Workers' comp not approving my future medical treatments?

by Elizabeth
(Lancaster, CA)

My workers comp case settled February 2012. It took the State Comp Insurance Fund eight months to approve my evaluation appointments with a pain management doctor, a specialist for my TMJ, and an internal medicine doctor. All three doctors recommended treatment which was never approved by workers comp but also never denied.

I was told by my attorney once a recommended treatment is not answered within a certain time frame (I don't recall the time frame) it is considered approved due to not being answered. However, only the specialist for my TMJ went ahead and ordered my mouth guard and continued treatment on me.

I am in severe pain with my neck. I know my last MRI reflected the need for neck surgery in the very near future (this MRI is already 5 years old). Is there any way to reopen my case since my medical condition has become worse due to lack of treatment?

My case was settled under Stipulation and Award with Future Medical. I see my primary doctor from workers comp every month in order to get relief from pain medications.

I am receiving medicare but was told workers comp has to cover medical treatment for my cervical spine, bilateral shoulders, lumbar spine, right ankle, psyche, chronic pain syndrome, sleep disorder, IBS, hypertension and TMJ, which does not leave much for medicare to cover.

Every visit my primary workers comp doctor recommends treatment and they do not hear back from workers comp. It is going on two years next month, is there anything I can do??? Thank you.

Visitor Question:
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ANSWER for "Workers' comp not approving my future medical treatments?":

Elizabeth (Lancaster, CA):

It is our position at not to interfere with the attorney-client relationship. To do so would be inappropriate.

Generally speaking, once a workers' compensation claim has been settled, especially when there exists a Stipulation and Award with Future Medical, the only issues left are the type of future medical care needed, and the amount of money the insurance company will pay for that treatment

In your case, you would be best-served by speaking with your attorney. Your attorney should be able to explain why workers' compensation has taken so long to respond.

Best of luck,

Judge Calisi

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Comments for Workers' comp not approving my future medical treatments?

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by: Anonymous

A settlement is a settlement. I settled for permanent "lifetime" care due to physical and mental injuries sustained.

In a bunch of mishaps my attorney passed (after settlement) which makes it hard to find a replacement and the insurance company is giving me "hell" knowing this. During settlement my employer was backed up against the wall so much, I think if it were possible they would have payed me double.

Now I'm reeling from discrimination, insensitivity, etc., in every way possible and have practically nothing. What can do about it until I get another lawyer.

Meanwhile, my condition, worries, fears are worsened week by week due to this "about face" by everyone involved. I'm left asking the same questions I asked when this case was awaiting settlement and I was being forced to see an army of doctors for years.

Future medical is a joke
by: Anonymous

I have settled my workers comp case with future medical...what a joke. I get pain medication every 28 days and have to fight to get it approved every month. I have called my lawyer and he stated he doesn't really care and that the defended insurance company wants to screw me.

The attorney got paid from my final settlement and now complains he will not get any new money, meaning I get my refill whenever the insurance company gets around to approval. This is future medical!

First off I am on a very strong and addictive pain medication...with the DEA urine testing every 3 months to make sure I have the medication in my system. Since I have no clue when my meds will be approved I will start going through drug withdrawals.

Before I let that happen I will visit the ER for pain medication, for a charge of $1,300, or end up buying illegal opiods from the streets. This is what you get for future medical care? What a wonderful system.

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