Workers Compensation Settlement "Lifetime Medical", Unpaid Doctors and Rejected Procedures and Testings.

Asked over 1 year ago - Orcutt, CA

I paid my doctor out of pocket because the "adjuster" dropped him off his MPN list (psychiatrist) with no
warning. my doctor was kind enough and continued to prescribe all my depression medications the "adjuster" continued to pay for. I sent my adjuster those bills I paid and he has ignored me three times and now they want to settle my case.

I live in a area where there are no doctors who take Workers Compensation and the only one was my doctor the "adjuster" has refused to pay for. I have asked five times with my attorney when I can go see my psychiatrist without me paying the bill. He has not gotten back with me with that, only that the "defense" wants to settle in May 2013. What's the point of life-medical if I can't see my shrink? How do I get my money back I paid?

Additional information

The doctor the adjuster dropped of his "MPN" list is the only doctor locally who accepts my WC Insurance. My attorney has not been able to figure out which psychiatrist the carrier will accept in North Santa Barbara County (Santa Maria- Orcutt area). Currently the doctor I paid is probably going to be the doctor the carrier approves. The attorney does not think it's a big deal to get the money back from the "Carrier" but to someone on a limited budget, $500 in money is a lot of money! How do I get my money back and should I sign a "Settlement" without any knowledge of who is going to be my doctor and when I am allowed to see a psychiatrist.


carrier has been screwing with me, late each month on "pain medication" and some of my meds this psychiatrist has been prescribing. How do we fight against late medication "refills", should we go to the ER and is it legal to refill meds late every month?

Attorney answers (5)

  1. George Ellis Corson IV

    Contributor Level 20

    2

    Lawyers agree

    Answered . Your Attorney now has the ability to litigate your MPN issue by way of Expedited Hearing. Discuss the matter with him, because he may have a litigation plan of which you are unaware.

    We offer general concepts, but you should give ALL your facts to a licensed Attorney in your state before you RELY... more
  2. Peter Joon-Sung Hong

    Contributor Level 12

    1

    Lawyer agrees

    1

    Answered . The rules regarding mpns and when you are able to treat outside a network is complex and highly litigated. It sounds like your ability to get reimbursed is connected to this issue. Discuss litigation strategy with your attorney.

  3. Brian Daniel Fleischer

    Contributor Level 2

    1

    Lawyer agrees

    1

    Answered . As a defense attorney I always advise my clients with MPN issues to make sure they have provided the injured worker (or their representative) with a list of appropriate providers in the needed specialty. There are clear rules governing whether an injured worker can treat outside of that MPN. If there arent enough providers within a reasonable geographic area you may be able to treat with a provider of your choice. You should contact your attorney and discuss this further with him/her.

  4. Gerald Franklin Batchelder

    Contributor Level 13

    1

    Lawyer agrees

    Answered . I'd suggest you schedule an appointment to sit down with your attorney and come to a clear understanding of what is happening in your case.

  5. Bobby L. Bollinger Jr.

    Pro

    Contributor Level 17

    1

    Lawyer agrees

    1

    Answered . Here in my state I could file a motion to (a) get your doctor back on the approved list and (b) get your out of pocket expenses reimbursed. Your lawyer may be able to do something similar there. Ask him if he can file a motion to get this done.

    This answer is intended as general information and not as specific legal advice. If you want to have a free... more

Related Topics

Types of personal injuries

There are many types of personal injuries for which financial damages can be awarded, including physical, emotional, and psychological injuries.

Work-related personal injuries

Employees can sue for damages if they’ve suffered work-related injuries. These lawsuits are separate from workers’ compensation and cover more kinds of injury.

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