When you brought up the subrogation letter it appeared that there is another dimension to your case you failed to mention. Subrogation is common when there is a third party suit involved. Is there a third party involved in your case?
If there is subrogation being dealt with then I would think there would be an accepted claim, yet denial of surgery points to an unaccepted claim. I have asked you at least once if your claim has been accepted and you have not answered the question.
Here's what you posted about your claim:
You have a shoulder injury that needs surgery.
Your surgery has been denied.
You are not getting any TTD.
Your DR will not proceed with surgery using your PI.
You have some sort of medical card.
You have an attorney that has scheduled trials 3 times and none of them have happened.
You received a subrogation letter.
You think you are being given the runaround.
You are no less frustrated than those of us trying to help you with such limited information. And no one is asking you your name.
BTW the vast majority of the poster here had zero experience with WC before they were injured themselves, just like you. Most of us did research and worked shoulder to shoulder with our attorneys to get the knowlesge we now have. Those of us that stick around after our claims are settled do so because we want to help others. Some times it is necessary to ask more questions to be able to give support. Don't be offended by questions asked of you.
Is the medical card, medicade? If it is that may be why the Dr is saying no to the surgery. Many Drs will only take a certain number of medicade patients. If it is a regular PI through your employer than my original answer to why the Dr won't do the surgery stands as is.
What reason have you been given as to why your claim was denied, are they claiming pre exisiting, or ??? Does your attorney feel you have a chance to get it accepted? Has s/he filed for a 19b hearing yet? Just so you know even after a 19b hearing takes place it can be up to 180 days until you receive an answer.
And again don't be offended. Questions are a necessary part of support on forums like this.
19b is an emergency hearing in front of an aribtrator comingly used to get get weekly payments (also knows as TTD) started or restarted, get medical bills paid and get denied claims accepted.
Considering your employers IC for their WC (Workmans Comp) is saying you were not injured at work I now understand the delays. Im thinking it is going to be a fight of length to get to the final decision. That might be why your attorney has toild you to change DRs and get your surgery done. If your claim is accepted, even after you have surgery, the IC for your employer will have to pay the cost of surgery or pay back your persoanl insurance, if that is what you would be using. You didn't say if the medical card is personal insurance or medicade.
If no one has provided you with the Handbook on Workers Compensation and Occupational Diseases I highly suggest you go to the state web site, www.iwcc.il.gov, and read the handbook. It will help you understand the way WC operates in Illinois.
Did you ask your lawyer why you received a subrogation letter? I'd do that if I were you if you haven't already.
I had the same problem in 2004. My work comp insurance company didn't deny my claim but did deny my first surgery that was ordered by my surgeon. I had to hire an attorney at that time and he took my surgeons deposition and filed for a 19b emergency hearing. I had to testify at this hearing along with the deposition of my surgeon. The arbitrator ruled 100% in my favor that my injury was work related and ordered the IC to pay for my surgery right away.
The Dr doesn't want to take the state insurance card. Many Drs won't take that card or if they do they limit the number of patients they see that have it.
Good for you for calling your attorney and asking. The subrogation letter now makes total sense too.
Hey, any time.
If there is anything else I can help you with post here, or of it's something you aren't comfortable talking about on the open forum you can private message me.
hi there, been gone for awhile just now able to physicaly and mentaly get back on. this same thing happened to me. in 07 my doctor ordered medical procedures--being it was workcomp it had to be approved by them. they would not aprrove it. in the state of illinois if you have a letter from your w/comp stating they will no longer pay for any further medical treatment your personal insurance or ss is then able to cover it.
be warned that the w/comp do not like to write this letter as it comes back to haunt them if they are found liable at that time to have been responsible for your medical care. my w/comp atty took almost 1 year to write the letter but as soon as it was written ss and my personal ins took over immediately.
my trial will be coming up to determine whether or not they were liable for not only the medical but ttd that they stopped.
if anyone has had experience with going to trial in il i would like to know what to expect. my attorney has no doubt i will win--but i would like to know how the w/comp atts handle the questioning etc,
thanks in advance