California Worker's Compensation - Help For Injured California Workers

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  1. #1
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    Jun 2012
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    4

    Default How to File a Complaint on Workers Comp for Lack of Treatment

    ok i'm new so sorry,
    my wife was injured when she was running her crane, two guys dropped a 18lb 2ft spring from 104ft breaking her neck in 3 spots and crushing her face when it was shoved in the control pannel. plus many, many other injurys!!!!! many weeks in the hospital and rehab, and nothing after? seen a bunch of dr's who r pissed off that nothing has been done, atleast 7 drs,,, (oh check this out, one dr even told us it would be good to buy a taco truck!! this was a phycoligast) idiot!!!!! besides comp deniying everything dr's r requesting. shes been out of meds for a month, and has to mail off for her meds? what a joke, we cant pick them up at our own rite aid or anyplace comp said? we live 45 min away from towns that have the dr's, but we have all the places to fill them here and they still wont? and we have two attorneys working on this. my problem is comp wont agree to anything and was told i cant complain to anyone as comp does what it wants? I want to file a complaint on our local office or state but was told by them i couldnt, then they called my attorney and told them to tell me not to call them for anything? it was my first time calling them asking to speak to a supervisor, but was refused... (9they arnt doing anything) I feel like wheeling my wife into their office and leaving her there so they can see shes jacked up, i could use a good meal in the jail as i know id be in alot of trouble if i did. please help, how can i complain to someone or file somthing? sorry stressed out big time!!!
    they wont even give her rehab for speech, body or mind... my attys have filed papers complaining and that will take another month or more, i see the road is long but this is delaying her recovery and health. they wont even give her depression meds or anything for her dizzyness???
    i know this is just another horror story but could use help here as attys r tied up following the same road they always use, so is there anything i can do to speed this up or what? Oh i was told by a retired comp judge to take her to her primary health place and see if they would do anything, but im sure that would cause more issues like whos treating what??? PLeASE HELP././././
    OH another thing i was told by my atty that comp is now removing my primary dr off the auth comp list this week!!! (comp made me go to him in the first place) so is this going to push her case even further into the abiss, will i have to start all over with nothing??
    tks greg

  2. #2
    Join Date
    Oct 2006
    Posts
    9,108

    Default Re: How to File a Complaint on Workers Comp for Lack of Treatment

    disputes are handled by the comp court.
    denial of benefit cases can file for an expedited hearing.
    you can write a complaint letter to the supervisor or the carrier's claim manager.

    you can also contact your congressmen and legislators but more then likely they will refer your complaint to your attys and the comp court.
    many many cases have some denial of benefits and unless she can show her situation is somehow unique she too will have to use the established processes.

    if proper procedures/rules were not followed she can file a complaint with the audit unit:
    http://www.dir.ca.gov/dwc/Audcomp.pdf
    Last edited by .SH; 06-14-2012 at 05:14 PM.

  3. #3
    Join Date
    Jun 2012
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    4

    Default Re: How to File a Complaint on Workers Comp for Lack of Treatment

    tks, but really???
    cant they read what is being said by the drs they send her to? its theirr drs saying this and i have to live with it aswell as her now. why is this legal. shes not claiming some typewriter injury, this is a TBI,,, Tramaitic brain injury. insane system if u ask us, or any dr shes seen. she wants to get better and go back to work unlike others. but no, the state workers comp attys (who works for the state) just want to drag this stuff out so THEY can try to file for a slice of the pie she will get in the end... why dont they hurry up and give the treatments that r needed at this time, their going to sooner or later and they know it. i cant understand why they want to probley run her out of her 104wks of comp then get us into a money crunch so we will be begging for anything? we dont want this we want treatment, recovery, then back to work. but now were going to be taking money from the state and now she will have to file for SS benifits and go down this road. completely not needed, extra BS for everyone. they almost force people to play stupid and want a medical retirement and milk the state.... no wonder our country is jacked up and needing money... please3 forgive me but this is 3 months and nothing but denials?? i guess its job security for comp workers and their attys, not for the workers...
    tks and will read anyones response as we need help even if its stupid, cant get any worse.... they still havent moved this case to a catastrophic injury??? hit on the head with 20lbs broke neck, face, back injury, leg issues, sholder, eye damage, and other injurys and not catastrophic? what is catastrophic for comp?

    greg
    Last edited by gregkk; 06-14-2012 at 07:04 PM.

  4. #4
    Join Date
    Aug 2011
    Location
    san antonio tx
    Posts
    109

    Default Re: How to File a Complaint on Workers Comp for Lack of Treatment

    Hello Sir, I am so sorry to hear about your wife, she is blessed to have you. I was going to mention as far as meds are concerned if her md will prescribe them like depression/anxiety whatever if she doesnt have her own ins still thru her company you can just run them thru your own ins, pay a little copay cash price is super cheap. W/comp stopped paying for any depression type meds, but since they are so cheap not a biggie. same for pain meds not sure what pain meds she needs but like vicodins stuff like that are also super cheap, most states have programs to help get meds if needed, as I was told I will share with you I would go for SSD I was denied so got a lawyer for that as well your frustration is totally understandable. I still can't decide who is more stupid my company or workers comp. Been fighting these people over 2 yrs for my rights. And you are correct Their Dr's are paid to make us look like we are animals with no dignity. When I saw the Lawyer my company hired it was like looking at satan, it's sad and disgusting Don't be ashamed to ask for any kind of assistance whether it be food or any thing else you guys need, you are not begging. You still have to maintain your family no matter what, keep yall in my prayers.
    sheila,

  5. #5
    Join Date
    Oct 2006
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    9,108

    Default Re: How to File a Complaint on Workers Comp for Lack of Treatment

    Quote Quoting gregkk View Post
    tks, but really???
    cant they read what is being said by the drs they send her to? its theirr drs saying this and i have to live with it aswell as her now. why is this legal. shes not claiming some typewriter injury, this is a TBI,,, Tramaitic brain injury. insane system if u ask us, or any dr shes seen. she wants to get better and go back to work unlike others. but no, the state workers comp attys (who works for the state) just want to drag this stuff out so THEY can try to file for a slice of the pie she will get in the end... why dont they hurry up and give the treatments that r needed at this time, their going to sooner or later and they know it. i cant understand why they want to probley run her out of her 104wks of comp then get us into a money crunch so we will be begging for anything? we dont want this we want treatment, recovery, then back to work. but now were going to be taking money from the state and now she will have to file for SS benifits and go down this road. completely not needed, extra BS for everyone. they almost force people to play stupid and want a medical retirement and milk the state.... no wonder our country is jacked up and needing money... please3 forgive me but this is 3 months and nothing but denials?? i guess its job security for comp workers and their attys, not for the workers...
    tks and will read anyones response as we need help even if its stupid, cant get any worse.... they still havent moved this case to a catastrophic injury??? hit on the head with 20lbs broke neck, face, back injury, leg issues, sholder, eye damage, and other injurys and not catastrophic? what is catastrophic for comp?

    greg
    how is it that you think the state attys will somehow get part of your wife's benefits if the claim is delayed?
    I think you are confused.

    for workers compensation premium calculation purposes a catastrophic injury is more then one person injured during the same event.


    there is not a separate standard for accepting liability for those with TBI then other work injuries.
    her health care provider should authorize care since workers comp has denied liability.
    Last edited by .SH; 06-14-2012 at 11:42 PM.

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

    Default Re: How to File a Complaint on Workers Comp for Lack of Treatment

    Quote Quoting gregkk View Post
    tks, but really???
    cant they read what is being said by the drs they send her to? its theirr drs saying this and i have to live with it aswell as her now. why is this legal. shes not claiming some typewriter injury, this is a TBI,,, Tramaitic brain injury. insane system if u ask us, or any dr shes seen. she wants to get better and go back to work unlike others. but no, the state workers comp attys (who works for the state) just want to drag this stuff out so THEY can try to file for a slice of the pie she will get in the end... why dont they hurry up and give the treatments that r needed at this time, their going to sooner or later and they know it. i cant understand why they want to probley run her out of her 104wks of comp then get us into a money crunch so we will be begging for anything? we dont want this we want treatment, recovery, then back to work. but now were going to be taking money from the state and now she will have to file for SS benifits and go down this road. completely not needed, extra BS for everyone. they almost force people to play stupid and want a medical retirement and milk the state.... no wonder our country is jacked up and needing money... please3 forgive me but this is 3 months and nothing but denials?? i guess its job security for comp workers and their attys, not for the workers...
    tks and will read anyones response as we need help even if its stupid, cant get any worse.... they still havent moved this case to a catastrophic injury??? hit on the head with 20lbs broke neck, face, back injury, leg issues, sholder, eye damage, and other injurys and not catastrophic? what is catastrophic for comp?

    greg
    There are NO state benefits paid in WC. There are NO attorneys working for the State of Calif.
    If you are covered by a policy the ER purchased from "State Compensation Insurance Fund", you should know that SCIF is a seperate entitey, funded wholely by the policy holders. NO tax monies fund SCIF.

    IMHO...the reason you are having so much difficulty with this claim, and contacting any CA is because YOU are not a party to the claim. You did not suffer the injury, you did not file a claim...you have no vested interest in the process or outcome.
    please3 forgive me but this is 3 months and nothing but denials??
    By law, the ER/IC has 90 days to accept/deny a claim. During that time, the IW is entitled to medical care, up to $10K, according to ACOEM/MTUS treatment guidelines. When there is dispute to PTP report, or UR denial, you go to AME or PQME.

    It may help if you spent some time reading the IW Fact Sheets at the DWC web site.

  7. #7
    Join Date
    Oct 2011
    Posts
    112

    Default Re: How to File a Complaint on Workers Comp for Lack of Treatment

    I don't have advice but share the same story as you....I had a TBI as well as many other body parts, sat here for a year with no help either, in horrid pain, got pain meds from doctors office and that was it, wc would not pay for rx's at pharmacies. But same thing here, sat and went thru this with no help at all, I often wonder who in their right mind's could allow this to happen to someone. The doctors take an oath to do no harm yet the states facilitate them in harming us in this system. See if you can get generic rx's from doctor and go thru Buena Vista pharmacy for meds. Also, I do not qualify for SS because my employer failed to report 2 years of my employment with them, now not enough credits, so everything I had worked for is gone in a split second. This system has made me a very hateful person towards those who have treated me this way. Good luck to you and your wife.

  8. #8
    Join Date
    Aug 2011
    Location
    California
    Posts
    46

    Default Re: How to File a Complaint on Workers Comp for Lack of Treatment

    L.A. Attorney Scores Record $8.9 Million Settlement, Rebuking System in Major Brain Injury Case

    http://www.prweb.com/releases/2012/3/prweb9229143.htm

    Just an FYI

  9. #9
    Join Date
    Oct 2011
    Posts
    147

    Default Re: How to File a Complaint on Workers Comp for Lack of Treatment

    I am horrified! I have been put off in the processes of the "system" as well, and have believed it to be because my injuries, RSI, were not "serious" enough for WC to consider. Now I hear this story, and again, my blood is boiling. Something has to change.....

  10. #10
    Join Date
    Jun 2012
    Posts
    4

    Default Re: How to File a Complaint on Workers Comp for Lack of Treatment

    [QUOTE=BvIA;174833]There are NO state benefits paid in WC. There are NO attorneys working for the State of Calif.

    I'll find out again what the retired comp judge said to my atty, terms i guess? but i remember her saying once she got off phone that the atty that works for workers comp, who is assigned our case on their behalf, can come after fees/time he's accured during this and bill our 3rd party settlement??? when we sue the company who caused this horrific injury, u know more than i do, but im going off what was told so i'll find out more so its clear to me as well. (i really dont care, i just want treatment for my wife).

    oh i was also told today that because my wife had a fusion to her neck over 20+ yrs ago from a work related injury when she was a peace officer that they will subtract the percentage she recieved from this case. so if she got 50% on her neck then, and this one is at 70% she'll only get a 20% rating on her neck injury??? stupid!! this is a completely new injury, all the bones that broke were below her fusion, even the drs have said that if she didnt have the fusion, this injury would have snaped her neck and killed her. her old fusion took the blow and sav4ed her life, they should b happy comps old dr did such a good job on it... she was even retrained and had two differant jobs sense, but wasnt allowed back as a peace officer do to the fusion, so she became a crane operator so she could support her 5 kids. i'm also a retired peace officer who got hurt at work and even sued the state after my injury and won a futher settlement because it caused me a total of 7 back surgeries, and was just told that both of our past comp injuryes will now effect comp doing anything for us? that they will slow play this even tho this was a unquestionable work related injury that almost killed her. you have to excuse me as i dont know all the terms nor the abbreviations, i'll try to catch back up sooner or later

    now we have to go see our own drs, and hope they'll give the meds needed and therapy thats way over due? what a racket this system has become..... I'm sorry for everyone who really has a injury and gets jacked around by the state, all we wanted is to be treated fairly, and be treated sooner than later as these injurys will now take longer to heal/recover. we have an appt with her other dr on tues, so that will be interesting to see if they will step in and help with whats needed,.,.
    tks again for reading my posting, its more a sounding board and stress reducer hearing the other people, also i really respect everyones knowledge in this field. it does seem that the comp attys who get 15% fee for their comp work only want to do the minimum... you really have to stay on top of them to get anything done, and once you feel good about them doing their job you get a response back from state comp that they r refusing to do anything. one of comps own drs wrote in his report that this has been a CALAMITY of errors on comps behalf, i bet he's going to get removed off the state authorized treating dr list too!!! it seems all they want r DR (NO'S) not a dr who says yes to anything???
    tks again and will keep ya posted.
    g

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