Junior Member
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Join Date: Sep 2014
Location: Massachusetts
Posts: 55
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Junior Member
Join Date: Sep 2014
Location: Massachusetts
Posts: 55
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I was injured at work almost 5 years ago. It is an uncontested case as far as it is clear cut that I was injured at work and developed CRPS after surgery for that injury. My employer did not fight the fact that I was injured at work.
I worked for a very large hospital system (it owns hospitals all over the country). They are self-insured for WC meaning that every treatment/drug etc. has to be approved through the WC system and then the hospital has to agree. Absolutely #@$%!
Every time my doc submits something it gets denied. Even if UR agrees it is appropriate treatment my case worker (with no medical training) denies it. I haven't had any treatments or meds approved in 3 years! I do not get how someone with no medical background can make medical decisions. It's crazy! I have to get the denial from WC and then use my health insurance with it's crazy high deductible followed by Medicare (which pays for almost nothing).
Of course I am in litigation, but that moves slower than *#@! here. In one week it will be two years since my case was first heard by the judge (it took over a year to get on his docket). He has had my completed case on his desk since January and my lawyer says not to expect a decision until at least late summer (and then my employer will appeal it taking another 3-4 years).
Even if I win my case, WC can continue to deny every claim I submit. The whole system is rigged against the injured worker!
Anyway, there is a mail order pharmacy named IWP (Injured Workers Pharmacy) that will supply your meds and then fight with WC for payment. There are several other pharmacies like IWP, but I have found them reliable.
Best of luck to everyone fighting this awful WC system.
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