[Azaila]

I was injured at work on 3-25-09, Fracture to right great toe, I have MRI, CT SCANS, X-RAYS, have seen around 50 doctors, 1 not a MPN doctor my first attorney sent me to that states I have CRPS, I went to a QME March 30, 2010, that has stated I basically am lying, after that I was sent to new PMD, that went over QME report and my last Dr. report, he says I have CRPS, then we found out my last PMD with held an x-ray report that shows in my right foot sever bone demineralisation, sever bone decay, I feel now it has become an emergency situation, W/C in Ca. allows insurance carriers the obligation to maintain responsibilities, therefor, to receive proper medical treatment, they have to approve it first, however, I had an appt. to see specialist who was only asking me to produce were the MRI, CT RESULTS & ANY X-RAYS. Do I have a right to go to an ER with these same documents and receive treatment without financial responsibility, providing proof of services rendered clearly relates to original work injury? Thank you for all your replies I'm not sure what I have a right to do.

[Azaila]

I am not looking for legal advise, I am just looking for suggestions thanks so much!

[Lisa in Ohio]

Azaila, I too am a WC patient in Ohio. I know that the laws vary from state to state. My attorney told me that it is very rare for WC to pay for ER visits here in Ohio. There is a very good link through this site for WC questions where you may find more helpful information. Unfortunatly it seems like what they are best at is denying treatment and making you jump through hoops. I am beginning to give up hope that I will ever get the treatment that I need, but wish you better luck. Lisa

[SandyRI]

I am also a victim of WC.

Often when I have needed treatment for my RSD I have pulled out my private insurance card (United Health) and used it when WC has refused to pay - at the pharmacy, for PT, and for medical procedures. My lawyer spent hours transferring charges from United Health to the Hartford last year when WC finally decided to accept responsibility for a raft of charges that had accumulated over a period of several months. Not my problem.... of course, I also had to come up with a co-pay in many instances, but it was better than going without anything at all.

If you have secondary insurance, see if you can use it to get the services you need.

Good luck, WC sucks. Try not to get too stressed out about it. Sandy

[LIT LOVE]

I can help a bit. I'm also in CA and have been in the WC system since 99.


The bad news: since the WC "reform" here, you have even fewer rights than I do.

The QME's for the insurance co. are not on your side. It sucks, because you assume all docs care about helping and healing you, that isn't what their function is in this case.

I can't imagine how you've seen so many doctors? The laws here are written to keep that from happening.

What you need to focus on is your care under your Primary Treating Physician. You should preferably have someone with RSD patients. If you haven't had any blocks yet, that would be something to discuss. You need to start testing meds out, it'll be a long process of trial and error.

Going to the ER is a quick fix to a long term problem. I'd make an emergency appt. with my WC Primary if I were you. Also buy a book on CA WC laws to understand the system. NOLO publishing should have one.

[LIT LOVE]

http://neurotalk.psychcentral.com/thread106250.html

I'd check out the above thread, btw.

[Jomar]

Our WC forum- Layoffs, Unemployment and Worker's Compensation =
http://neurotalk.psychcentral.com/forum30.html

might find some useful info there also.

[Azaila]

Originally Posted by LIT LOVE

I can help a bit. I'm also in CA and have been in the WC system since 99.


The bad news: since the WC "reform" here, you have even fewer rights than I do.

The QME's for the insurance co. are not on your side. It sucks, because you assume all docs care about helping and healing you, that isn't what their function is in this case.

I can't imagine how you've seen so many doctors? The laws here are written to keep that from happening.

What you need to focus on is your care under your Primary Treating Physician. You should preferably have someone with RSD patients. If you haven't had any blocks yet, that would be something to discuss. You need to start testing meds out, it'll be a long process of trial and error.

Going to the ER is a quick fix to a long term problem. I'd make an emergency appt. with my WC Primary if I were you. Also buy a book on CA WC laws to understand the system. NOLO publishing should have one.

My husband has read the W/C books and also read the rules and everything online about W/c, and what to do, I wish I knew ahead of time to look for an attrny that deals with CRPS I just didn't know there were so many cases. Thank you all for your replies!

[finz]

Azalia,

Hello. I am dealing with the added frustration of WC too, but I am in Mass. I've read on here that California does WC a little differently and people are having very specific issues with having to go through multiple URs and getting nothing but denials.

A great resource is one of our posters tshadow. Here is a recent thread: http://neurotalk.psychcentral.com/thread116994.html

tshadow and ocelyn are both very knowledgable and vocal advocates for NeuroTalk'ers in California and dealing with WC. They are trying to gather stats and support to help people battle WC. They both have TOS and RSD, but tend to be found mostly on the TOS forum here.

[hope4thebest]

Hi Azaila,
I am in CA and have a WC case as well..
First and foremost, let your ins. company know you are well-informed, aware, and educated about RSD, protocols for treatment, and the rights you do have with a WC case. This will make them aware that you just 'won't go away' a..make it clear that you are not going to give up and will fight for treatment..assertively and 'diplomatically..'
Then, make sure you have an attorney who is familiar with RSD and its implications..
The inusrance company wanted me to have a QME with someone whom I thought was not a qualified specialist and I let them know I was aware of this.
At that point, I did get an attorney because I knew they were going to play 'hardball'. I didn't attend that QME and had another one rescheduled.
Keep us posted and good luck...don't give up!
Hope4thebest xox