Question about Workman's comp..non aviation

corjulo

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Corjulo
As anyone here had any experience dealing with workman’s comp insurance in New Jersey? To make a long story short my stepson was working, right out of college, in a home for severe autistic teenagers. About 9 month in he let his guard down and was clocked in the head by a patient. He woke up on the floor and since then he’s been in chronic neck and arm pain. He was fired from the job because that neck and arm pain made it impossible to restrain patients, which was a big part of the Job. The workman comp has been an utter disaster. The kid has yet to be allowed to see a neurologist or orthopedist. Instead he has been forced to see Works Comp hack doctors, who promptly sent him back to work where he was fired the same day. I have found out this is normal practice

Now Mom and Dad are involved and let me tell you, I am stunned by how rude and condescending the workman comp people are. They will hang up on you if you so much as raise your voice. No good neurologist will even take the case when they hear it’s a workman’s comp case.

We have been helping him pay to see his own doctor but that doctor says he desperately needs to see a neurologist and get something called a Flexsion Entention MRI (Big Big bucks)

So, any tips on dealing with Workmans comp. I hate to get lawyer involved and doubt they can do much fast enough. There has to be a department or procedure that will get these people moving. And how do I find a good neurologist if none will take a case involving Workman’s comp insurance companies
 
corjulo said:
As anyone here had any experience dealing with workman’s comp insurance in New Jersey? To make a long story short my stepson was working, right out of college, in a home for severe autistic teenagers. About 9 month in he let his guard down and was clocked in the head by a patient. He woke up on the floor and since then he’s been in chronic neck and arm pain. He was fired from the job because that neck and arm pain made it impossible to restrain patients, which was a big part of the Job. The workman comp has been an utter disaster. The kid has yet to be allowed to see a neurologist or orthopedist. Instead he has been forced to see Works Comp hack doctors, who promptly sent him back to work where he was fired the same day. I have found out this is normal practice

Now Mom and Dad are involved and let me tell you, I am stunned by how rude and condescending the workman comp people are. They will hang up on you if you so much as raise your voice. No good neurologist will even take the case when they hear it’s a workman’s comp case.

We have been helping him pay to see his own doctor but that doctor says he desperately needs to see a neurologist and get something called a Flexsion Entention MRI (Big Big bucks)

So, any tips on dealing with Workmans comp. I hate to get lawyer involved and doubt they can do much fast enough. There has to be a department or procedure that will get these people moving. And how do I find a good neurologist if none will take a case involving Workman’s comp insurance companies
Find a good Anesthesia Pain specialist, pay him from the pocket for the evaluation. This is one of the heinous sins of the comp system: the "Independent Medical Evaluator" is never independent. He is dependent on the insuror to keep paying him to deliver good "results" e.g, no money goes out.

There is little we can do from the medical board level, as such a physician has NOT undertaken care and has only a limited Physician Patient relationship. Once you have the real opinion, the attorney will be able to get some traction.

One of the biggest sins of the current system, is if you don't have health insurance, and can'g maintain it, the comp. people deny you, then you are truly unable to get fixed. Then you can't be employable and get heatlh insurance. The Work comp people hate me becuase I am always clobbering their expert witnesses.

Sigh.
 
bbchien said:
Find a good Anesthesia Pain specialist, pay him from the pocket for the evaluation. This is one of the heinous sins of the comp system: the "Independent Medical Evaluator" is never independent. He is dependent on the insuror to keep paying him to deliver good "results" e.g, no money goes out.

There is little we can do from the medical board level, as such a physician has NOT undertaken care and has only a limited Physician Patient relationship. Once you have the real opinion, the attorney will be able to get some traction.

One of the biggest sins of the current system, is if you don't have health insurance, and can'g maintain it, the comp. people deny you, then you are truly unable to get fixed. Then you can't be employable and get heatlh insurance. The Work comp people hate me becuase I am always clobbering their expert witnesses.

Sigh.


Thanks Doc

Any suggestions on how to find a good Anesthesia Pain specialist in Connecticut?
 
corjulo said:
Thanks Doc

Any suggestions on how to find a good Anesthesia Pain specialist in Connecticut?

My wife is not a Doc but she runs a CME company. I shot your question to her and the reply is:

"I would say that whoever lives in CT can go to New York. The best pain specialist I know is Charles Argoff, a neurologist. He is at North Shore in Long Island. In NYC proper, Marco Pappagallo."

FWIW. Hope the situation turns better soon.

-Skip
 
Dan;

Sorry about the situation, it is a mess. I have worked in the personnel world for close to 30 years and the whole issue of WC has not changed. Doctor B is so right on. get an out of pocket doc now. Keep all the records and expenses. Log everything from day one. It will be a long road full of twists and turns. Most states have an appeal system and take advantage of it. I will be glad to help out.

John J
 
From the American Pain Society Directory:

Cheshire: John W. O'Brien
Danbury: Mitchell Prywes
Enflield: George Donahue
Fairfield: Michael Brennan
Gales Ferry: Edward Hargus
Kensington: Gerson M. Sternstein
New Haven: Keun S. Chung, Brenda C. McClain
Norwalk: Gerald B. Weiss
Salem Paul A. Pudimat
Stamford: Lucille Russell
Sheryl E. Siegel
Trumbull: Lawrence Kirschenbaum
West Haven: Davide B. Glassman

I get so tired of clobbering Insurance Company Docs. It's even gotten to the point where I tell the defendant attorney after the deposition to use a different doc. They don't get it. It's cheapest to take care of the problem and close the file. I even have judges ask me what to do with all the B-S and I simply tell them, with a sigh, "the best you can.".

Then I get asked, do you do...and I cut 'em off, "no, I am NOT available". Drinking that sort of opiate is terminally addictive. "Then who do I get?" and I have to say, I can't help them. They are the next thing to selling your soul for a living in medicine and I can't hide my sometimes contempt for the guy who is discredited by a total cure for something that they denied was there. THEN the fun REALLY begins.

Email for addresses and telephones....
 
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Too bad it didn't happen in Tx, the system is designed for injured and malingerers alike.
Sorry to anyone representing the TWCC here but that is my experience and I have heard way too many similar stories.

Dan, the result of abuse of the WC system is what caused the terrible experience you are having. After many thousands of 'injured' workers cheating the system, that is the reception you can expect. Your goal has to be to convince the WC insurance system that this claim is valid, and not just another ruse. Tough road especially with no overt evidence of injury, just pain. Good luck.
 
bbchien said:
Then I get asked, do you do...and I cut 'em off, "no, I am NOT available". Drinking that sort of opiate is terminally addictive. "Then who do I get?" and I have to say, I can't help them.

Or as the lawyers like to put it "let's conflict him out so he can't testify against us". I've seen that game played in more ways than this...
 
No doubt there is abuse. But I believe the insurance companies use that as an excuse to hide long established pattern of dent deny deny.

At this point I'm getting the independent evaluation arranged but it looks like there is no way to avoid a lawyer. My step son really really wanted to avoid this. But, not being able to even drive the pain is so sever seems to have left him no options.

The ironic thing is the patient that clobbered him was thrown out of two other institutions for being extremely violent. My stepson was not told this when we was assigned this kid. It's a wonder anyone works in mental institutions
 
Let'sgoflying! said:
Dan, the result of abuse of the WC system is what caused the terrible experience you are having.

NO, it is the insurance company's desire not to pay claims. They do not pay claims if they can bully people, they do it all the time even when the there is no question the claim is legitimate. Insurance companies do not have the insured's interest in mind, but rather the stock holder's interest. This is a conflict of interest which can never be resolved and is why there is so much litigation over insurance claims.
 
Let'sgoflying! said:
Too bad it didn't happen in Tx, the system is designed for injured and malingerers alike.
Sorry to anyone representing the TWCC here but that is my experience and I have heard way too many similar stories.

Dave, you've got that right.

Challenge, as always, is to find a system which: (1) provides predictable and medically-responsive treatment for legitimately injured workers, and (2) does not promote or support abuse of he system (ie, support malingerers).

It don't take a genius to figure out that a sytem which has "medical" clinics advertising, as a key selling point, "Medical-Legal Liaison on Staff," is an inherently-corrupt system. Lawyer, and medical clinic, advertising are symptoms of a bigger problem.

I have, in dealing with the comp system for clients, seen both sides of it: On the one hand, limitless "treatment" and lost time for falsely-injured employees, and on the other, comp docs beholden only to the carrier, claiming that "MMI reached, released for work" for people whose pain and disability are genuine.

Answers? I got none.
 
Dan,
I deal with Work Comp on a regular basis. I am sorry to hear about your son.
1st = Get an attorney, that tends to wake them up some
2nd = Realize that once you get an attorney they WILL NOT AND CANNOT talk to you or your son any longer because you are represented by council.
Who is the WC insurance company?
ANY treatment not authorized by them is HARD to get payment for.
Have you son return to the doctor that originally saw him and ask for a "return to work without restrictions", the doctor probably will not give that with his symptoms. Once he writes retrictions then it can become what the call "TTD" Total Temporary Disablity. The doctor is NOT going to risk his license/malpractice insurance in a hearing for the insurance company by writing a return to full duty with your sons symptoms.
Once he has the TDD slip. Have him call the insurance company and advise them of this and also send them a registered letter to the same effect. His claim will be "pushed up" to a level 3 adjuster who wants to just get it off their desk and settle or get the treatment needed.
MAKE SURE AT ALL COSTS that he NEVER refuses to see any doctor they send him to. Once you "refuse treatment" they have you.
To get their attention the fastest, mention the phrase "bad faith"
Email me off line if you need more help.
I am NOT an attorney, I just deal with w/c cases everyday in my work.

Mark
 
markb5900 said:
Dan,
I deal with Work Comp on a regular basis. I am sorry to hear about your son.
1st = Get an attorney, that tends to wake them up some
2nd = Realize that once you get an attorney they WILL NOT AND CANNOT talk to you or your son any longer because you are represented by council.
Who is the WC insurance company?
ANY treatment not authorized by them is HARD to get payment for.
Have you son return to the doctor that originally saw him and ask for a "return to work without restrictions", the doctor probably will not give that with his symptoms. Once he writes retrictions then it can become what the call "TTD" Total Temporary Disablity. The doctor is NOT going to risk his license/malpractice insurance in a hearing for the insurance company by writing a return to full duty with your sons symptoms.
Once he has the TDD slip. Have him call the insurance company and advise them of this and also send them a registered letter to the same effect. His claim will be "pushed up" to a level 3 adjuster who wants to just get it off their desk and settle or get the treatment needed.
MAKE SURE AT ALL COSTS that he NEVER refuses to see any doctor they send him to. Once you "refuse treatment" they have you.
To get their attention the fastest, mention the phrase "bad faith"
Email me off line if you need more help.
I am NOT an attorney, I just deal with w/c cases everyday in my work.

Mark

Getting an attorney may indeed 'wake them up' but it will also expose the patient to the nefarious underworld of W/C. While it is in the best interest of everyone to move the claim forward it may not be in the claimant's best interest to settle quickly. Getting an attorney involved may help to move up the time line but the claimant has to be ready to ward off backroom settlements in order to protect their right to medical care, including future needs. Attorneys want to settle quickly and to make that happen they may not take into account all the patient's needs. However, bottom line, getting proper representation is better than not having an attorney.

WRT TTD, a Dr who is reluctant to provide a return to work is even more reluctant to provide restrictions. Oh, he may say it but it needs to be in writing, properly formatted. Even then the depth and breadth of those restrictions will be disputed. A 2nd, 3rd,...12th opinion will be required. Some states have allowed that ONE opinion is enough to make a ruling. But while it is disputed which one is THE opnion, be prepared to present yourself to ALL office visits.

Yes, DO NOT refuse treatment. Even if it is a hardship to make it to that Dr. It is a war of attrition and sending the claimant to multiple Drs, perhaps hundreds of miles distant, is one tactic of the Ins Co. A good W/C attorney will have anticipated this.

There are things the claimant should do to protect their interests. Any communications MUST be recorded. Phone conversations are promptly entered into a phone log. All mailings are registered with a return receipt. Include receipts for cost of mailings--they will add up and may factor into any awards. Date of mailing and recipient's name is entered into a log. It demonstrates plausability if entries are made in chronological order. Get an expandable file. Prepare for war.
 
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