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  1. #1
    Join Date
    Mar 2012
    Posts
    8

    Default Carpal Tunnel Syndrome and Ulnar Elbow

    My workers compensation claim was made in the State of: California. I have had several diagnosis from nerve tests to mri's to internalist to 8 hours with a phyciatrist. All of which has stated I have sever carpul tunnel in both hands and ulnar elbow in the left. I have an attorney who never calls me back. I'm wondering how the insurance company gets away with not paying me a dime until after six months into this claim and then when they do start paying me my stubs read Permanently disabled? To add to my misery I collected sdi until workers comp kicked in and they now have a lein on my settlement for the monies they paid me for the insurance negligence.
    I started this claim in 2009 still no surgery and I finally hear from my attorney indicating that I should do like every other American does and take the money and run. He says "if you want surgery wait a year or two and go get it, you have insurance right". How ridiculous is this system where I have been out of work awaiting surgery that continues to get denied just to have these results? I never wanted money I only wanted surgery so I could get back to work.
    almost 3 years later yes I definetely need the money but I still want the surgery and that is not going to happen is it? Workers comp cut my checks off last year due to some Doctors report so they say, but that Doctors report states that I have severe carpul tunnel and need surgery immediately.
    Where does temporary disability ever fit into this picture? Exactly what does maxium medical care really mean? I don't know what to do but I do know my attorney must be tired of it all and just want his cut or is he right is it normal to just take money and pretend it never happened? It all seems to be a no win situation and I'm confused.

  2. #2
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,021

    Default Re: Advise

    Once you claim industrial injury/causation, you cannot use your own health insurance, your atty is wrong. Your atty doesn't make the rules your health ins carrier pays benefits to. Ever.

    There is no "maximum medical care", there is MMI/Max Medical Improvement, that means your condition is stable, not expected to change in the next year with or without treatment. MMI does not mean you won't be provided additional medical care.
    Workers comp cut my checks off last year due to some Doctors report so they say, but that Doctors report states that I have severe carpul tunnel and need surgery immediately.
    For TTD to stop, there must be a Dr report saying you have reached P&S/MMI. If your PQME Dr reports said surgery is necessary...and they are denying benefits, your atty should file for a hearing in court. Let a judge decide.

  3. #3
    Join Date
    Feb 2007
    Location
    Charlotte, NC
    Posts
    2,959

    Default Re: Advise

    The health insurance will pay after the comp case is settled, though, wouldn't it?
    The North Carolina Court of Appeals has held that "In contested Workers' Compensation cases today, access to competent legal counsel is a virtual necessity." Church v. Baxter Travenol Labs, Inc., and American Motorists Insurance Company, 104 N.C. App. 411, 416 (1991).

    Bob Bollinger, Attorney at Law

  4. #4
    Join Date
    Mar 2012
    Posts
    8

    Default Re: Advise

    I have never received a check stating Temporary disability. My checks once they started have always read permanent disability. My QME from the beginning of all this stated I needed surgery, so I was sent to a surgeon that indicated all procedures he wanted to do and they denied the surgery and then cancelled my workers comp permanent disability checks due to that doctors report. My attorney had 10 days to appeal that decision and did not and would not return my calls.

    ---------- Post added at 01:07 PM ---------- Previous post was at 12:59 PM ----------

    So here it is yet one more year later than the issues in the above paragraph and I have taken it upon my self after not hearing from my attorney for almost a year after calling and documenting every call I made to him found yet another doctor in the insurances mpn to see me and they have approved all diagnosis only, and he wants me to start all over again with MRI's, nerve tests, etc, everything I did two years ago and got no where. Does this happen to everyone or am I singled out here? Is all this normal for these workers comp cases? Even though from day one I have stated that both of my hands go numb; never once did any of the Dr.s ever test my right hand until two weeks ago with the Doctor I found and he did a nerve test and says it is severly worse than my left (the only one everyone focused on), again leaving several messages to my attorney regarding the lack of attention or tests to my right hand to never hear from him about it.
    One thing for sure my attorney does not want me to have this surgery.

  5. #5
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,021

    Default Re: Advise

    There really isn't enough detail/info here from the time you filed the first report of injury with your employer.

    When you that, the ER/IC is required to notify you how to seek medical care. Apparently that has been done. You rec'd treatment/diagnosis, and the CA disputed the PTP report, you were evaluated by QME who found your injury compensable, and surgery warranted. IF....If the defense does not begin to provide benefits/treatment they must file for a expediated hearing with the WCAB/court. That's the process.

    You say you rec'd SDI during the denial/delay period, THEN permanent disability kicked in, and you began to receive those benefits.
    My QME from the beginning of all this stated I needed surgery, so I was sent to a surgeon that indicated all procedures he wanted to do and they denied the surgery and then cancelled my workers comp permanent disability checks due to that doctors report.
    Do you have a copy of that report? It would be important to know exactly what that PQME said. QME does not outline treatment, but either agrees with the PTP/surgeon, or disagrees.

    There is no 10 day period for your atty to dispute... if the CA wants to deny, a DOR for hearing must be filed.
    If they don't file, your atty can, requesting penalties/sanctions for unreasonable delay.

    When you claim industrial causation, your health insurance won't pay for treatment until/unless a judge finally determines the ER/IC is not liable on an industrial basis.
    If you have someone at your health carrier say otherwise, get it in writing.

    Too much missing here... we don't have the file, don't know the facts beyond what you are providing here.

  6. #6
    Join Date
    Mar 2012
    Posts
    8

    Default Re: Advise

    Let me correct myself and word this the way my paperwork is worded. My AME is the sole person to make any ratings (I was told by my atty) I saw this Dr. 1/2010 shortly after the date of claim (I incorrectly called her my QME in paragraph above) , she ordered MRI's that took place 1 month after my visit with her however she did make a report that stated in her opinion it would be reasonable to be referred to a hand specialist for consideration of bilateral ct surgery and would require a period of temporary total disability and therapy, it also states if examinee does not want surgery then her condition has attained mmi. it also has impairment ratings before the MRI report came back. Exactly 1 year later did she finally give another report with the MRI included only after I hand delivered it to her office a copy of it with a cd I got from the MRI Dr.

    You are correct regarding both the QME Internal Dr. report & a QME psychiatric Dr. report clearly agree with the surgeon and even request an mri for the right hand that has been ignored this entire process.
    Last edited by Itript; 03-10-2012 at 01:33 PM.

  7. #7
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,021

    Default Re: Advise

    however she did make a report that stated in her opinion it would be reasonable to be referred to a hand specialist for consideration of bilateral ct surgery and would require a period of temporary total disability and therapy, it also states if examinee does not want surgery then her condition has attained mmi.
    You have an 'either/or" situation in the AME report.
    If you delay/deny surgery, it would stand to reason your TTD would be suspended. You could be rated for PD/WPI, and the PDA's...Permanent Disability Advances begin. Sounds like that is what has happened here. PDA is a much lower rate than TTD.
    If you go ahead with the surgery, you could be paid TTD again, up to the 104 weeks, within 5 years of your org DOI/Date Of Injury.

    both the QME Internal Dr. report & a QME psychiatric Dr. report clearly agree with the surgeon and even request an mri for the right hand that has been ignored this entire process.
    When you are evaluated by PQME/AME, there is no "request" for diagnositcs or treatment. That MRI would be part of the medical/legal process and costs.

    Only your PTP can request treatment, through the UR process. If the AME had a MRI performed, there isn't likely to be another authorized for the same body part, or diagnositcs. Unless the surgeon feels the year old MRI is stale at this point.
    request an mri for the right hand that has been ignored this entire process.
    When/if your PTP requests a MRI that is denied by UR Dr, you go back to the AME to resolve the dispute. If the CA simply ignores a PR-2, your attorney has recourse in filing a DOR for expediated hearing. The lose the ability to control medical when this happens. (for this specific request)

  8. #8
    Join Date
    Mar 2012
    Posts
    8

    Default Re: Advise

    PTP? & DOR? & PR-2? this is why I got an attorney to begin with; I don't know what those abbreviations mean. But I do know since my last response my attorney has told me "why don't you do what every other american does, and take the money and run!" Me personally, I never wanted the money; I only wanted to be fixed and back to work....... 3 years later .... as he says : the people looking after you or paying your bills for you must be getting tired of it by now!" Ok he wins, he is right I cannot afford to go on like I have with no income at aLL! i GUESS THEY WIN.

    Let me move on to only last weeks messages. I called his office to let him no I quit! i GIVE IN. He immideatly calls me back, to see if I'm ready to settle!? I advised him that I have gone to see another surgeon (from the insurances mpn) (that his office would not for some reason set up for me,. so I did it my self) ( I didnt tell him that). He asked what that dr. had said, I advised him that he said my right hand was worse than my left hand! Keep in mind from day 1 I have always stated my LEFT & RIGHT HAND, but for some reason the insurance company has removed my right hand from the equasion even though i AM RIGHT HANDED. I feel any good attorney would have figured this out, but he obviously did not.
    Long story short, I told him I was ready to settle, because i see this is going nowhere at all. He advised me to TEXT him every day reminding him to read the reports from my Doctors so that he can figure out the numbers at home (breaking out the books etc...) alot of work to do......
    So every day I texted him for 4 WEEKS asking him if he had figured out the numbers yet as he asked me to do? He always resonded "Friday or Monday, I should have them", so the following Wed. I asked him again if he had the numbers for my rating yet? and I happen to mention that I AM SINKING HERE! because he told me the day I tell him I want to settle it would take3 months top and I will have my money! do sbout 3 years and 6 months later I give in...... And he popped a nut! (so to speak). He got so mad..... he in all caps said "THATS IT I WILL SEND YOU PAPERWORK NEXT WEEK TO SETTLE FOR 45K" Now just the week before he told me 70k due to the fact the new dr. (I set for myself) has claimed that my right hand is worse than my left! (I am right handed). I am so confused with this attorney. I have always had a good and positive outlook on EVERYTHING
    !!!!!! What do I do from here? I am lost in this what seems like such a crooked world I am not familiar with!
    Last edited by Itript; 04-11-2012 at 12:16 AM. Reason: additional

  9. #9
    Join Date
    Sep 2011
    Posts
    68

    Default Re: Advise

    It sounds to me like you are settling this based on emotion which is not a good thing to do. If what you are saying is true about your attorney you need to find another one. If what you are saying regarding surgery is true then your new attorney should be going to bat for you to get these denials turned into approvals.

    If you do end up settling (which in my opinion, do not use this as fact or legal advice, I'm no lawyer, isn't the right thing to do) make sure you know what exactly it is you are getting and know all the fine details. Does it include future medical? Or is a cash sum that YOU have to use towards future medical. 45k, from what I've read, is on the grander scaled of settlements (most settle for less) so just make sure you know exactly what it is you are signing. At this point, it sounds like, you can't trust your attorney so YOU need to become your own advocate (which you probably should have been doing from the beginning) and do your research so that you aren't going by just his word.

    If I were you (again just my humble opinion) I would seek a second opinion from another WC Attorney before you sign anything with your current attorney to make sure you are doing the right thing for you medically.

  10. #10
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,021

    Default Re: Advise

    While many attys are pretty adept at reading a PTP (Primary Treating Physician) or AME report, (which should include a PD/WPI rating if you are declared MMI), attys do not do ratings... doctors do ratings, and the DEU/Disability Evaluation Unit.

    If you have not completed the PTP recommended treatment plan, or been declared MMI, WHY would you settle this claim?
    You said you wanted treatment (and WC is all about money by the way... treatment = money, your ER/IC pays the bills, not you).

    WC isn't about "winning/losing", your PTP is responsible for getting prior authorization for treatment recommended... AME resolves disputed medical issues, WCAB court is the trier of fact. It's not unusual for attys not to want to go to court over a disputed medical issue, that takes time... but the AME does not "request" MRI, if that's necessary to complete a report, you get the MRI.

    Go to www.caaa.org for names of attys in your zip code... you can change at any time. There will be but one fee.

    You said you have no income for 3 years... when didn't you file for SDI/State Disabiltiy Ins benefits? Contact EDD for that info.
    she did make a report that stated in her opinion it would be reasonable to be referred to a hand specialist for consideration of bilateral ct surgery and would require a period of temporary total disability and therapy, it also states if examinee does not want surgery then her condition has attained mmi.
    Did you accept/deny surgery based on the AME report?
    As the AME did rate you, in your then present condition, you could resolve the claim based on that... maybe.

    Need to know what you did post AME evaluation/report.

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