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

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?

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?

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Attorney answers 5

Posted

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 consultation with me, please contact me through AVVO.

Posted

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 upon any legal advice.

Asker

Posted

He wants to settle the case on May 10, 2013 and will not return my phone calls about the psychiatrist I will see and repayment of the doctors bill. We are going to sit down with the attorney of the "Defense" to sign off life-time medical with the defense agreeing to a portion of "depression". It's strange to think we are going to sign off this case and i do not know who is going to be my psychiatrist and I am going to have to eat the medical bills? Why are we sitting down with the defense and a judge and I have no idea who I am going to see?

Asker

Posted

The pharmacies and doctors are talking about the cordinated efforts of insurance companies filling pain medications and psyche medications two to four days late, leaving the patients who follow their doctors instructions in Hades. What will the future hold for me and other injured workers being played with, denied treatment requests by our PTPs and unanswered phone calls from the adjuster and attorney. Is the Adjuster now the person I am to go to after my attorney sign's off my case on the 13th? appreciate your time and others looking here are probably having their meds refilled late each month. thank you!

Posted

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.

Asker

Posted

We did sit down and there is no clarity of who I am going to see as my future psychiatrist. The next sit down appointment is to sign off the case with a judge and the defense attorney. What's the point in sitting down and signing off the case if I have not been repaid for the same doctor the adjuster is going to use in the Future. It's hurry, hurry, hurry to sign and I am stuck with not knowing who my doctor is. Am I allowed to walk away from the signing if my attorney has not given me any information about my complaints?

Gerald Franklin Batchelder

Gerald Franklin Batchelder

Posted

No one can force you to sign settlement papers. Sometimes a judge at a settlement conference is willing to talk directly to the injured worker, with both attorneys present, to hear about your concerns and give you an unbiased view about them. You might want to see if you can arrange that through your attorney.

Posted

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.

Posted

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.

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