Worker's Comp denying me
 

They denied my doc's request for the series of lumbar sympathetic nerve blocks. And they denied my MEDICATIONS. I am in shock.

Becca - I am so sorry to hear about your denial of treatment, that may provide relief of this terrible CRPS. I know how important treatment options can be, as they give us hope for better days. I recently had my workers comp claim denied after recieving benifits for just over one year. They have what they called a CRPS specialist to perform my second IME. He was unlike any physician I have ever worked with. I will be reporting him to the state board of licencing, at my primary physician urging and I am pretty sure she will be doing the same.

Workers comp is all about money, not so much about treatment that may help us with this severe pain from CRPS. I have been receiving workers comp since a work related injury. It took them 16 weeks to cut my first check. They were penalized by the state for this ridiculous delay. I had my first IME, which accurately described my issues. They spent me to another MD for a second IME and his report was completely false, misquoted me and basically said I need a psyc consult and all of my treating physicians should stop encouraging me. This includes my primary, pain specialist, neurologist and cardiologist. He spoke with an exaggerated accent, spoke very fast and often mumbled. I could not understand him, therefor he claimed I was severely anxious. Regardless, my WC benifits have stopped. I am now securing a lawyer and pray that you also seek legal council ASAP! Thank goodness my husband was present during this shame of a exam and at one point he asked the doc to please slow down and allow me to respond to his questions. If I could have, we would have terminated the exam, but feared reprocussions.

I am sending gentle hugs your way and praying for better days.

Rain

I have a lawyer and he has already sent for IME, but I may not even get to see anyone they may just look at my records and thats it.

I'm so sorry. Just because work comp denies...doesn't mean that's the end of it. Your case can have a hearing regarding the denial of benefits and they will review your treating doctor's notes as well as the IME. They know IMEs are weighted in favor of work comp and take that into consideration. Doesn't help in the mean time of course. When it happened to me I went through my regular insurance and that got me by for a while until the hearings sorted it out.

Hugs...hopefully you are in good hands with your attorney and they will sort things out as quickly as possible. If you can get a copy of the IME from your attorney then go over every detail, correct any errors, etc. It's hard not to be emotional...on our side we are dealing with immense pain and frustrations, lack of sleep, etc and this sort of news is devastating...but try to stay calm and focus on the things you have control over...not what is out of your control. Helped me through some very bad times with work comp to just focus on what the next steps were for ME and then to keep my focus on that and not on what work comp was doing. Let the lawyer fight with them...you focus on YOU and what steps you can take now.

Thankfully the Methadone is affordable. But Gabapentin is not. However I've been getting that through my Kaiser as I had it already for another nerve pain issue at a lower dose. I have a copay for it, and its not the right dose, so it won't last. But ...

Is your atty appealing or contesting that denial?

Is your claim accepted , but the denial is for future treatment/meds?
Or is the whole claim denied?

This California based info , but could apply in other states also-
Why can’t I get the medical care I need?
(Along with the denial will be a form to request review of that UR denial by another anonymous doctor. This layer of review is called “Independent Medical Review” or IMR.)
Why can't I get the medical care I need? - Law Offices of Robert S. Havens


There may be ways to still get the treatments and have the bills placed on hold pending approval after review..
That should be something to ask Atty about..
my RSI claim was in 2003, and I was able to keep getting PT, by using my pvt medical as the secondary ins, pending wc case close/settlement..etc...
My atty wrote a letter to the providers , and they held the billing until after my hearing date.. but states have differing laws and changes over time,..

im so sorry you are having so much trouble becca. gabapentin and pain meds are so helpful to me too. one without the other would not be enough for me. i hope that your lawyer can get you the help and meds you need soon because you shouldn't have to suffer like that. sending prayers and hugs your way.:hug:

Well I got another letter. IME is letting me have three refills of my gabapentin. But only one refill of my pain med. I guess I'll just be paying out of pocket for that one, unless I decide to taper off of it (which is what they are giving me the refill for) but its the most effective pain med I have.

Hi Becca,

Please try downloading the app GoodRX. It lets you see the most affordable prices of any drug in your area. For example, I'm able to get gabapentin for $20 or less, which is pretty good. I hope this helps as the website or service gets good discounts with stores. You need your medications. No if and buts about it. Don't let these people bully you around. Take care..

If you do pay out of pocket at all, keep all the receipts with your claim & medical records and maybe wc will have to reimburse you later on..

more discount RX info -
Savings Cards | Partnership for Prescription Assistance
Drug Discount Card | NeedyMeds
Free Prescription Drug Discount Card - Drugs.com