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Workman’s comp

does anyone know if WC pays for pain management? I was trying to pay all my appointments and injections ect myself with my personal health insurance but the out of pocket amounts have me in serious debt , so I have turned to workers comp since it is a job injury and I just not sure if Comp has to authorize pain management before I go or can I just go and they pay the bill. I do have a lawyer but he’s out of office until next Wednesday so was just hoping somebody is familiar with comp rules. I hate that I have to turn to them but financially I have no choice. 

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13

Comments

  • L4_L5LL4_L5 Posts: 1,460
    edited 04/18/2018 - 3:56 AM

     Call your lawyer today and ask to speak with the paralegal. They should be able to give you the name of a doctor in the area who specializes in pain management and who is a certified WC doctor.

    You should also submit bills to WC for reimbursement at some point down the line. Ask your lawyer about that. 

    What are the allowed conditions in your claim? It doesn’t sound like your diagnosis was much given you’re having to put everything through your own insurance.

    What state do you live in? That matters too .

  • Shyann, you are a W/C insurance dream lol. If your W/C MD has advised that pain management is needed, then yes W/C WILL pay for all your treatments including mileage as well. Please as stated above, call your attorney and advise him that YOU,VE been paying for prescribed treatment. This might help you further down the road. W/C is NOT your friend and especially your case manager if you have one is not your friend. They work for the insurance company. Again please advise your attorney!

    DavidG

    Veritas-Health Forum Moderator

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  • I'm surprised that your health insurance hasn't questioned you regarding claim subjugation.  In our state, if you go to ER and get an Xray, insurance sends a form wanting to know who hurt you, when they hurt you, how they hurt you, etc.  The last question is typically where they want you to write out in detail all the facts surrounding why you needed an x-ray. 

    Just an FYI - they (insurance) doesn't like it when you answer, "Because gravity sucks".  Trust me! 

    Several Epidurals, L4-S1 360 ALIF, Numerous Facet Joint Injections, RFA x2
  • Lol EMS guy, insurance companies have no sense of humor

    DavidG

    Veritas-Health Forum Moderator

  • Well I never turned in how I was injured since I was still having visits with my surgeon every 6 months, but everything was fine until I was put in a position at work to lift more then my weight limit and that cause the disc above my acdf to rupture so I’m sure that’s why my insurance didn’t ask any questions. I was just gonna do this myself cause I know Comp is a pain in the ass to get things done but the bills omg are crazy for out of pockets and now I must let them pay what they will pay. I will call my lawyers paralegal today to see what she says before I call back the pain management cause I need to get in I will be out of meds by Monday and my surgeon can’t fill anymore with all these new laws so I have to get in to see the pain management dr. Thanks for all your advice, i live in ga for those who wondered. i really appreciate it. I am just worried if I got hurt this quick for lifting above my 20lb weight limit I’m just wondering will I EVER be able to lift more then this? Has anyone had this issue and if yes how has your life changed?

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  • Shyann, Your correct in saying that W/C is a Pain in the ....., You ask how it has affected us? Sept 2014 ACDF C5- C-7 with left sided Radiculapthy, non- fusion, every day pain some fair days and some bad days. Was given a 10 pound lifting restriction following reaching MMI. Was medically retired from a career I loved even though I wasn’t mentally ready to retire and found myself in a very deep depression where I would sit at my work bench in my man cave and collect empty bud lite cans. You find out who your true friends are during this period trust me.After I accepted reality, The sun started shining again, and I would do what I could do and not worry about what I couldn’t do. It’s coming up to the 4 year mark and now having issues with other parts of my spine including adjacent disk disease at C4 through C8 But not going to worry about it. Life’s to short so take it as it comes. In my prior life I was a Lt/ FF/Paramedic, But now I’m just me and actually enjoying it. Back to you, get your attorney involved! I can,t stress that enough!

    DavidG

    Veritas-Health Forum Moderator

  • How long have you had this WC attorney and what exactly has he or she done to help? Unfortunately it doesn’t sound like much. I apologize if I’m wrong.

  • L4L5, If I’m reading this correctly, it sounds like she didn’t report the new injury to her employer. Shyann, insure you report this injury if not then you will be responsible for the bills. Either way, contact your attorney immediately! You don’t want to be responsible for any future treatments, future medications or even future surgeries if needed.

    DavidG

    Veritas-Health Forum Moderator

  • Yes I did report to my employer right away but after dealing with comp before I really didn’t want to work with them again if I did t have to but now that the cost are overwhelming me I don’t have a choice after all my employer new my limitations and should have never put me in the position to lift more than my dr stated. So I shouldn’t feel bad but I do. I was referred to this lawyer through my old Comp lawyer he said he’s very good and I loved my old lawyer but unfortunately his father has  dementia  So he is not practicing right now as he is the sole caretaker. I was already off work when I contacted him and I only did cause I was wondering if I can’t do the physical work I have done my whole life without injuring myself what am I to do I was so frustrated. He had me explain what happened and he said this is the fault of your employer they must follow dr restrictions so he started the case and then handed over to a  colleague . I have read reviews on this lawyer and they are impressive I must admit. I know the older we get the more fragile are bones are but omg I hate not knowing what my future is like. I have to say it sucks getting old. I had to call my dr office and report my Comp claim number now I have to wait for Comp to authorize pain management so here I wait. I have to say again I truly hate workers comp! I am 53 and had acdf on C4-c-C5 and C6-C7 and now I have ruptured C3 , has anyone around my age gone through this and what was your future like? I just can’t believe less then a year after surgery here I am again just so frustrated!

  • You should see your WC doctor and ask him to fill out the form for a referral to pain management. If the referral to pain management gets denied by the MCO, then appeal. 

    You may have to go to a hearing with your lawyer to eventually get things done that you want done. Otherwise you’ll be forever stuck at square one.

    One of the key purposes behind WC is so injured workers don’t go broke, lose their apartments, homes, cars, etc. and wind up on the street just because they got hurt on the job. 

    WC will no doubt make you jump through hoops to get things approved but that’s where your attorney comes in.

    You really have to stay on top of things and be unrelenting. Otherwise it’s going to be very hard to proceed further.

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