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Thread: Psychiatrist

  1. #1
    Join Date
    Jan 2008
    Posts
    41

    Default Psychiatrist

    I have been on a workers comp for industrial injuries: two knee replacements and foot and ankle reconstruction since 2003. I also have an accepted psyche claim (AME P&S 26% WPI Oct. 2008). I had an existing PTSD condition prior to injury. My comp claim injuries had aggrevated my psyche condition. My Attorney and claims adjuster could not find a Psychiatrist for me, so I paid one out of pocket and Workers Comp. would reimburse me. Six months ago I could no longer afford out of pocket expenses. I told my attorney to find me a Psychiatrist as my condition has worsened. My claims adjuster knows this also, but no one is helping me get treatment. I am scheduled to surgically remove a plate in my left knee (bone alignment). At this point I cannot go into the surgery under my current mental condition.
    My question/s are: How do I go about getting treatment when my Attorney and Claims adjuster do nothing as my condition worsens. The window for surgery is open until 1/10/2010. How do I address the surgery? Do I request a later date? Can I use the emergency room for Psyche treatment? Please any direction or input would be helpful. I am getting desparate for help and suicidal thoughts are very strong!

  2. #2
    Join Date
    Sep 2009
    Posts
    35

    Default Re: Psychiatrist

    First of all, if you are having suicidal thoughts, GO TO AN EMERGENCY ROOM ASAP!! NOW!!!!
    You can get help started at an Emergency room.
    Suicidal thoughts with intent, are an emergency.

    A hospital social worker can help you get set up with the follow up care you need.

    GO___GO___GO___GO

  3. #3
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,011

    Default Re: Psychiatrist

    My Attorney and claims adjuster could not find a Psychiatrist for me, so I paid one out of pocket and Workers Comp. would reimburse me. Six months ago I could no longer afford out of pocket expenses. I told my attorney to find me a Psychiatrist as my condition has worsened. My claims adjuster knows this also, but no one is helping me get treatment.
    Nearly evey IC has a MPN/Medical Provider Network... including the services of a Psychiatrist. There should be no reason for you not to find one on that list.

    Your PTP/surgeon should be able to help you find a Dr/Psych.... there are lots of resources available...even those through your County Social Services Dept.

    If you use the emergency room, you should be ready for admittance to a 48 hour observation period. Sometimes, whether you agree or not, the laws permit the Dr to do this.

  4. #4
    Join Date
    Jun 2007
    Posts
    344

    Default Re: Psychiatrist

    Quote Quoting BvIA View Post
    Nearly evey IC has a MPN/Medical Provider Network... including the services of a Psychiatrist. There should be no reason for you not to find one on that list.
    Not necessarily always the case. I know from experience and having just checked the provider list for SCIF they do not list any psychiatrists within a 50 mile radius of where I live. Don't know who the IC is or location for poster but it is quite possible that there may not be any providers on the MPN.

    As I recall and I know BvIA can answer this, If the MPN does not have any provider within a reasonable distance then the IW can go outside the MPN for treatment. The problem is still to find a Dr. who will deal with the IC.

    In any case you need to get help. Speak to your PTP and let them know what you are experiencing. They should be able to assist with some sort of recommendation.

  5. #5
    Join Date
    Jan 2008
    Posts
    41

    Default Re: Psychiatrist

    Thank you for the advice
    The MNP has no Psychiatrist at all. My claims adjuster, Attorney say they have been trying to find someone for weeks, but no Psychiatrist is willing to see me under workers comp as of yet. I will follow up at the emergency room this afternoon. The are no mental health crisis services in the county that i live in. My PTP has tried also, but could find no one willing to take me on under workers comp.

  6. #6
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,011

    Default Re: Psychiatrist

    A pain management facility has psychs'... that is a part of the program.

    As I said, and since 2004 and SB899 this is particularly true, nearly all carriers have MPN... that's how they control the medical costs in a claim. That doesn't mean there will always be on in your neighborhood... and if it's more than 35 miles...or ''reasonable'' distance, the CA will have to deal with it.

    There is something missing here though... if the CA or your AA can't find an Dr willing to accept the OMFS...then your AA should file for a hearing and get a WCAB judge to order the IC to pay usual and customary fees... it can be done. Not usual, but can be done. If the MPN is Kaiser...there are lots of Drs in the MPN who are simply not aware they are in the MPN to begin with.

    The statute is confusing... ''there should be 25% of the treating physicians in the MPN who do not treat industrial injury/illness...." or to that effect.

  7. #7
    Join Date
    Jan 2008
    Posts
    41

    Default Re: Psychiatrist

    Thanks to all concerned
    I finally got the help i needed. Medication had to be drastically increased, but I am starting to feel better. My AA has found me a Psychiatrist (50 miles away) and will see him next week. After all this, I have found my condition worsening. Sleep is nearly immpossible, and thoughts race in my mind nonstop. As I mentioned previously, I was P&S by the AME psychiatrist last year at 26% WPI. I believe my condition has worsened and I am still on TTD with orthopedic concerns (surgery to remove plate upcoming). Will I be forced to take the surgery as scheduled (late december) or can I hold off until my mental condition levels? Should I request an AME for the psyche to address my current concerns? I am proactive in getting back to work, will finish a BS in Accounting this spring and hopefully sit for the CPA sometime in late 2010.
    Thanks for any help

  8. #8
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,011

    Default Re: Psychiatrist

    You only get a AME when there is a disputed medical issue...not for the reason you are asking here. AME is not involved in your treatment... AME is a medical/legal opinion, carries the same weight as oral testimony in a courtroom.
    Will I be forced to take the surgery as scheduled (late december) or can I hold off until my mental condition levels?
    Those decisions would be left to your PTP....if treatment is recommended, and you decline without valid medical reasoning...your likely to see your TTD benefits stopped until you decide to proceed with treatment/surgery.

  9. #9
    Join Date
    Jan 2008
    Posts
    41

    Default Re: Psychiatrist

    My PTP wants to hold off the surgery until my condition is better. It is my AA who is pushing to settle the case. He is telling me that I must make the surgery deadline in order for my AME in May which he believes I will be P&S for my orthopedic problems. As I mentioned I am P&S for the Psyche.

  10. #10
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,011

    Default Re: Psychiatrist

    YOU are the only one who can ''settle'' your claim.... if you are MMI, and rated, the carrier must begin paying PD advances on the indemnity due...that is the default settlement, with open medical. Your AA can't do anything with out your signature.

    If you are MMI on the psych, why are there questions on surgery delay due to your psych issues ?

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