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Member
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Join Date: Jan 2009
Location: Paradise
Posts: 855
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Member
Join Date: Jan 2009
Location: Paradise
Posts: 855
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Quote:
Originally Posted by Broken at Work
I was injured on the job, originally in 2002 after falling. I went through their physical therapy, pm, on my lower back. I tried telling them that I was having pain in my neck, but the company doctors kept telling me that the muscles in my neck were working hard because of the injury to my lower back. They released me to go back to work on modified duty. That was a joke. Anyhow, in 2004, my family doctor took me out of work as I was blacking out. Come to find out, it was because of disc's in my neck. I filed a workers comp case. Their orthopedic surgeon decided that by doing a fusion in between the damaged disc's, that it would stabilize the others. This was in 2005, it didn't work. I've had to have both of my shoulders done, and even though I've had two neurosurgeons advise me and right up reports stating that I need a triple fusion, the insurance company wouldn't authorize it because their doctor that saw me for all of 15 minutes, said that I didn't need it, that I was faking it. Anyhow, now that I'm on social security disability, I have to pay for my workers comp injury, and I'm in an extreme amount of pain. I need to find somewhere that I can get my surgeries on my neck, and my lower back down for as reasonably inexpensively as I can without risking my health. I live in Southern California. If anyone has any advice or suggestions, I'd sure like to hear them. Thanks  |
Is your case still open, have you had panel QME (Qualified Medical Examination) from the state before you were represented?
It is a very bad omen when you are complaining about multiple regions of pain initially after the accident but your doc apparently only diagnoses and treats a lower back injury. If your neck or other regions were injured in the fall but not reported by the initial medical physician and then you push to add them later, the ins. carrier will very likely view that as embellishment or fraudulent. If your neck was not ACCEPTED by the ins. carrier, it seems that you should be able to see a doctor independant of your WC claim.
It starts to get complicated on who should pay. And treatment is regionally specific (the area of your body that was hurt) to the ACCEPTED diagnosis. If your case is "open" then you are at the mercy of the ins. co. doc or you are treating on a "green lein" thru a WC attorney. If your case is closed with no future medical, then any other insurance you have is a potential reimburser. If your case is closed WITH future medical, then you are back to bowing to the mercy of the ins. co. doc for the ACCEPTED diagnosis.
Ongoing care while your case is open is subject to ins. review (and ACOEM) but if your case is closed, further care is specifically addressed by the physician who authored your "permanent and stationary" report, the QME report (if done) or some variation thereof thru "compromise and release" or stipulation and award." All of the medical treatment however is subject to scrutiny by the good book from the American College of Occupational and Enviornmental Medicine (ACOEM). Really sucks!
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