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  1. #1
    Join Date
    Aug 2009
    Location
    Massachusetts
    Posts
    2

    Default Mixed Issues

    My workers compensation claim was made in the State of: Massachusetts

    I was injured in March 2009. Pain started in one shoulder, radiating up to my neck after the injury. After several months of seeing a chiropractor & Orthopedist, and electro-stimulation by the Chiro, and the Orthopedist giving steriod shots, 1 shoulder MRI that shows nothing wrong with the shoulder which then led to a MRI of the neck, which showed 2 bulging discs (Chiropractor states herniated), with narrowing of the spinal column in the neck, and evidence of a healing fracture at C-6. Cat scan was ordered because of the Cervical MRI, also validating possible healing fracture (described as unusual appearance at C6 with facet hypertrophy and possible healing fracture with callous formation and incomplete osseous union with spur formation) & the following: Disc space narrowing at C4-5 and C5-6 both anteriorly and projecting dorsally. Dorsally projecting osteophtes at C4-5 minimally efface the ventral thecal sac and at C5-6 there is also associated bilateral C6 Foraminal narrowing. (Keep in mind it was 3 months between injury date & them figuring out it wasn't my shoulder that was injured but rather my neck)

    My Orthopedist says basically I broke my neck, he gives me steroid shots every few weeks, gives me anti-inflammatory & pain pills, and demands I stay off work for rest, this has been going on with him for months. He also clearly states he cannot treat my neck, and everything should be done to avoid surgery; which means just staying off work and doing nothing.

    3 weeks ago, after my Ortho and my chiro stating they could take me no further in recovery, suggested a total work up by a Spinal specialist at the big hospital here. I called the hospital, was told no appointment can be made until they negotiate a rate with my W/C insurance company. I gave them all the info, they said they would fax the adjuster, could be 2 weeks to 2 months before I get an appointment.

    Its now been three weeks. Attorney said she spoke to the CA, and that the CA said nothing was ever received by fax. Today I spoke to the hospital spine center, they not only faxed the CA on 8/8/09 but also have left repeated messages for the CA 4 times over the past week, and have had no response. My lawyers on vacation until next week. I left her a message as to what is going on.

    Today I received a letter requiring me to see an Orthopedist that the W/C insurance company requires me to see for assessment.

    So, all this leads to, am I going to have trouble getting the approval to see the correct kind of doctor for my injury. Due to delays with the W/C insurance company I sit with no further treatment unless they figure out the negotiations for prices. No doctor will see me unless I take it this route.

    Is there anything I need to know for this doctor's visit ordered by the W/C insurance company?

    It needs to be noted, that the first MRI done on my neck, was moved to an imaging company my employer owns, done in an open MRI unit, film quality was poor, and my employer got the MRI done basically for free. I requested the imaginge company who did my Cat Scan to re-read the disc from the first MRI due to the poor quality. The reports did come out differently.

    What do i do next and am I missing anything

    thank you,
    Ava

  2. #2
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    17,943

    Default Re: Mixed Issues

    The ER/IC has the right to evaluation by a doctor of their choice. That is the ortho you are being sent to see. The basis is to determine IF there is medical necessity for the referral to the medical facility you are talking about waiting for autho for.

    There isn't anything to do until you have that evaluation, the report issues... and your atty returns.

    There is very little in WC that can be forced. It's a very slow process at times, and disputes can be cause for litigation...a judge to make the decision.

  3. #3
    Join Date
    Aug 2009
    Location
    Massachusetts
    Posts
    2

    Default Re: Mixed Issues

    Quote Quoting BvIA View Post
    The basis is to determine IF there is medical necessity for the referral to the medical facility you are talking about waiting for autho for.
    This is incorrect. The CA hasn't received any contact by the hospital Spine center. The scheduling of this appointment I believe is just their next step to determine why I am still off work, not whether I need a Spine Doctor or not since the CA states no such request has even been received despite the hospital saying contrary.

    If your patient comes to you with complaints of pain in the shoulder, and through 4 months of deductions you determine that patient didn't hurt the shoulder but rather his neck, and you don't treat the neck, you refer that patient to the doctor who handles injuries of the neck. Doesn't take another medical evauluation to know an arm/leg orthopedist isn't a cervical/Lumbar specialist.

    And I don't see what I am trying to force??? Expecting a CA, who up till now has been pretty good, to process a request appropriately is not forcing anything. Hospital states they have tried numerous times to contact CA. CA says no contact has been made. Who is telling the truth? I will stay on top of it to not let anything fall through the cracks. This is what I have done since I got a lawyer and its paid off at every turn. Being diligent is not forcing anything.
    Last edited by Avalon; 08-19-2009 at 12:00 PM.

  4. #4
    Join Date
    Aug 2009
    Posts
    42

    Default Re: Mixed Issues

    Hi Avolon, CA works for IC. They will lie out their teeth, delay you drs, surgery, and meds, medical supplies, anything, that will cost the IC money. They are one of the lowest scum of earth. Dhs first dr. the one IC will send you to, is the shark, on a leash, and owned by IC. DH went to 4 other drs. waiting 15 months, before they did surgery. This is inhuman. It should be criminal. If one of us, was to neglect our child like that, we would go to jail, and maybe prison. Something needs to be done about this. I don,t know what good it would do to call the WC, but, you might try. I do not have answers, but, I would ask to get all copies of your reports from first dr now. You need to see what lies, might be stated in your reports. You might be shocked at what he has said about you. Protect yourself. and I wish you better luck than we had. Let us know what happens.

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