Hi guys!

Is there anyone who can advise me about how Work Comp actually works?
My Attorney seems to get particular delight in NOT providing me any info that helps me know how to plan my life, etc.

I was injured over 5 yrs ago. Finally "gave up the fight" & stopped working totally in Oct '03. I have RSD as well as other injuries, and a "Psych Case" of Depression etc also.

I went to an AME Appt Feb '06 (which my Attorney's ofc said was not going to be the last one), and contrary to my 1st AME a few years ago, this guy was sarcastic, etc. I learned several months later that my Attorney sent my medical records, but MISSING THE PREVIOUS 18 MOS OF TREATMENT BY MY PAIN MGMT DOC! So the AME reported that I was "Permanent & Stationary" and only a small % disabiled. He said I only required access to "over the counter analgesics" & an "occasional visit with an Orthopedic if her RSD comes back", etc. (No mention of the Lyrica, etc I'd been on). My Attorney said they would TRY to get him to look at the missing records, but he could decline. I've NEVER even been told whether or not he did.

Due to this AME report, since 1st of May my disability pmts were reduced to about $724 per month, and my RENT IS $650! I began to live TOTALLY ON MY CREDIT CARD, NOW I'VE HAD TO BORROW MONEY FOR THE OVER $400 A MONTH PAYMENTS!

last July my Attorney's ofc told me they did arrange for a depo of this Orhtopedic AME to be on Nov 20th. I was in a severe flare up when I went to my Treating Phys visit on Aug 4th. I was asking for HIM to go ahead & put me at P&S, because I heard this may "hurry up" my case being finished. I was trying not to go "bankrupt".

When myTreating Doc (also an Ortho) saw me he said he would put me at P&S, just because no additional PM procedures were being allowed (due to AME report) so there was nothing at the moment he could do to help me. He also said he was angry with the AME doctor, & that an Orthopedic is NOT an expert in RSD and so should not be making life long decisions. (Even tho in CA's WC system, apparantly Ortho's are the one deciding on RSD pt's).

My doc then told me he always considered me 100% disabled, not only due to RSD, but I have cervical problems, too. (This was poo-poo'd by the AME, who didn't KNOW I'd had occipital blocks, etc). My doc told me I should contact my Attorney & tell him to expect this report from him, saying I was 100% disabled.

When I arrived home my phone rang & it was my Attorney (rare conversation) telling me he had JUST gotten off the phone with Work Comp & they want to settle for a certain amount. It sounded pretty good to me, only because I keep hearing how hard it is to get ANYTHING! But when I told him what the doc said, he said he would "hold off" with the settlement talks UNTIL he got my Doc's report. Then, IF there was some medical facts strong enough he may consider going for more. But he said, "But, according to WC standards, it's going to be hard to convince them 100%".

I rcvd a copy of my doc's report 10 days later! I waited a couple of weeks & didn't hear from my Atty, so I began to leave messages, asking if he'd read it yet, and what did he think? That was mid-Aug. At the END OF OCT I STARTED SENDING EMAILS ASKING WHAT WAS GOING ON!!!

Still no answer. I was fairly certain he had just taken it upon himself to "turn down" the offer and forgotten to call me to let ME DECIDE. So I called him & asked the receptioinist to just let him know that "I HAD DECIDED TO ACCEPT THE OFFER FROM AUG 4TH, so please let me know how long it will take to get it."

BOY, THAT GOT RESULTS. HE WAS ON THE PHONE WITH ME WITHIN THE HOUR, SWEETLY JABBERING ABOUT ALL KINDS OF THINGS...EXCEPT THAT! FINALLY HE SAID ONCE MY DOCTOR SAID 100% THAT WORK COMP REQUIRES YOU TO GO FORWARD (FUNNY HE DIDN'T TELL ME THAT ON AUG 4TH).

1) DOES ANYONE KNOW ANYTHING ABOUT THIS??

2) MY ATTY TOLD ME, "OH, YOU WON'T GET 'FUTURE MEDICAL', IT HAS TO BE TAKEN IN A LUMP SUM". IS THIS TRUE??? OR IS HE JUST WANTING HIS % TO COME OUT WITH MORE $$$'S?

3) HE ALSO SAID THAT MEDICARE WILL DEFINITELY DO A "SET ASIDE", NOT JUST IF I'M FOUND 100%. IS THIS TRUE??? I WENT TO THE SSA SITE & IT STATED THAT THE MEDICARE SET ASIDE IS ONLY DONE WHEN THE SETTLEMENT AMOUNT REACHES $250K OR MORE!!! DOES ANYONE KNOW WHICH IS THE TRUTH?

Thanks for any help! I'm so stressed out because I have NO FAMILY SUPPORT, WHATSOEVER!! I'M single, live alone, have 2 sons who live hundreds of miles away & are having family, health, job problems, too. I've never tried to "lean on them". I've usually had a pretty hopeful attitude
but my life has been more & more constricted due to pain and finances. I stopped going to church a couple of yrs ago. I'm trying to get back into it someplace closer to me right now. But yreas ago I usually "flaked out" when friends invited me places, etc, so eventually they gave up. I don't like "whining" about the pain. It's hard for people to understand. No one has ever heard of RSD/CRPS (including me...& I worked in medical billing for years).

My last remaining friends are my landlords too. I live in their guest house & they've been wonderful. I let her help me occasionally, but they had 3 kids & a newly blended family (chaos!!), & she works full time. But she began having health problems too about a year or two ago. AND SHE WAS JUST DIAGNOSED WITH FIBROMYALGIA!!!

Due to legal & health care costs, their house went into FORECLOSURE in December. They let me stay here paying NO RENT for Dec, which helped me, but is still thousands of dollars short of what I need. They need to get the full rent possible to save their house (I pay a reduced amt). So I need to move, but WHERE.

I truly can see myself winding up living in my car if something isn't done soon! I've tried to explain this to my lawyer, & that is why I would have considered accepting a lower amount. But he never seemed to think it was important enough to have even ONE conversation about it.

I'd appreciate any info anyone has. Sorry I rattled on so long. Believe, I've left out hundreds of incidents of mistakes this lawyer has made (including filing with the WRONG date of injury, and they won't correct it, etc).

DeniseG

each case is so different and the states have their own laws too.
it's so hard to try to give helpful advice.

The best advice I ever got was to get copies of everything, and have a big folder or box to organize each category -
bills, atty letters, comp ins letters, dr notes, test results == everything!

use a fax or email to correspond about anything comp/medical related then you will have the original copies from your side for your records.

go over the papers and highlight any mistakes {or note any questions} and follow up with your atty.

I am confused about the AME part - You went for an AME a couple times??

As I understood it- { I could have this wrong}
usually you get sent to a QME or IME first {or a few times}
- and the AME is used sometimes after you are P&S as a final independent compromise that both sides will agree to.


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Regarding question 3 about Medicare set-asides: my attorney told me the same thing, but I have no idea if that's true or not. I'm also confused by the discrepancy between that and the "set-asides are for settlements of $250,000 or more" thing on the Medicare Web site. I'm also in California.

For what it's worth, if I had settled by C&R, my attorney said I probably would be getting around $40,000 for a 38% disability rating. I decided to settle by Stips for quite a bit less, but it's a very tough call when it's so incredibly difficult to actually *get* any medical treatment through Stips in California.

I hope you can check out that support group -- they're great sources of information. Best of luck.