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  1. #1
    Join Date
    May 2014
    Location
    Central Oregon
    Posts
    3

    Default How to Find a Doctor Who Accepts Workers Compensation

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

    I am writing for a friend, who is currently have to deal with problems with her workers comp claim.

    She currently lives in Oregon and her original claim was in Alabama. After her claim was settled and they said they would provide lifetime care, she moved to Oregon to be closer to her family. At this point she was able to find a Dr. that would treat her, and things were okay for a few years. Then moved again (over a year ago), and when she went to transfer her medical care to Central Oregon the workers comp insurance company denied her. They told her she had to go and see her original Dr. which was now a 5 hour drive away. After fighting with them for months she finally gave in and tried to see that Dr., well her original treating physician had since moved out of state and the clinic where she being treated at won't see her claiming that she was no longer local and so they did not want to treat her.

    Another six months go by and finally the insurance company agrees to let her see someone locally here, she has been without treatment for over a year at this point, and now the local dr's here won't see her. Basically she has been told that no one in this area will treat her, so I suggested she go to Oregons major teaching hospital in the Portland area, I could not imagine that they would not see her. No they claim that their neurology department is not accepting new patients at this point (which strikes me as total BS).

    She has an empty pain pump, according to the manufacturer should be removed as soon as possible as it is not designed to be empty and could cause a number of problems at this point for her.

    She needs to find a Dr. that will see her, but I don't know where to tell her to look.

    I suggested she try for the Dr. who saw her that moved out of state, but he is in the Mid-west now. The only other place I can think of sending her is to one in Alabama if we can find one because I think part of the problem is that it is an out of state workers comp case?

    Suggestions? Ideas?

    Thanks!
    Amy
    Last edited by Edgeofthemiddleofnowhere; 05-09-2014 at 05:21 PM.

  2. #2
    Join Date
    Oct 1971
    Posts
    4,996

    Default Re: Can't Find a Dr. to See Me

    Start with the local health clinic, someone should see her.
    If that fails, go to the emergency room, they have to treat her and refer her to a doctor for further treatment.

    Tony
    Moderator Responses are based on my personal bias, experience and research - They do not represent the views of the admin nor may be accepted in the legal community, always consult an attorney.

  3. #3
    Join Date
    May 2014
    Location
    Central Oregon
    Posts
    3

    Default Re: Can't Find a Dr. to See Me

    Quote Quoting tony View Post
    Start with the local health clinic, someone should see her.
    If that fails, go to the emergency room, they have to treat her and refer her to a doctor for further treatment.

    Tony
    Tony,

    She has been to the local clinic to see her general practitioner dr. and she has been referred to 4 dr's locally and the university in Portland. She has been turned down for all of them. Her dr. thought that it was a missing medical records issue, they re-ordered all of her records and got her a referral specialist, and then resent the referrals. Still a no go.
    I thought of the emergency room but since the referrals have not worked so far I am skeptical that they would work from a emergency room dr any better.

    Amy

  4. #4
    Join Date
    Feb 2007
    Location
    831 East Morehead St., Ste 355, Charlotte, NC 28202
    Posts
    3,744

    Default Re: Can't Find a Dr. to See Me

    The emergency room is probably not going to fill an empty pain pump. Her lawyer back in Alabama may be able to make the carrier pay for a doctor that will see her. The out of state comp payor is a lot of the problem here. She will not be able to get any legal work done in Oregon because it is an Alabama case. If the carrier cannot find her a doctor near her in Oregon, then perhaps she may be able to get the carrier to furnish transportation for her. But really, she created a lot of this problem by moving, so she may have to put up with some inconvenience to get the treatment she needs. There may not be a perfect solution. No one can force a doctor to see her or treat her.
    Last edited by complwyr; 05-09-2014 at 08:14 PM.
    The North Carolina Court of Appeals has held that "In contested Workers' Compensation cases today, access to competent legal counsel is a virtual necessity." Church v. Baxter Travenol Labs, Inc., and American Motorists Insurance Company, 104 N.C. App. 411, 416 (1991).

    Bob Bollinger, Attorney and Board Certified Specialist in NC Workers' Compensation Law

  5. #5
    Join Date
    Oct 1971
    Posts
    4,996

    Default Re: Can't Find a Dr. to See Me

    If these refusals to treat are based on method of payment, apply for Medicaid.
    I recently learned that because of the new health reforms, Medicaid will cover the cost of any care that your insurance won't cover.
    The rules say you only need to apply for eligible coverage, not be approved.
    As long as you presented the carriers information to these doctors and they refused to treat, you're in compliance.
    Because these doctors don't accept an out of state carrier, you qualify - you're considered uninsured.

    Just have these refusals in writing and present them to your case worker if needed.
    These people are easy to work with, they'll help you along and explain everything.
    Apply for Social Services today in the state in which you reside.

    Be aware, Medicaid is income or age based.
    If you're young and wealthy, you'll have to pay the bills on your own and submit them to the carrier for reimbursement.

    Tony
    Moderator Responses are based on my personal bias, experience and research - They do not represent the views of the admin nor may be accepted in the legal community, always consult an attorney.

  6. #6
    Join Date
    May 2014
    Location
    Central Oregon
    Posts
    3

    Default Re: Can't Find a Dr. to See Me

    @Tony
    Thank you for the suggestion I will let her know. I know that she is already on Medicaid, and I do think that the payment issue is part of it. The rest I am not sure what is going on, I almost feel there is some red flag in her file that we don't know about.
    I have hopes that she will be able to see someone because it is not fair that she is having to go without treatment for such a long period of time.
    @Bob
    I don't think she ever expected her moving to cause such an issue, and then on top of it, the dr. that she was seeing relocating to the mid-west.

    Amy

  7. #7
    Join Date
    Oct 1971
    Posts
    4,996

    Default Re: Can't Find a Dr. to See Me

    I know that she is already on Medicaid, and I do think that the payment issue is part of it. The rest I am not sure what is going on, I almost feel there is some red flag in her file that we don't know about.
    So, the problem isn't getting treatment or finding a doctor, it's getting that pump filled.
    That "red flag" may be the narcotics contract she has with the doctor who gave her the pain pump.
    It's the patients responsibility to make the proper arrangements to accommodate any changes that may affect treatments.
    By moving out of state and not keeping up on treatments, she violated her contract.
    That pain pump can be filled only by the doctor who prescribed it and has a valid narcotics contract in force.
    She must now be re-evaluated and have another narcotics contract signed before anyone can legally fill that pump.

    Tony
    Moderator Responses are based on my personal bias, experience and research - They do not represent the views of the admin nor may be accepted in the legal community, always consult an attorney.

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