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  1. #1
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    Apr 2009
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    Default Representing Yourself in a Worker's Comp Case

    Quote Quoting seekinginformation View Post
    Hey BvIA. Two or three pages in one will find three separate threads I started. You responding to them all. I've been dealing with so many issues related and unrelated that I haven't been back. As you said, I should keep all questions in one thread so there isn't a troublesome need to jump around.

    From one of those past threads BvIA wrote:

    If you read through the DOR form, you'll find the instructions at the bottom of the page describing the need of the applicant to provide medical evidence in written form (#5). That means medical reports by your PTP, or AQME or AME as the case may be.

    My question:

    What medical evidence do I supply if I haven't been to sent to a doctor by W/C for something so obviously related to injury and surgeries? As an example, W/C says no neuro treatment even though I have terrible electrical and pain problems that come from lumbar and neck.

    What do I do if W/C won't send me to doctors save the what is covered an AME (my father just told me that so the my original post above need be ignored). But, as I said above, no Neuro. And even when I submit MPN doctor request for what covered, they don't not respond.


    More later as I read through yours and others past responses to those past threads.

    Thank You.
    for some reason I can't save changes...checking to see if works now

    Please note that I do not have an attorney, nor can I retain one as I spoken of in past post that I have copied and will paste below.


    I do not have an attorney. He got himself into trouble via something he did wrong and some other client of his filed charges so he turned in his license to practice law. When he took my case, he was all ready being investigated. I didn't know that. My case was 10 years old when he took my case from another attorney who dropped my case and his lean because he did wrong and my father called him on it.



    I'm on my own here. In pain and confused. Am I allowed to request to see the judges to tell him of events that have occured in last two and half years (like corrupt attorny, having Neuro thrown off claim, refusal of AME to discuss and injury that occured during detox...etc

    I don't have a PTP either.
    Last edited by seekinginformation; 08-31-2009 at 01:08 PM. Reason: new info

  2. #2
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    Oct 2006
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    9,109

    Default Re: for Bvia ( and Others) About Court/Medical

    are you saying there is no medical recommendation or support for seeking a specialist evaluation? and the only evidence that you will present is your request for one that was denied?
    did you make your request in writing?
    when you discussed your request with your other physicians what was there response?

  3. #3
    Join Date
    Feb 2007
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    Calif
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    Default Re: for Bvia ( and Others) About Court/Medical

    I'm on my own here. In pain and confused. Am I allowed to request to see the judges to tell him of events that have occured in last two and half years (like corrupt attorny, having Neuro thrown off claim, refusal of AME to discuss and injury that occured during detox...etc
    No you don't go to a judge to discuss your claim. You go to court to resolve a disputed medical issue.

    The judge has no interest in how you have been treated or mistreated, your courrupt attorney or whether you have an attorney.

    You can request a status conference...as I think I told you before. But don't go in there expecting to rant and tell all your woes... you'll get tossed right back to the hall way.

    Have you tried to contact and work with an I&A officer with the WCAB? As you don't have an AA, and can't get one, that is your best source of help.

    I'll try an go back to some of your previous posts...

    What are you thinking is a need for 'neuro' treatment... a Neurologist is a doctor who basically performs surgery on the nervous system...eg. cervical spine or any part of the spine...(?) What is the treatment you are seeking at this point ?
    And what are you seeking a hearing for ?

  4. #4
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    Apr 2009
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    41

    Default Re: for Bvia ( and Others) About Court/Medical

    The questions above (the ones I wrote and the ones submitted by Sh and BiVA) I will address here, though they might have been answered elsewhere.

    A 12 year old case. Severe neurological problems that I know are due to three lumbar/saccrum and two cervical surgeries. Because these issues not addressed by AMEs for reasons stated elsewhere here, Work Comp is able to now say that I am not covered for neuro problems. So, bladder/bowel/electrical pain/buring/et cetra are not covered.

    I have had electrical pain since injury. It's why I had the surgeries. But now told not covered. Work Comp told my dad that: Not covered.

    I written letters, etc. Work Comp refuses to send me for neuro treatment by neurologist not to mention a neurosurgeon. They don't not respond in writing.

    When they chose a new surgeon to oversee the ortho segment of my case, they chose a an ortho that is not a spine surgeon. I wrote Work Comp about that. They did not respond. My father eventually got this answer via a phone call: The surgeon they chose in familiar with Work Comp procedure regardless that he isn't a spine ortho.

    So they will not respond to my request for a spine surgeon that is in the MPN because they say they all ready chose one. They say yes he isn't a spine surgeon, but he knows about the spine. Whoever responds to this, ask yourself this question: Would you entrust the care of your spine after five surgeries and a whole lot of pain and neuro problems to a sports medicine surgeon who does not do spine surgeries?
    Last edited by seekinginformation; 09-05-2009 at 05:49 PM.

  5. #5
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    Calif
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    Default Re: for Bvia ( and Others) About Court/Medical

    I written letters, etc. Work Comp refuses to send me for neuro treatment by neurologist not to mention a neurosurgeon. They don't not respond in writing.
    One, the CA is not obligated to respond to any of your requests regarding treatment issues. ONLY your PTP can make a request for treatment, and that includes a referral to a specialist for evaluation and report. That doctors report must be included in any report presented by your PTP.

    When there is a disputed medical issue you go to a PQME/AME to resolve the dispute... if necessary, you go to WCAB for a judge to decide.

    Two... can't tell what your difficulty is as you are talking about ''neuro'' problems and ''ortho'' injury. A neurologist is a doctor who treats nerve damage...ortho treats bone injury. Where there is a spine injury, and nerve damage, obviously there are 'bone' and 'nerve' issues involved.

    When they chose a new surgeon to oversee the ortho segment of my case, they chose a an ortho that is not a spine surgeon.
    Ok...Three.. It is not clear why the CA/IC is choosing a doctor for you. Or why the ortho was brought in on your claim.
    You must have a Primary Treating Physican/PTP. Any other doctors you see would be subject to prior authorization by the CA/UR doctor, OR a medical/legal evaluation when there is a disputed medical issue.

    Work Comp is able to now say that I am not covered for neuro problems. So, bladder/bowel/electrical pain/buring/et cetra are not covered.
    For a body part to be treated under your WC claim, you must have supporting medical evidence, including your PTP or AME opinion the condition IS due to your injury. The ER/IC is not liable for treatment unless the condition has been accepted as compensable.

    Would you entrust the care of your spine after five surgeries and a whole lot of pain and neuro problems to a sports medicine surgeon who does not do spine surgeries?
    Why was this ortho doctor chosen by the CA and not you ?
    Aside from that, if this ortho is now your PTP, he doesn't have to be the one to perform a surgery on you.
    If you missed a timeframe to select a PQME of your choice, and the CA did it...then the ortho you were seen by is a PQME and not a treating physican.

    You have a lot of issues in your claim. You need to get a good understanding of how the comp system works. There are specific processes in place for requesting treatment, getting a subsequent condition/symptom accepted as compensable, and how to resolve disputes as they occur.

    You don't use WC benefits as you would a personal health coverage insurance... it just doesn't work that way.

    I don't remember if your claim is settled... by Stipulation or Finding/Award from a judge... are you getting medical treatment under a future medical award?

    You FIRST step here is to get a PTP...you can't go anywhere without one.

  6. #6
    Join Date
    Apr 2009
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    41

    Default Re: for Bvia ( and Others) About Court/Medical

    BvIA One, the CA is not obligated to respond to any of your requests regarding treatment issues. ONLY your PTP can make a request for treatment, and that includes a referral to a specialist for evaluation and report. That doctors report must be included in any report presented by your PTP.


    First, thanks for your tiredless work here, and for responding my my post.

    Second, if you have a chance read about Arachnoiditis, it's symptoms that is, and you will understand some of what I'm suffering.

    OK, I need a PTP, I understand that. I don't have one, but I used to have two. That is a mess of a story to explain why they are now not, but it has to do with the attorney who scammed me. I'm reading on...



    When there is a disputed medical issue you go to a PQME/AME to resolve the dispute... if necessary, you go to WCAB for a judge to decide.

    Got it. Need a PTP to issue medical reports because I, as my own attorney, am not allowed to.


    Two... can't tell what your difficulty is as you are talking about ''neuro'' problems and ''ortho'' injury. A neurologist is a doctor who treats nerve damage...ortho treats bone injury. Where there is a spine injury, and nerve damage, obviously there are 'bone' and 'nerve' issues involved.

    Exactly, it is obvious. Still, Work Comp via my attorney, have made it clear that the neuro aspect of my injury is not covered. I am seeing my own neuro, but Work contacted Medicare saying I'm seeing doctors on my own for a Work Comp claim. Makes no sense, but they did it. There is no neuro coverage according to them. And I like I said elsewhere, 12 years of neuro problems since original injuries, and now told not covered.


    Ok...Three.. It is not clear why the CA/IC is choosing a doctor for you. Or why the ortho was brought in on your claim.
    You must have a Primary Treating Physican/PTP. Any other doctors you see would be subject to prior authorization by the CA/UR doctor, OR a medical/legal evaluation when there is a disputed medical issue.

    The ortho on my claim because have had five spine surgeries. Work Comp choose a new ortho (the one who isn't a spine surgeon) as my after my PTP Ortho of 9 years said he doesn't want to deal with my case, which is ok, because I didn't want to keep seeing him if he didn't want me around. I was told by that attorney he had choosen a new ortho for me, that was a lie.

    For a body part to be treated under your WC claim, you must have supporting medical evidence, including your PTP or AME opinion the condition IS due to your injury. The ER/IC is not liable for treatment unless the condition has been accepted as compensable.

    OK, I understand that.

    Why was this ortho doctor chosen by the CA and not you ?
    Aside from that, if this ortho is now your PTP, he doesn't have to be the one to perform a surgery on you.
    If you missed a timeframe to select a PQME of your choice, and the CA did it...then the ortho you were seen by is a PQME and not a treating physican.

    First, after I realized that the new ortho is not a spine surgeon, I told Work Comp I will not see him. Please keep in mind that that attorney had told me he choose a spine ortho for me. Well, he didn't. A lie.

    Work Comp will not allow me to go to a spine surgeon in their MPN instead of the one they chose. Don't know what to do. I was told by that attorney that I can switch doctors as many times as I want that are in the MPN. I'm going to guess that he was lying about that too.



    You have a lot of issues in your claim. You need to get a good understanding of how the comp system works. There are specific processes in place for requesting treatment, getting a subsequent condition/symptom accepted as compensable, and how to resolve disputes as they occur.

    And there is the rub. I'm having trouble just dealing with the little bit I spoken to you about here. I'm overwhelmed to terrible pain, and I can't deal with this situation. And where is there an advocacy group for situations like mine where an attorney does what mind did to me and gets away with it by turning in his law license and thus not having to answer to the Bar? There isn't one to the best of my knowledge.

    You don't use WC benefits as you would a personal health coverage insurance... it just doesn't work that way.

    I know. But after you read about Arachnoiditis, I'm not saying I have that, I'm still in the phase of trying to get to neuro. There is a remark in AME report that says should have neuro consult for Arachnoiditis. How do I force Work Comp to send me to a neuro when I don't have PTP? Well I do, it's the psychologist. I don't know why I listened to her. She told me make her the PTP and she will work hard for me. Then after Work Comp makes her PTP, she changes her mind, and Work Comp tells me that even when she makes request for medical treatment, they will ignore it because she isn't a medical doctor. She says that's bs because she is.

    I don't remember if your claim is settled... by Stipulation or Finding/Award from a judge... are you getting medical treatment under a future medical award?

    Yes it is. 100% Disability.

    You FIRST step here is to get a PTP...you can't go anywhere without one.[/QUOTE]


    I'll do what I can...thank you.

    Hey Bvia, I'm I allowed to meet with Work Comp attorney/agent to discuss this mess? And, am I not allowed to chose a different pain mangment doctor from MPN even though Work Comp chose one for me that I'm reporting to AMA? Like I said above, that attorney told me could switch doctors as many times as I want as long as they are in MPN.

    I think I know why you asked Why did Work Comp chose my ortho instead of me? You mentioned a "timeframe"...are you asking because you think I was just injuryed? I spoke to my father and he has no idea what this "timeframe" is and he doesn't know why Work Comp chose the doctors instead of me.

  7. #7
    Join Date
    Jul 2008
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    California
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    Default Re: for Bvia ( and Others) About Court/Medical

    seekinginformation,

    I am sorry for what you have been going through. I can tell you this, a psychologist is not a M.D. however a psychiatrist is.

    It sounds like you are getting the complete run around. I would like to help you.

    If you give me the name of your MPN, I will do my best to find the link to that MPN, and then we can look for Neurosurgeons/orthopedic surgeons in that MPN.

    Screw your insurance company. You should be able to change PTP up to 3 times. They (your insurance company)should not be picking a PTP for you.

    With the members on this California forum, I have no doubt we can figure out how to find and access your MPN. After that, you just need to look for Neurosurgeons or orthopedic surgeons on that list, unless you would prefer another specialty.

    There are neurosurgeons that specialize in the spine that may be helpful to you as a PTP (IMO).
    Last edited by kelly38; 09-08-2009 at 03:33 PM.

  8. #8
    Join Date
    Feb 2007
    Location
    Calif
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    Default Re: for Bvia ( and Others) About Court/Medical

    You can change PTP up to 3 times in the MPN...all you have to do is notify the CA in writing of the name/doctor you select. If there is a problem, like the ones you are describing... you file for a hearing at the WCAB.

    The IC MUST provide a PTP for you... regardless of your claim status...as long as the claim is not C&R'd, you are entitled to medical treatment.

    You can have a MD, DO, DC, Phd... but it must be a ''doctor'' under the DWC rules/definitions.
    The CA is taking advantage of you because of your ignorance (NOT stupid...) of the laws/rules...

    As you are having difficulty with an attorney, and that is due to your claim being 'settled'... there is no money for a new attorney, you need to contact an I&A officer to intervene for you with the CA/IC.

    Just approach this now as though you are filing a new claim.
    Forget everything about your former AA... it doesn't matter now and there is nothing you can do about it.

    GET a new PTP. Just select one from the MPN, and notify the CA of the name and appt time. The doctor will take it from there. The CA canNOT deny you access to a PTP, and if s/he does... call the I&A officer and file a DOR for expediated hearing.

    It's difficult to tell exactly what the problems are just from the info you can provide here... there are obviously a lot of issues you are facing... so the personal contact with a Information and Assistance Officer at the WCAB where you claim was filed is you best bet.

    There are seminars conducted at the WCAB offices too where you can go and learn the ropes...ask questions and get the help you need to navigate the system.

    It is tough... and when you are experiencing pain as you describe it's even tougher... and while message boards are helpful...they are not legal advise.

    If you'll PM me with your location it would help if I could refer you to someone who might be able to help... don't know.

  9. #9
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    Jul 2008
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    California
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    Default Re: for Bvia ( and Others) About Court/Medical

    Hi seekinginformation,

    My offer to you still stands if you need help in locating your MPN and accessing it.

    I went over a year without knowing how to get into the link to my MPN, because it requested a pass code, that I was never given.

    Changing primary treating physicians is fairly simple. You look up the specialty and doctor in your area that is listed in your MPN. Make sure you call the doctor’s office and ask them if they are taking work comp patients. I have found there are doctors listed on my MPN that no longer take work comp patients. If the doctor you pick does take work comp patients, then make an appointment and send a letter to your attorney and insurance carrier that states who your new primary treating physician is. It is as easy as that.

    Since you have had 5 spinal surgeries and possible neurologic problems that have not been denied, I recommend you look for a neurosurgeon that specializes in the spine, not the brain (this is just my own opinon from the information you have provided). You can google these doctors after you find them on the MPN list or ask those questions when you call their office.

    http://www.dir.ca.gov/dwc/mpn/DWC_MPN_Main.html

    In the above link click on current list of approved medical provider networks by name of applicant, located under the bold question “who has an MPN?” On the left side it says name of applicant. This is actually the name of your employer or their insurance company. There are pages of these, and they are in alphabetical order. So I would first look for your employers name if they are self insured, and if not look up the insurance company you are dealing with. If you are in an MPN they should have sent you information on how to access it.

    I believe that the insurance company picking your primary treating physician for you is wrong and they are taking advantage of you. Injured workers have limited rights in our state, but we are allowed to pick our own primary treating physician on the insurance companies MPN.

    I wish you well.
    Last edited by kelly38; 09-09-2009 at 11:04 AM.

  10. #10
    Join Date
    Apr 2009
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    41

    Default Re: Representing Yourself in a Worker's Comp Case

    Sorry for not responding quickly. I'm reading through your post right now.

    At the same time I have State Funds MPN open and searching through the doctors and looking to see if the rated by another website. I'm also calling their offices.

    This is the honest truth: The disks above and below the double fusion have been slowly bulding as is seen in MRIs over the last nine years since the cervical surgery. OK, so not been the same since the surgery. Year and year of massive headaches and neck pain. Last night, my neck so stiff, I stretch it, heard a loud pop (cracking too) and this severe pain rushed down my left arm from the shoulder.

    OK...I will come back and read your responses. I have to figure out to do here. UCSD Medical is near my home, but they aren't in the MPN. So, as I told my dad, go to the ER and tell them about the pain. Thanx.

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