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  1. #1
    Join Date
    Nov 2011
    Location
    FL
    Posts
    31

    Default Needing Some Answers/Advice

    I injured my back at work in September, at first my case manager seemed to be invested in everything going on. As time went by, it's been very hard trying to get her on the phone. Physical therapy has helped me, I can now stand up on my own and get around but I'm still in pain and can't remain standing or sitting for a long period of time.

    I was given a prescription for a night roll to wear while I sleep to offer support and a lumbar support pillow to place on any chair I'd be sitting in. That was back in late October and I still haven't heard an answer from her. My physical therapist called her and still nothing.

    Last week I had a follow up with my doctor and he said he was going to refer me to an orthopedic doctor. I never hear anything from my case manager, I couldn't even get her on the phone to tell her I'd gone to my appointment. The doctor told me that the insurance company was starting to "tighten" up. Would be why I feel like I'm being given the run around? I've left messages like crazy and I don't even get a call back.

    At what point should one seek out an attorney? This is such a stressful time, I haven't been to work since I got hurt back in September. So far I haven't had to pay for anything and I've been getting bi-weekly checks so I'm not sure I should get one involved, but it's SO frustrating that they're taking so long to get me to the next doctor. Both the doctor I have seen and the case manager seem to be more worried about the insurance company and what they're spending/will spend than on my well being.

    I'm just over all of this and want this whole ordeal to be over with, it's all just so very stressful!

  2. #2
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    17,941

    Default Re: Needing Some Answers/Advice

    It would be a big help if you would provide your State... WC is State specific.
    Any time you are in need of treatment, or the medically necessary equip... your Dr is responsible for getting the authorization...a CA/Claims Adj won't even respond to a PT...

    Any time you are delayed/denied benefits, you consult with a WC attorney.

  3. #3
    Join Date
    Aug 2011
    Location
    Georgia
    Posts
    790

    Default Re: Needing Some Answers/Advice

    Quote Quoting Sadie83 View Post
    At what point should one seek out an attorney?
    Right about now. The IC is already starting to delay treatment, which is detrimental to your recovery.

  4. #4
    Join Date
    Nov 2011
    Location
    FL
    Posts
    31

    Default Re: Needing Some Answers/Advice

    I'm sorry, I completely forgot to name the state I live in. I'm in Florida.

    I'm having a real battle in my mind about contacting an attorney. I've been getting adverts from many different attorneys in the mail for a couple of weeks now. Part of me wants to get one but the other side thinks I shouldn't since the insurance company hasn't denied payment of treatments/medications. Ugh, I'm so conflicted!

    What happens if I do get an attorney? Will my employer fire me? Will the insurance company bring out their guns and make things harder?
    This is all new and so very confusing, it's the first time I've ever had to go through any of this and no one I know has ever been injured on the job.

  5. #5
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    17,941

    Default Re: Needing Some Answers/Advice

    This is all new and so very confusing, it's the first time I've ever had to go through any of this and no one I know has ever been injured on the job.
    The very reason to consult with a few WC attorneys. How would you handle/approach a hearing in WC court without the knowledge of what you may be facing... they have very expensive attorneys that do nothing all day but try to find ways not to pay you benefits you may be eligible for... talk to a few attorneys. THere is no up front cost...a fee would be awarded by the court based on your recovery of benefits/award.

  6. #6
    Join Date
    Aug 2011
    Location
    Georgia
    Posts
    790

    Default Re: Needing Some Answers/Advice

    You're being a bit contradictory.

    I was given a prescription for a night roll to wear while I sleep to offer support and a lumbar support pillow to place on any chair I'd be sitting in. That was back in late October and I still haven't heard an answer from her. My physical therapist called her and still nothing.
    I never hear anything from my case manager, I couldn't even get her on the phone to tell her I'd gone to my appointment.
    My physical therapist called her and still nothing.
    I've left messages like crazy and I don't even get a call back.
    And now ........

    I shouldn't since the insurance company hasn't denied payment of treatments/medications.
    Either the IC is working your case appropriately, or they aren't. I'm having a hard time telling which it is, based on your comments.

    Both the doctor I have seen and the case manager seem to be more worried about the insurance company and what they're spending/will spend than on my well being.
    You seriously need an attorney to navigate this nightmare for you. I wouldn't be so quick to even CONSIDER the attorneys sending you advertisements......most of those are "settlement mills", interested in the bottom line, and not your medical care.

    Find some locally, and interview them.

  7. #7
    Join Date
    Nov 2011
    Location
    FL
    Posts
    31

    Default Re: Needing Some Answers/Advice

    Okay. Short clear version:

    1. Got hurt at work.
    2. Went on workers comp.
    3. Insurance company has never denied payment to me or anything my doctor recommended.
    4. Two months + have gone by and it seems like they're taking longer getting me to the next step, seeing a specialist.
    5. During last week's doctor visit, the doctor made a comment about the IC "tightening up". I'm sure they're not happy about me still being on WC.
    6. The fact that it's getting harder to get in touch with my NCM, the fact that she doesn't return calls and that it's taking more time than I'm comfortable with to hear about an appointment with a specialist is making me wonder if they're trying to "brush" me off.
    7. I'm having trouble deciding on talking to an attorney since the IC hasn't really refused anything that the doctor has asked them to do, they've just taken longer and the whole issue with the NCM. I blame my young naive mind wanting to believe that I won't be screwed over, they're just busy. (dumb.. I know!)

    I don't want to waste an attorney's time, or mine, going to them and them saying "they're paying for everything, you don't need me" and looking like a fool. Hence why I came to an online forum to get opinions from people that have gone/are going through similar situations.

    Hope that was more clear than my initial post.
    Last edited by Sadie83; 11-18-2011 at 05:30 AM.

  8. #8
    Join Date
    Aug 2011
    Location
    Georgia
    Posts
    790

    Default Re: Needing Some Answers/Advice

    Quote Quoting Sadie83 View Post

    4. Two months + have gone by and it seems like they're taking longer getting me to the next step, seeing a specialist.

    6. The fact that it's getting harder to get in touch with my NCM, the fact that she doesn't return calls and that it's taking more time than I'm comfortable with to hear about an appointment with a specialist is making me wonder if they're trying to "brush" me off.

    7. I'm having trouble deciding on talking to an attorney since the IC hasn't really refused anything that the doctor has asked them to do, they've just taken longer and the whole issue with the NCM. I blame my young naive mind wanting to believe that I won't be screwed over, they're just busy. (dumb.. I know!)
    4. Not so unusual after the initial visits and treatment. IC's get a little anxious when the bills start to look like they're going to pile up.

    6. Same reply as #4.

    7. You're having MORE trouble talking with the IC (NCM). Talking with an attorney (in a FREE consultation) might set your mind at ease. You won't be wasting anybody's time.

    The issue here is that the IC is DELAYING treatment ordered by the treating physician - or the diagnostics ordered by the treating physician. It doesn't cost you anything to have an attorney take the helm and steer this case to a reasonable resolution.

    The bottom line is that nobody on this forum has much more to go on than what you've provided. We don't have the specifics of the claim and can't give you a legitimate and useful direction in which to move. WC is full of statutory regulations and time limits. You really need an attorney experienced in getting the IC to move forward. You wait, you suffer.

  9. #9
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    17,941

    Default Re: Needing Some Answers/Advice

    I'm sure they're not happy about me still being on WC.
    What difference does this make to you...? Stop trying to "think" like an IC... you go nowhere...real fast.
    The fact that it's getting harder to get in touch with my NCM, the fact that she doesn't return calls and that it's taking more time than I'm comfortable with to hear about an appointment with a specialist is making me wonder if they're trying to "brush" me off.
    um... see above....
    I blame my young naive mind wanting to believe that I won't be screwed over, they're just busy. (dumb.. I know!)
    um...
    I don't want to waste an attorney's time, or mine, going to them and them saying "they're paying for everything, you don't need me" and looking like a fool. Hence why I came to an online forum to get opinions from people that have gone/are going through similar situations.
    That's what attorneys are there for... to consult with. There is no fee until/unless there is recovery or award in your claim.
    Waste your time?... what else are you doing if not working?.
    A message board, regardless of what others may have experienced, is not a substitute for valid legal advice in your claim. TALK to an attorney... before it's too late.

  10. #10
    Join Date
    Mar 2007
    Location
    Georgia
    Posts
    1,923

    Default Re: Needing Some Answers/Advice

    Sadie I agree with what the others have told you about consultation with an attorney. Not getting the "night roll and support pillow" as soon as prescribed is NOT a good indication that the IC is going to cooperate with the bigger issues. As to the NCM once you are repped by an attorney that person is usually CUT out of the equation. AND that is a good thing usually, IMO.

    Good to know your cash benefits and doc appts., are covered as they should be but anytime a doc orders DME, Durable Medical Equipment or Supplies, that should be provided just as a medication Rx is and should be so immediately. No delay, especially for something so simple to provide as those items.

    ***Just a side note to LeglEgl and BvIA on the upper right hand corner of the OP Sadie did indeed provide her/his state as FL.*** (Just for future reference it is always a good idea to check that area before asking a poster to provide their state) NO offense intended .

    Hope everyone has a wonderful day and is able to enjoy this awesomely wonderful Fall Weather we are having. Can't speak for anyone else but I absolutely LOVE this time of year .
    "He who is his own lawyer has a fool for a client"
    Abraham Lincoln


    Take Care and Be Well.

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