Changed My Doctor Against Their Advise

[spock]

I'm in california
I was injured in March of this year from a fall.
After getting the run around from my employers group medical plan, I decided to get a lawyer and he said I could get another opinion and sent me to his doctor who is treating me very well and with the upmost respect. The Company doctor was rude and demanding telling me to go back to work when there was no way I could. Since all this came about, My employers I/C has cut off my benifits,prescriptions and won't pay for any doctors visits. My lawyer says" don't worry, I've got it covered!" I now get my benifits from EDD and not from my employers I/C anymore. I have 160 employee's at work and I specified no private doctor before the injury. I thought that after 30 days, I could use who ever? I'm 48 years old.

All my care is on a lien....he says??

My questions are?
How do the doctors get paid?
How did my lawyer get around me not using the employers doctor?
How will this effect case?
I've gotten as better as i will ge, says my Doctor.

If my doc says that I'm as good as I'm going to get, then I guess my case is close to being finished?

I still can't lift over 20lbs. and my job requires 150 lbs.

Do I get Re-training??

I was on the job 11 years!!!!

Thanks in advance.........

[BvIA]

All my care is on a lien....he says??

My questions are?
How do the doctors get paid?
How did my lawyer get around me not using the employers doctor?
How will this effect case?
I've gotten as better as i will ge, says my Doctor.

If my doc says that I'm as good as I'm going to get, then I guess my case is close to being finished?

I still can't lift over 20lbs. and my job requires 150 lbs.

Do I get Re-training??

Your Dr's are placing a lien against your claim because they don't have prior authorizaton to treat. They may or may not be paid when the claim settles. That is a risk they have chosen to take.

Dr gets paid by the IC.
Your AA hasn't gotten around anything. It sounds like you were notified at the time of employment, or before your injury, of your ability to pre designate a physican of your choice to act as PTP in the event of industrial injury. You appearantly did not exercise that option.
The IC can compel you to select and treat in the MPN/Medical Provider Network. As the Dr you are treating with now are not in the MPN, they are using the lien process.

There are some IC"s who refuse to even talk to or recognize a Dr treating you that is outside their MPN. And they are in their rights to do so, if the rules have not been met.
Your' AA knows the correct system, and appears to be acting based on what you were informed to prior to your injury. The labor code says if you were not provide the info on actions to take in seeking treatment at the time of hire, or when you first reported your injury, you are permitted to treatment by a physican of your choice. Out side their MPN. I'm guessing here, as your info is all we have to base an answer on.

If your Dr feels you have reached MMI, your condition will be evaluated, and rated for PD/WPI. Once that report issues, you or the CA could dispute that number and go to a AME for resolving that issue and another shot at a rating. Once that is complete, you'll begin receiving PDA/permenent disability advance payments. Those will be bi-weekly same as your TTD was paid.

When you talk about ''re-training'', ... the old "VR" system has been tossed. What we have now is a SJDV/Supplemental Job Displacement Voucher. The amount of the voucher is based on your final rating. The amount is between $4K and $10K to be used at a certified/approved program or facility of your choice.

Listen to your AA... take that as legal advice. A message board should not be substituted for what your AA can do for you.

[spock]

I did exercise my right to predesposing a doctor and it was my family doctor.
My family doctor referred me to a specialist and the insurance company denied his treatment! Its a catch 22...........What family doctor is not goin g to send you to a specialist?

[BvIA]

I have 160 employee's at work and I specified no private doctor before the injury.

I did exercise my right to predesposing a doctor and it was my family doctor.

Which one is it....?
When you pre-designate what permitted, you are allowed to treat with that physican as PTP. That Dr must agree when you name him/her to act as PTP when you suffer an industrial injury/illness. There are specific rules to follow.

My family doctor referred me to a specialist and the insurance company denied his treatment! Its a catch 22...........What family doctor is not goin g to send you to a specialist?

Your family doctor, If s/he is the PTP, is permitted to refer out, but that referral must go through the UR process just as any request for treatment would. The UR process is defined in the Title 8 CCR's http://www.dir.ca.gov/t8/ch4_5sb1a5_5_1.html

I don't see where there is any 'catch 22' if you are treating within the boundary' of WC. If the Dr your AA refered you to is not in the ER/IC MPN (if there is one), you could experience additional delays and need for litigation.

If your PTP/family doctor agreed to the process... s/he would have knowledge of the system and requirements.