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Need Workers Comp advice

ldmobleylldmobley Posts: 36
edited 06/11/2012 - 8:51 AM in Upper Back Pain, Thoracic
Hey all,

I need some advice. I fell at work on 2/11/11. I went to the clinic for an evaluation. They did X-rays which turned out normal and gave me pain meds and anti inflammatory meds. They took me off work for a week at that time. I continue having severe spasms in my upper back that I did not have before my fall. I have had back problems for years due to a car accident in 2001. However, the pain I have always experienced with that was lower back pain. The clinic I went to has referred me to a specialist to take over my treatment being that they are not qualified in that area. It has been 2 weeks since my fall and Workers comp has still not authorized me to see a specialist. I see the clinic physician every Monday for follow up visits. Last Monday the doctor was a bit reluctant to continue keeping me off work. She said I would heal faster if I went back to work because my mind would be focusing on work and not the pain. Hmmm. I told her I am having a very difficult time getting around at home let alone at work. Pretty much any kind of movement triggers spasms (walking, moving arms above my chest). They went ahead and took me off work for another week at that time. I don't believe that will be the case this Monday. I am still waiting on an appointment with a specialist. I call them daily and they tell me the same thing over and over again, no authorization. I just want something done about it. If I go back to work and I finally get an appointment with a specialist and end up having to take more time off, will I have to go through the 7 days no pay all over again? I am scared of losing any more income over this. My family is already suffering because of this. What should I do? Help!!


  • I have plenty of experience with workers compensation, but it seems each insurance carrier has different rules. My only thoughts are to call the specialist and try to speed up the appointment. See if he/she will see you billing WC first then your primary insurance second. That way they have a backup payment if WC denies the visit. You are entitled to treatment, it is just a matter of who pays for it. You could also find the name of your claims adjuster and call that person yourself. Make sure a claim has even been filed through WC. Is this clinic you are using an in-house medical unit provided by your employer? Sometimes employers try to handle the situation themselves before sending things off to WC. Be clear with the clinic physician when you see him/her on Monday that you are having a difficult time functioning. Perhaps he could order further testing in the interim of waiting for the specialist appointment.

    I understand your frustration. Fight for yourelf. No one else will. Feel free to PM me with any specific questions. I'm not an expert at WC, but I have been dealing with them for over 4 years now, so I can try to help with general questions.

    Surviving chronic pain one day at a time, praying for a reprieve because living another 40 years like this doesn't sound too fun!
  • Yes, try to find your adjustor and get the appointment scheduled ASAP. WC has a goal of getting people back to work asap, so tell yor current doc you do not feel that you are physically able to return at this time, and you are not comfortable returning before you are evaluated by a specialist.
    Where are you located-I think a lot of states have different rules.
    Keep pushing--you have to stand up for yourself.
    PM me anytime!!
  • I get on this site frequently, but this is the first post I have made since they restructured this site about 2 years ago, but something about your post just struck a chord with me. I agree with the others and think you need to contact the adjuster that is dealing with your case. You will probably have to ask your employer who the adjuster is. Worker Comp really tries to wait people out, hoping that it will discourage the person. I have found that if you take someone with you to the doctors appointment that has seen you suffer, and knows how this injury effects you daily, it helps. The doctor can hear about your problems from another prospective, and they may be able to sympathize more. I really feel for the situation that your are in, and know that it can be physically and emotionally draining. Keep pushing forward and standing up for yourself and the pain that you deal with. Evereyone on this site cares for each other, and has an unspoken bond that no one else could ever understand. I will be thinking and praying for you, and if you need anything or just someone to talk to let me know. Take care, and I hope you have less pain each and everyday. :)))
  • I appreciate each of you and your kind words. It is nice having others out there that can relate to the problems you are having.

    I have been calling the specialist and the adjuster daily with no luck. I think the adjuster is avoiding the issue. :( I did however recently find out that my neurosurgeon accepts WC and by the luck ~of who knows what~ the adjuster answered the phone for my clinic physician today. They discussed my neurosurgeon seeing me for the referral rather than a new ortho doctor. Being that the NS knows my case. Well long story short, the adjuster approved the switch from the ortho to the NS. YAY!! Maybe thing will start happening now.

    I have an appointment with the clinic doctor today at 1pm. I am going to take my husband with me today (thanks for the recommendation countrythug) :) I will let everyone know the outcome of that appointment.

    I still have not found an answer to my question about going back to work and then having to take off again. Will I have to go another 7 days with no pay before income assistance is restarted? I have been searching for several days with no luck. :( Texas WC site is very basic, it does not go into too much detail for employees. :(

    Thanks for listening!
    Hope each of you have a pain free day!
  • :D I can't remember how the seven day thing was handled if you went back to work, but I either found the info online or in our policy and procedure manual at work. :?
    I hope you get the answers and treatment that you need. :D
  • Can you get a hold of the caseworker for workmans comp to ask about the 7 day thing? I'm in MN and we have a workers comp hotline w/ the department of labor. Is there something like that for your state? I have found them to be extremely helpful in finding out the shady things the wc insurance caseworker was doing. Whatever you do, don't stop fighting for your rights because they really will try to discourage you. You have the right to medical treatment, and they can't make you wait forever for it.
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