disc problem,she refuses surgery) and is a friend,and I figure he's seen more of this stuff and can read an mri better than I and will give me his honest opinion on what my future will behold.I do know that my disc is "not" going to pop back in,lolPlus,this will stop me from looking at them all the time

It is really funny that having WC Insurance is mandatory for all Employers, yet we as the Employees have no choice in a lot of matters. So, why do they make them carry insurance on us in the first place if we aren't going to be the ones making our own medical decisions.

Lifes full of hypocrisy ain't it?

I would definitely get a WC Attorney NOW. I have read a lot of your posts and it seems to me you are being jacked around.

If you knew all the bull they've told me and I've sat there and played along with them,you'd yell at me.I'm probably 100 for 100 when matters come up with them.I know my disc isnt gonna magically fix itself,each flare up will
get worse.It's ruined.I finally got the inflammation down and move around alot better but the cramps in left leg,and sharp pain and pulling in tailbone area wont.I'm weak as hell too and have no endurance anymore.Before this happened I was in good shape,6'/180# and now I'm a wreck,I'm down to167# and can't sleep or eat.I'm not paralyzed or won't be but I don't think I can do anything heavy any more til it's fixed.Picking a gallon jug of milk off the floor cause sharp pains in spine,at lumbar region


Get a lawyer, and let all of them have to go through your attorney for all matters.

It is not necessiarily that having an attorney allows you to see the dr. of your choice, but that he will make sure your rights are not being swept under a rug, which right now they seem to be doing just that to you..

If they know you have a lawyer, it seems that things start running a lot smoother for people. I have been talking to an attorney a friend referred me to and he has helped me some and wanted me to call friday and set up a meeting but I didnt hear back from case mngr til late friday and wanted to see what they where gonna come up with.I knew I wouldn't be allowed to see this dr.he is the best of the best in my opinion,and my back deserves nothing but,so I guess I'll talk to him tomorrow also what ****** me off was she just went ahead and scheduled me an appt with an ortho of her choice w/out consulting me.I doubt she ever called dr I wanted..They've been given enough rope to make me justified in getting an attorney.

There also should be a WC Ombudsman for your State. If you will go to the WC handbook for your State, it should tell you how to contact the Ombudsman.

We have talked before and I did ******** the handbook (pdf) and I dont see anything in there about OMBUDSMAN.Whats that?I also wonder about the handbook because w/c is paying me evry 2 wks and according to the handbook,it specifically states that you're supposed to get paid on the same pay schedule as you hed before injury...every week.Talked to attorney on it and he said yeah,they can do that.No biggy,at least I have something coming in.

I had to do that last year with my case mgr. She was a new one for me and was trying to dick me around, when the office had lost all of my medical records from 1987 up to 2003. She was trying to deny treatment because she didn't have any paperwork showing I had neck injury, in addition to my back!

Thank God I had copies of all my Medical records from the date of injury so I scanned and emailed the initial report of incidence to her, which clearly showed my neck injury. They will do everything they can to try and starve you out, and make you settle with them prematurely....DON"T!!!

If you plan on suing them, and you certainly should, a lawyer will file the necessary papers to get a lawsuit started. You only have a certain period of time to start a lawsuit..I think maybe a year from the date of injury. Even if you do not plan on suing them, you still need an attorney. he/she will get all of them on the ball.

In my State, WC Dr. bills have to be paid within 30 days of the visit, so WC has no say so as to how long they can wait to make payment. It is a law they are paid in 30 days. This keeps the Dr.'s from worrying about having to wait a year to get paid for their services.

Are you the one who told me you had found the WC Handbook online for your STATE and downloaded it so you could refer to it??. If you are, I would do some reading now and if you aren't the one who said that to me, then if I was you, I would try to find it online and save it so you can go back and read a little at a time.

Good Luck and hope I said something that will help you.
Take care, Mammy

As always mammy,you are helpful It seems when one worked/works for government,they learn to keep paperwork and take notes.Always C-Y-A

Again,thank you
cash

 
Old 09-17-2007, 08:31 AM   #5
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MAMMYBOJAMMY HB User
Re: Just learning about comp...need help

Cash, An Ombudsman is a "middle man" for lack of a better description..

If the WC people aren't doing what they are supposed to for you, the OMB can be contacted and they will intervene and make sure things are getting done for us...the employees.

You are right, in that, your back will never be the same after an injury. Maybe if we were real young it would, but to me, if we are past the age of 25we do not heal well at all.

I wish you the best of luck Cash, in getting the "cash" that you deserve. I wish I had gotten what is called an Actuary when I settled...hind site 20/20.

An Actuary can take your wages, figure in any pay raises, etc. and come up with a figure you should get for your injury.

I have also read a person should get 4X their medical expenses as a financial settlement. I just know I didn't get enough. I really, really, thought I was going to be able to go back to my job....

How long have you been off work so far? I was off 14 months, and when I went back to try and work, I just couldn't do it. I loved my job and was making $$13.02 and hour wayyyyyy back in 1987.

That was big bucks back then. Hey, for most people, it is still big bucks even today.

I tried working at several different places and would go in when I knew I could not sit there all day.

I went through the WC Rehab program, they sent me to a Psychiatrist, and was going to send me to college to retrain me. The State would pay for everything.

I went and took the entrance exam, met with the Disability coordinator and was set to go....when.....the WC Rehab place called me and told me I had drawn to much LTD the year before and so they couldn't send me that Semester, but would the fall semester...This was a couple of days before I was to start classes.

I told them, I cannot wait until Fall. Who is going to pay my bills, etc??? They told me I could not get any help for anything except pay for college. Well, I was not about to lose my home, my car, etc. that I had been working for since I was 15 years old.

So, I met my current hubby, who had just been laid off his job. We decided to open our own business, and so we did. I maxed out my Credit Cards to do this. Talk about being scared to death!!! I was....Things turned out ok and we had a thriving business. I got the credit cards paid off in 3 years...what a relief that was.
It made us a living for 13 1/2 years. Then, my hubby had a stroke in 2001 and he could no longer help me with it. I sold it last April, sold another house I owned, applied for SSD, got it and here I am today. I am not getting a big check, but I managed to pay off every debt we had after I sold the place and had a little left over.

My hubby is 7 months younger than me and will take early SS next July when he turns 62. I can't wait. The added income will be welcomed.

Well, here I go again....writing a book....
Will talk to ya later. Let me know what you end up doing.
Mammy

 
Old 09-17-2007, 09:25 AM   #6
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cashmoni HB User
Re: Just learning about comp...need help

G-morn mammy,

Thanks for your reply,however I have to say I am not in it for the CASH my name is what it always has been long,long before this.I use to do alot of side jobs and I love poker so it came about one day where someone wanted me to do them something for free,and I said show me the cashmoney(my work isnt a hobby) and it kinda stuck.my kids made sure of it.I have an acct with a poker site and have millions of( fake of course)chips in acct.It's always been easier for me to keep this name etc..i forget stuff.

Now you made me feel self conscience about it.I suppose it's time to change it.I just want my back to feel better and be able to play with my kids and border collies.I use to be an engineer and am thinking about going back to that for at least awhile,however,I still need it right and dont want responsible party to not be liable.Plus some places make you take a physical exam too and i'd have a hard time.Understand,that light duty don't exist w/concrete(maybe a wk or 2 of bs work),and in this business they only want someone who has a strong back,which I don't now.

I see by your journey,it's been a long one and I fear the same(i never will have the guts to try a business like you).I still have children at home and house payments etc....I have been telling the misses that maybe we should sell house and take equity and move to a cheaper state to where I'd have almost no mortgage(did good on my house)but she dont want to til kids are done w/school.I hate this crap,my life has been a very long journey as it is,at 40 I've already lost 2 kids.One a few wks after birth,and the other to an accident in 03,she was 18y/o.I also see alot of friends and family get to retirement and die,never to have the chance to stop and smell the roses(as the saying goes)I just give up,if history "DOES" repeat itself,i suppose i'm destined to get screwed again.

Sorry if I sound crabby.I was feeling better the last couple of days,and got out and about and did some house chores to help the misses,nothing strenuous,just increased activity, but now my back is hurting like hell.My leg muscles are hurting like I went to gym,i suppose from the extra walking,sucks none the less.

I did go back and re-read handbook and it says I do not have to deal w/co case mangr.I think Ill go see doctor my wife has seen and see about a referral and start planning my own course of action.

Don't worry about writing a book,i too get caught up in the moment and try to be complete ,clear and concise in my postings.I enjoy reading your posts,wisdom isn't ez to come by these days.

thanks again,
CM(for a lilttle longr)

 
Old 09-17-2007, 07:10 PM   #7
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MAMMYBOJAMMY HB User
Re: Just learning about comp...need help

Hey, don't you dare change your name. It is a good name and has a "catch" to it. Ya know. I like it and sure didn't mean to come across as you being in this thing for the money...I already know you're not. There is no amount of money that can get us our good backs..back.

My daughter was in a roll over accident in Dec. (on her B'day, of all days). The insurance co. is trying to rip her a new one. I told her...TAKE IT TO COURT.... There has been a lot of lawsuits settled on the court house steops, believe it or not. They didn't have enough insurance to cover all the Medical treatments so she had to stop her therapy and is in awful pain.

As far as being a little cranky, hey, we all go there frequently. Pain does strange things to us...I'm surprised I am not crankier than I am....I told my family to tell me when I get like that, because we don't even realize it sometime.

Well, I will check back tomorrow and see what's going on with ya. I hope you can get a decent nights sleep tonight. I will tell you, I bought a Tempurpedic Mattress set in 2004, and it did help my back pain and has allowed me to sleep better.

Of course, I take my Tramadol, my Singulair, and a Unisom too. I still wake up constantly, but will go right back to sleep if I just get up and walk to the Kitchen and back to bed helps enough I go back to sleep...for another couple of hours, then repeat everything all over..

Have a good one...Mammy Brenda

 
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