California Worker's Compensation - Help For Injured California Workers

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  1. #1
    Join Date
    Mar 2012
    Posts
    13

    Default Lifetime Medical

    Good morning everyone,

    I have been reading this site going on 9 years now, thank you all for the info, it has helped, i'm writing today for this reason, about 3 years ago, i won medical for life, i have been fighting this battle for 9 years, i have yet to see a single medicine from anyone, i go thru GR to get my meds, i take over 8 meds for my condition, i'm afraid if i tell you my condition i will be uncovered, what i have is not the norm, i can't say much, sorry, but what i want to know is this please, i have been looking for work for some years now, i haven't found any, i'm ready to knock on doors and be more forward with my searching, when i start working, my GR will stop and i will not be able to get my meds anymore, at what point does WC make you whole, i received some funds about 4 years back and i'm told that's it, for almost 9 years i have not gotten any meds, how is this right? how can i win a life time medical award and not have any meds, we are still in court, i have had an AME and he agrees with my dr. but the defendents keep disagreeing with everything, is there no limit here, i feel like i'm not taken seriously, i have already lost everything and i have no support, this just can't be right? what am i missing here? thank you for listining and i appreciate your responses in advance.

  2. #2
    Join Date
    Oct 2006
    Posts
    9,109

    Default Re: Life Time Medical

    workers comp is "no fault" insurance. there is nothing in the law about having to make you "whole". that is a term from civil or negligence law.

    you need to read the posts that discuss how open, blank-check medical has changed in california and most other comp systems as well.
    there are posts and links as to how treatment has to conform to evidence based medical guidelines. you need to review the utilization review rules.

    the law allows both parties the ability to show evidence to support their position and appeal decisions. the law can be terribly cumbersome to some one who needs a quick decision without allowing for either of those.
    you may be able to hurry the legal process by changing attys.

    you are missing that the system has to work for both the payee and payor. comp is not welfare and as long as you need/want someone else to pay for your condition it has to be reviewed by others to make sure those decisions are fair, equitable and conform to the legal rules.

    workers comp is not health insurance.

    I am sure both workers and employers would each design a system that meet their interests much better then the one we have.
    but we can only have one system and it has to try and do both.
    Last edited by .SH; 03-22-2012 at 07:58 AM.

  3. #3
    Join Date
    Mar 2012
    Posts
    13

    Default Re: Life Time Medical

    Thanks SH.

    They have appealed and it was denied, yet deep pockets always find a back door, their dr., my dr. and the AME all agree i'm in this condition from my job, what i don't understand is what does a life time medical mean when i still don't have meds? I understand they have the right to fight as i do, but they have already been found that i got sick at work, my question was more about, why award me life time medical, yet i have no meds? How does that work? What does life time medical mean and when does it begin? and this question is for everyone please.

    Thank you.

  4. #4
    Join Date
    Oct 2006
    Posts
    9,109

    Default Re: Life Time Medical

    it doesn't mean open medical. it doesn't mean any medical.
    it means only the medical the law allows.
    this is not a new concept. every benefit system has limits.
    no system gives whatever you want or as much as you want.
    you don't get to decide.
    if you want 1000 oxycontin a week, society has a right to make laws limiting it; even if it's frustrating.

    I sorry the medical benefit clause was not better explained to you at the time,
    but i don't think you want to understand.
    Last edited by .SH; 03-22-2012 at 09:01 AM.

  5. #5
    Join Date
    Mar 2012
    Posts
    13

    Default Re: Life Time Medical

    Are you having a bad SH? If i did understand, i wouldn't be here asking for advise and help to understand the system, thanks SH, i'm done talking for now, i need to go find work, i hope your day gets better.

  6. #6
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,021

    Default Re: Life Time Medical

    they have already been found that i got sick at work, my question was more about, why award me life time medical, yet i have no meds? How does that work? What does life time medical mean and when does it begin? and this question is for everyone please.
    Having met the AOE/COE standard has nothing to do with future medical. AOE/COE means your injury occured/was caused by your job duties/function, and the claim is compensable.

    Future medical ... you already rec'd the PPD indemnity award, there are no more cash benefits. Medical is "open", covering the "natural progression of your injury/illness/disease:".
    When you need treatment/meds, you go to your PTP... the PTP must submit a PR-2, REQUEST FOR TREATMENT, to the CA, CA can authorize, or must submit to UR for determination of medical necessity, based on the diagnosis, and medical evidence provided by your PTP for the request. If UR denies...you go to AME....if the carrier disputes the AME, they must file for an expediated hearing in front of a judge. There is still the option of either side to appeal to a higher court.
    Are you having a bad SH? If i did understand, i wouldn't be here asking for advise and help to understand the system, thanks SH,
    SH will apprecitate this coming from me (LOL), I don't think s/he is having a bad day... I think the explanation was clear, concise and to the point of your quesiton...even to the point of more than usual.
    I sorry the medical benefit clause was not better explained to you at the time,
    but i don't think you want to understand.
    That's about as succinct as it can be...the FM coverage was apparently not explained to you by your attorney at the time of your stipulation, and you are confusing having a compensable claim, with that of FM coverage.

  7. #7
    Join Date
    Mar 2012
    Posts
    5

    Default Re: Life Time Medical

    You asked for advice so I shall try and give you some.

    For starters, write a letter detailing your issue as to the point as possible to your State Legislators, Senate and Assembly. It actually wouldn't hurt t send it too ALL of them but at a minimum your own. Never underestimate what a call from a Senator's office will accomplish for you. Moreover, too many people in WC complain here but don't make their voice heard by the people signing off on the laws in the first place. CC that letter to local media outlets.

    Secondly, yes, seek the advice of new council. It may be difficult given where your case is but it' worth a shot. You need an attorney who will hold their feet to the fire, fight or sanctions at every turn (assuming what they're doing qualifies), and not lose your case in their 200 their ones. That is an uphill climb.

    In my experience, sometimes the only way to get things done is to shine a big fat light on those doing it. Shame in the public square still works, and may be one of the few shots you have left. You indicate your concern of being "uncovered". My question is, so what? What are they going to do deny your meds?

    Also, see this thread: http://www.workerscompensationinsura...Yourself-Heard

    These people operate like any other predator, they depend on their victim's silence. It's up to people like you to to stop it.
    Last edited by TiredIW; 03-22-2012 at 11:55 AM.

  8. #8
    Join Date
    Mar 2012
    Posts
    13

    Default Re: Life Time Medical

    You know.....it was a big mistake to come here, i have read the aswers that some of you give out to a problem like mine, i have been thru court for 9 years, i have seen a lot and learned a lot more than some of you seem not to know, what i want to share with you is this, the law is not written in stone, each case is handled per the need of the injured worker, the answers you give and what i have gone thru are very different, it's like you all read a book because you can't admit that you don't have an answer at times.

    I never brought up anything about money here or in court or that i thought workers comp was a health insurance, you can't answer my question, you know why, because you are not the judge who decides the case, after many years, i will stop reading this forum, i'm so glad that i always did what i thought was right. I have won every single case in court that came up against me, i will stop seeking advise from anyone and just do what i have done all along, prove my case to the judge.

    Peace out.

  9. #9
    Join Date
    May 2010
    Posts
    342

    Default Re: Life Time Medical

    Quote Quoting Whenisitenough View Post
    You know.....it was a big mistake to come here, i have read the aswers that some of you give out to a problem like mine, i have been thru court for 9 years, i have seen a lot and learned a lot more than some of you seem not to know, what i want to share with you is this, the law is not written in stone, each case is handled per the need of the injured worker, the answers you give and what i have gone thru are very different, it's like you all read a book because you can't admit that you don't have an answer at times.

    I never brought up anything about money here or in court or that i thought workers comp was a health insurance, you can't answer my question, you know why, because you are not the judge who decides the case, after many years, i will stop reading this forum, i'm so glad that i always did what i thought was right. I have won every single case in court that came up against me, i will stop seeking advise from anyone and just do what i have done all along, prove my case to the judge.

    Peace out.

    Yea , and you dam kids get off my lawn!!!! Peace out?

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