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Old 04-28-2017, 05:27 PM   #1
bunnehead
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A month ago I was denied all of my pain medications by workers comp even though I was awarded lifetime medical, have had Chronic Regional Pain Syndrome for 20 years and am under care by one of the doctors I am allowed to see. In an effort to connect to others in my similar situation, I arrived at this site. Really surprised that there aren't more people sharing their situations here because I have read workers comp patients are being denied care left and right with the Independent Medical Review and Utilization Review set up. Can you imagine the impact we could have if we all decided to fight back together?
In California the horror that is Independent Medical Review and Utilization Review needs to receive more attention. I see a pain management dr who told me in January that he is "holding up the white flag" and giving up fighting workers comp for his patients, reducing their medication without prior notice - in my case not because I received the treatment that my dr stated I needed - but because of pressure from workers comp.

Anyone else experiencing anything similar that you would like to share?
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Old 09-02-2017, 11:12 AM   #2
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My last PM visit was denied payment, even though I arranged it through the doctor's office. I need a new prescription for tramadol, but I hesitate to jump through the hoops of asking for an appointment. It is in the insurances companies ultimate benefit to deny us care, because settlement is based on the care you have received.

A year ago I was cut off from aqua pool PT and I went right into a major flare, because I tried to walk for exercise. Lesson learned: Do not over do.

I was forced to join a gym to do my own PT, as it is presently I can only use the stationary bike and the pool. Other equipment aggravates my CRPS. I need to take an ongoing balance class, because my body seems to forget how to maintain balance after a two week hiatus of classes. I still cannot walk down stairs properly-the pain is too much.

Today I received a WC discontinuation of benefits informing me I am fit to work part time at a sedentary job with minimal lifting. I doubt it. I wonder who would hire me when I pass out from exhaustion. The most I am able to do is a few things per day. I tried to help my daughter look at baby carriages, but after going to the gym and tidying a single bathroom I was basically worthless to her. I had to go to bed with my foot throbbing at 3pm. The fact is standing and walking, lifting and toting may not be in my future, unless I get significant PT.

Would anyone hire a senior citizen with my issues?

My doctor gave me a letter stating that I will need to attend a gym for the rest of my life to maintain what little stamina I have. I go three days a week and pedal for an hour. I stopped the pool, because I could not do both and not having to change is easier and less painful.

My husband is going to look for a lawyer, but I am not too hopeful.

I have not been able to travel to visit my friends, because they have property that is too dangerous for me to traverse, never mind the issues of being confined for hours traveling. I had to give up gardening in my yard, because I can fall over from the terrain. No uneven surfaces are in my future.

My daughter lives in another state, in an apt building with no elevator I have not visited her once since I was afflicted. Now she is pregnant, but I am not sure how much help I can be to her, even if I manage to travel there.

I don't like griping, because compared to being bedridden 24/7 as I was I am much improved, but I sadly I am not in remission.
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Old 09-04-2017, 03:28 PM   #3
davOD
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Quote:
Originally Posted by BioBased View Post
My last PM visit was denied payment, even though I arranged it through the doctor's office. I need a new prescription for tramadol, but I hesitate to jump through the hoops of asking for an appointment. It is in the insurances companies ultimate benefit to deny us care, because settlement is based on the care you have received.

A year ago I was cut off from aqua pool PT and I went right into a major flare, because I tried to walk for exercise. Lesson learned: Do not over do.

I was forced to join a gym to do my own PT, as it is presently I can only use the stationary bike and the pool. Other equipment aggravates my CRPS. I need to take an ongoing balance class, because my body seems to forget how to maintain balance after a two-week hiatus of classes. I still cannot walk down stairs properly-the pain is too much.

Today I received a WC discontinuation of benefits informing me I am fit to work part time at a sedentary job with minimal lifting. I doubt it. I wonder who would hire me when I pass out from exhaustion. The most I am able to do is a few things per day. I tried to help my daughter look at baby carriages, but after going to the gym and tidying a single bathroom I was basically worthless to her. I had to go to bed with my foot throbbing at 3pm. The fact is standing and walking, lifting and toting may not be in my future, unless I get significant PT.

Would anyone hire a senior citizen with my issues?

My doctor gave me a letter stating that I will need to attend a gym for the rest of my life to maintain what little stamina I have. I go three days a week and pedal for an hour. I stopped the pool, because I could not do both and not having to change is easier and less painful.

My husband is going to look for a lawyer, but I am not too hopeful.

I have not been able to travel to visit my friends, because they have property that is too dangerous for me to traverse, never mind the issues of being confined for hours traveling. I had to give up gardening in my yard, because I can fall over from the terrain. No uneven surfaces are in my future.

My daughter lives in another state, in an apt building with no elevator I have not visited her once since I was afflicted. Now she is pregnant, but I am not sure how much help I can be to her, even if I manage to travel there.

I don't like griping, because compared to being bedridden 24/7 as I was I am much improved, but I sadly I am not in remission.
It is highly recommended that any worker gets an attorney, as all insurance companies will fight you to the end with their attorneys!

You need to fight fire with fire!.....There is never up front money with a WC lawyer!....best of luck, it will be slow....
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Old 09-07-2017, 03:51 PM   #4
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One of attornys I talked to today said I need an attorney who specializes in disability and WC. Has anyone gone this route?
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Old 09-08-2017, 12:03 PM   #5
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One of attorneys I talked to today said I need an attorney who specializes in disability and WC. Has anyone gone this route?
Well you MUST get a WC attorney....Any lawyer can do it, but WC attorneys are unique and understand the twists and turns.

Not sure I have met or read a Bio that one is exclusive to disability?...Now if you are filing for SSDI I also suggest get a specialized attorney for that as well.

I signed up and was approved first time, which I have been told is rare, as I was 44 at the time of my TBI(work related).

So I had a WC attorney, and a PI also, and they worked together.
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Old 09-08-2017, 04:18 PM   #6
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Today I engaged an attorney and I have to say it was an upsetting experience, due to reliving the months and months of pain and the many unhelpful doctor visits. Plus the 40 minute drive nearly did me in. The lawyer said I needed him two years ago!

I cannot get into see the pain management doctor until October and in the meantime I was told they do not write disability letters. I need the letter so I can have a hearing, so I can get the additional PT I need. It's true I should have addressed this earlier, but it caused me so much anxiety I avoided addressing it.

I have asked my PCP for the letter, but I am worried that because I have improved to the point that I don't always need a cane,but I always carry it, he will not see me as disabled. If anyone has ideas, please share.

I do not believe I will ever get back to being 100 percent normal, and I will have CRPS for the rest of my life. I am afraid that my positive outlook is going to work against me.
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Old 09-09-2017, 05:59 PM   #7
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Quote:
Originally Posted by davOD View Post
Well you MUST get a WC attorney....Any lawyer can do it, but WC attorneys are unique and understand the twists and turns.

Not sure I have met or read a Bio that one is exclusive to disability?...Now if you are filing for SSDI I also suggest get a specialized attorney for that as well.

I signed up and was approved first time, which I have been told is rare, as I was 44 at the time of my TBI(work related).

So I had a WC attorney, and a PI also, and they worked together.
Actually, about 1/3 of SSDI claimants are approved at the first stage. Not every type of disability has a Listing, and some Listings are rarely approved before an ALJ hearing. You must have had enough medical evidence to prove you meet a Listing, (which can be complicated and very particular).
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Old 09-18-2017, 10:27 AM   #8
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Lit,
Unfortunately, I am not eligible for SSDI. The lawyer was able to get a continuance for me based on differing medical opinion. He used my doctor's report from the past which said I was "disabled" and the lawyer argued that CRPS is a lifetime, ongoing condition and despite being denied doctor requested aqua PT I have tried on my own to rehab myself, but found the cooler water in the gym pool aggravated my CRPS.

I almost laughed out loud when the WC's doctor recommended that I could work at a job, which allowed me not to do any prolonged sitting, or standing, walking around or lifting. What job is that?
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