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  1. #1
    Join Date
    Jul 2010

    Default How to Get Long Term Care

    My workers compensation claim was made in the State of: Washington DC

    I have a question about lifetime pain management, I will try to keep it short.

    Treating doctor recommends pain managment,
    IC sends me to IME and the IME report comes back in my favor for pain management
    I request the IME doc be my treating pain management doctor which is agreed to.

    A year goes by and my pain management doc (was IME doc) orders continued PT which the IC refused so off we go to court for informal conference. The hearing goes in my favor and the IC says they are going to appeal....but a week later they say go ahead and make appointment for PT....sooooo I call therapy office and tell them to call IC so they call and get no response. They call three times and almost a month goes by without approval.

    So heres the question,
    When the IC lawyers failed to appeal the decision can they just refuse to authorize treatment? I am having the same problem with follow up appt. and prescriptions? I am young and worried if this is gonna be the plan for the next 50 years? I have good lawyers working on this now but I am just so damn surprised they can be ordered to pay for treatment, fail to appeal and then just not authorize it? Is there some kind of penalty for this? I am just curious and want to discuss.

  2. #2
    Join Date
    Feb 2007

    Default Re: How to Get Long Term Care

    Is there some kind of penalty for this? I am just curious and want to discuss.
    If they fail to appeal within the statutory timeframe... the judges decision stands. Treatment is to be authorized. If there is a delay, unreasonable, your atty would file for penalties.( If penalties are provided for in the comp act).

    Not really much to disuss've provided the scenario... your atty should be the one providing the answer to why treatment hasn't been autho. If the carrier doesn't respond by phone...(and it's difficult to believe NO ONE is answering the phone), ask that he send a USPS, certified letter to the CA.

  3. #3
    Join Date
    Jul 2010

    Default Re: How to Get Long Term Care

    Do you think the letter is needed to prove they are delaying? It could help but would the time start at the end of the appeal timeframe? And the penalty idea is something I will look into. Thanks BVIA

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