Workers Comp case was fine till I hired a lawyer.

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Latest post 03-12-2011 4:14 PM by noperona. 8 replies.
  • 02-10-2011 7:37 PM

    • noperona
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    • CA
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    Workers Comp case was fine till I hired a lawyer.

    Filed my claim in 2005. Had 2 injuries. One I had surgery for(carpal tunnel) in 2006 and was out of work about 3 months. The WC surgeon said I would need arthoscopic surgery for my other injury (shoulder), if the injection he gave me didn't work. In A few months later, the doctor told me that WC was insisting he release me. In 2/07 I got a letter from WC saying they were going to close my file since I was all better. I hired a lawyer (was really naive and hired the one on T.V.). Since then I have done nothing but wait. Finally went  to the WC doctor, who wanted to do the surgery after I did therapy(2010) to get back my ROM.  The lawyer calls and tells me that they want me to go to their doctor again because the WC doctor is taking too long.  I go to their doctor and he tells me he can't do surgery, he's only a chiropractor. He refers me to a surgeon. A few days before the appointment, they call and say I should have had xrays done, so they need to cancel the appt till then.  That was in October 2010. I have been trying to get the xray appointment since then. When I called last Friday, I was told by the doctors office that I had been discharged on 9/29/2010, so didn't need to come in. I can never talk to my "attorney". Have had 3 different hearings but only think only law clerks or aides came to represent me.  Coincidentally, the day after I discharged, I got written up for my attendance at work.  Does anyone know what happens next?  Is it possible I can lose my job, or my coverage for doctor visits and prescriptions? Judging by everything I have read, I am relatively new at this, so if anyone tells me what happens next I would appreciate it. Help 

  • 02-11-2011 8:29 AM In reply to

    Re: Workers Comp case was fine till I hired a lawyer.

    You can change attorneys at any time you find a new on to agree to take over your claim. A new AA/Applicant Atty would notify and get your file from your current AA. Go to www.caaa.org for a referral to an AA in your zip code.

    Going to your AA doctor does not advance your claim forward. That process was repealed years ago.

    There is a dispute resolution process in the labor code. You are also required to see a Dr in the employer/carrier MPN/Medical Provider Network. Seeing a Dr outside the MPN won't get authorization for any requested treatment.

    You can have ONE PTP/Primary Treating Physician at a time. You can change PTP up to 3 times in your claim. If you are not seen by your PTP at least every 45 days, or 6 weeks, you will be automatically MMI/Max Medical Improvement and rated for PD/WPI.

    Doesn't look like, from the info you provide here, that your AA is following the process of Calif WC system. And, your PTP isn't either. There is a specific process for all medical care and prior authorization. A request for treatment/tests/medications going through the UR process can't take more than 14 days...not months.

    You can find fact sheets for injured workers/IW's here http://www.dir.ca.gov/dwc/InjuredWorker.htm, just follow the links at that page.

    Your job is only protected for up to 12 weeks under FMLA, if you are elilgible. The comp claim is open for 'life' or until you cash it out. Or, if you don't seek treatment for 18 months after the last payment of benefits or medical care, they can close the claim.

    There are no job protections in filing a WC claim. You can be laid off, terminated at any time with or without cause. You can't be fired for suffering the injury, or filing the claim, or receiving an award in closing the claim.

  • 02-11-2011 3:14 PM In reply to

    • noperona
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    • CA
    • Posts 7

    Re: Workers Comp case was fine till I hired a lawyer.

    How do I find out who my PTP is?  I was originally approved for carpal tunnel and an impingement.  The MPN had an MRI done, which showed a torn rotator cuff. I was just recently told that by the MPN pain doctor. Do I file a new claim for that injury?  The AA doctor they sent me to on 9/29/10 has no knowledge of, or has ever examined me for the impingement or the rotatator cuff. Thank you so much for your time.  I have called my attorney so many times and never once has he/she called back. Even tried to email and they wrote a letter suggesting I call. I'm thinking they don't want to put anything in writing.

  • 02-12-2011 9:23 AM In reply to

    Re: Workers Comp case was fine till I hired a lawyer.

    Your PTP/Primary Treating Physician is the Dr you saw who treated you, and released you at MMI, IN 2007.

    Why are you waiting 3 years later to address this injury ?

    Why wasn't the PTP recommending shoulder surgery, at the time you were declared MMI ?

    The CA doesn't tell any Dr what to do to treat or release an IW at MMI. The PTP controls the medical in a claim. Not the CA.

    ''I was originally approved for carpal tunnel and an impingement.''                                               Ok, and you said you had the CT surgery...

    ''The MPN had an MRI done, which showed a torn rotator cuff. I was just recently told that by the MPN pain doctor.''                                                                                                                                If you are seeing a pain management Dr now, in the MPN, that is your PTP.    Why didn't you tell the Dr your AA sent you to about the injuries, including all you claim, shoulder included ? Dr's don't read minds...if you don;t tell, how would he know ?  No, you don't file a new claim...you already did file, you said the CTS and shoulder were claimed... only the shoulder hasn't been treated.  It may not do any good for surgery to your shoulder at this point. Rotator cuff tears don't heal on their own, however the longer you wait for surgery, the more difficult to repair, if at all.

    You can file a complaint with the state bar on your attys actions, or mis actions.

    At this point, IMO... try to find an attorney who will take over your claim. That new one will get your file, and notify the current AA and WCAB of your change.

    The CA cannot just 'close' a claim, unless like I said, you have not sought treatment for 18+ months. As you have apparently continued to see a Pain Managment Dr, in their MPN, the claim is still open. Based on the info you provide here.

    You really need to consult another AA, message boards are not good substitute for valid legal advice. The AA needs your file.

  • 02-13-2011 1:50 PM In reply to

    • noperona
      Consumer
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    • Joined on 02-10-2011
    • CA
    • Posts 7

    Re: Workers Comp case was fine till I hired a lawyer.

    They finally sent me to their doctor on 9/11.  I assumed it was so he could be doing the surgery. I brought him my MRI, told him the shoulder had got worse and they had never taken me out of cashiering as they had promised to.  He told me there was nothing he could do.  He was a chiro, so he couldn't do surgery anyway. He was under the impression I was there for him to do a report on, but he never examined me. He made me an appointment with an ortho dr for the next month but then they called a few days ahead to cancel due to no appt set for me to have xrays. When I tried to reschedule, they said Dr. Miles (Ortho) had discharged me on 9/29/10. In Jan I got that notice saying that the employeer now had a new MPN ... I assume everyone got one of those.  That threw a monkey wrench into everything. I didn't know whether to go to the new MPN dr, or the AA dr , or the old MPN docrtor.  Had one question, my biggest question. The doctors have kept me on tbese pain pills. At first it was Vicodin (11/2 years) now Oxycontin (4 yrs). How do they get people off these things?  I don't even like taking an execdrin, so this is very hard for my body to feel like it need these things or that I'm dependent on something.  At the end of it all do they put you through a program to get rid of it?  I see the p[ain doctor wednesday. Should I ask him to lower my restrictions?  Is he authorized to do so? Since I am in limbo land with AA. I just don't know how much longer I can do my job (it's like grocery clerking, only heavier items) Thank you so much for your time.

  • 02-13-2011 3:00 PM In reply to

    • noperona
      Consumer
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    • Joined on 02-10-2011
    • CA
    • Posts 7

    Re: Workers Comp case was fine till I hired a lawyer.

    The PTP in 2007 tried a cortisone injection in my lower back (8-23-06).  He said if the shot didn't work he'd do a "scope". I wrote my next appt down wrong. I put 18th. It was the 17th. That's why I got the letter closing my case, even tho I had already re-scheduled for Feb 12h. I had never heard my PTP raise his voice, but when he told me he had to release me, (according to his papers it looks like Dec 30ish was when wanted to do the scope),  he was furious. He said he'd lose his business contracts if he didn't. I think my problem is and has been that they gave me a 10lb lifting restriction on my wrist. In the big rush to have Dr. Shoji release me, no one ever gave me restrictions for my impingement. Took years for the drs to figure out if I had one or not, by what Ive read. My HR at work told me when I returned to work originally that she needed to move me out of cashiering forever. Something called a 98, I think she said. She put me on the Express lane until she could figure out where she was going to move me. Unfortunately, she got sick and no longer works there.  Everyone there now doesn't even realize I was injured on the job unless I tell them. Dr. Shoji filled out a PR-4 form and checked not to return to my usual job but the rest of the form just says "see dictation" under each heading. The HR I have now just says "if you have something that weighs more than 10lbs, call us".  Unfortunately the 1- to 15 people waiting to be checked out tend to get moody and it's very embarrassing to have to explain to people that I have a disability. This past week I received formal written  counseling. They HR cited  I had missed 2 days in October of 2010 and 1 day in November of 2010. News of me being discharged by the dr on 9/29/10 travelled fast.Took me tons of phone calls, faxes, and emails until I  found out on February 8th.  I can hardly wait til work today.Have looked for another lawyer but even this cite rates their firm high.  Hard to believe an injury (and not even a big injury) 14 years worth of work and a promotion poof.  Lost my health, vacation, sick-pay benefits and haven't been scheduled full time since my injury. I didn't want 2.1 million. Just to be better. Thanks for letting me ramble.  

  • 02-13-2011 3:14 PM In reply to

    • noperona
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    • Joined on 02-10-2011
    • CA
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    Re: Workers Comp case was fine till I hired a lawyer.

    Forgot to address the 3 year wait.  My doi was 9/22/2005.  It took Sedgwick or the workers comp dept until 7 to 8 months to get things approved. Had surgery on 7-11-06.  They had originally sent me to a Dr. Gonzales but when I googled to see if there was a suite number, there was a site that showed what a butcher the man was, so I switched to Dr. Shoji. After the surgery, I did therapy for my hand. The dr had said he thought the beginning of the year would be a good time to do a "scope". That's when the nurse from workers comp sent the mean letter to the dr and then I missed my January/ 2007 appointment. The WC lady sent that letter claiming I must be better, case closed.   If anyone does know of another attorney that they have dealt with, please let me know. Alot of these rating systems on the internet give the one I am currently using a good rating, so would rather go with word of mouth.  Thanks for being so nice and kind to a newcomer. It feels so nice just being able to share this.  I'd wish none of these things had happened to any of you, but have gained more insight on this forum than from anywhere else. 

  • 02-14-2011 10:51 AM In reply to

    Re: Workers Comp case was fine till I hired a lawyer.

    While it may help you to explain all the details of your injury/treatment, that isn't really relative to the procedures here.

    In Calif WC, you file a first report of injury. The employer files with their carrier. Here, you mention Sedgwick..they are a TPA/Third Party Adm, for a legally self insured employER.

    Once the ER assigns the claim to TPA, the ER steps aside.

    You see a Dr ER/TPA selects. In the MPN. If you seek treatment on your own, unless you are predesignated, they can force you to the MPN. When there is a change of your PTP out of the MPN, or a new MPN. you must be given 45 days notice to select a new PTP. There are some conditions for continuity of care issues where you may stay with the PTP you are happy with.

    Going to your attys doctor does not qualify, nor does the TPA have to address a request for treatment. Only the PTP you have selected controls your claim and certifies for any benefits. There is a legal timeframe for requests for treament to be authorized/delayed/denied...and that Utilization Review time is 14 days from the receipt of the request. NOT 7 months or longer.

    The "work comp lady" cannot close your claim. A TPA knowing you can be intimidated by the process will tell you anything. A NCM/Nurse Case Manager is often assigned, and discusses everything with your PTP. And, tries to intimidate the PTP too...Your claim cannot be "closed" because you are "better" or 'cured'. Medical stays open for life, until you cash out, or don't seek treatment for 18 months post the last payment of benefits/treatment.

    Apparently someone has dropped the ball in your claim. Whether it's the PTP, or atty office...don't know.

    IMHO...you should make a date/time specific appt with your attorney, and get this cleared up. Now. It's too difficult given the variables here to give you any direction...and responses on a message board should not be taken as legal advice.

    If you want to consult with a few attys, go to www.caaa.org for a referral in your zip code.

    You should expect your current atty office to have good ratings...if no one has provided a unfavorable opinion. The state bar doesn't rate attorneys. Don't know where you are looking.

  • 03-12-2011 4:14 PM In reply to

    • noperona
      Consumer
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    • Joined on 02-10-2011
    • CA
    • Posts 7

    Re: Workers Comp case was fine till I hired a lawyer.

    Thank you for all your help. Noticed I have the same attorney as another lady on this site, so explains one of the reasons we are both up a creek. . I have found that there are 4 people with the same name and  from the same area as me, who have workers comp cases. I think that is why I have doctor reports in my file, from doctors I have never seen. This is why it has taking so long for me to get treatment. Whatever is in my file has everyone  thinking I already had shoulder surgery (approx 2007 from what I've been told) but I haven't.  I was told by a doctor two days ago that a QME report of mine states that I may need "another" shoulder surgery in the future. This doctor asked me if I was sure I had never had shoulder surgery. Sorry if I sound frustrated but for years I  have been mistook for the person(s) who have already been healed.It wasn't until this week that I'm figuring this all out.  I've had to work under this person's (people's?) work restrictions and it's very difficult to deal with. My restrictions (from 2007) are not to lift more than 10 pounds. My HR idiot's solution is to tell me "don't lift more than 10 lbs. I'm a cashier. I can't look at a bag and tell if it weighs 9lbs or 12 lbs after all the stuff is in the bag. I have bags of dog food and boxes of detergent that I know weigh more than 10 lbs. The HR's brillant solution is that  I  find someone else to lift it. That would be great if all my customers didn't have to wait. Of course we are timed on how fast we check everyone out, so there's the big catch 22.  Wanted to say thank you for this website. So much fantastic information. Wish I had known it existed in 2005.

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