WORKMAN'S COMP IS TRYING TO END MY CLAIM

by GentlyFeral 7 Replies latest jw friends

  • GentlyFeral
    GentlyFeral

    ...because of a mistake I made, near as I can make out.

    I've been a medical marijuana patient for several years, and usually I have Workman's Comp send me a copy of the year's treatment/doctor visit records to take to "Dr. Green" so he can prove that I'm actually getting real treatment for a real sure-nuff ailment, per Prop. 215.

    This year, I wasn't quite sure the records would arrive at my house in time, so I asked the claims adjuster to send them directly to "Dr. Green"."

    "Are you changing physicians?" she asked. Well, I wasn't, and said so.

    "Are you seeing him on a non-industrial basis?" she asked.

    Well, kind of. In a manner of speaking....or so it seemed to me at the time. At any rate, "non-industrial basis" seemed to me to be the magic words to pry the records out of her and get them expeditiously into "Dr. Green's" hands. So I said Yes.

    Big mistake. Because six weeks ago she sent me a letter saying:

    ... I understand that you are pursuing treatment with a pain management physician for a non-industrial condition or symptoms. Based on this, it would appear that treatment with that physician would encompass the body parts related to this industrial injury ...

    As a result, I would like to offer $10,000 to resolve your future medical Award by a Compromise and Release Settlement. ...

    (This would be on top of the money left to be paid out on my Permanent Disability Award.)

    Lastly, I wanted to inform you that, as a benefited employee, you may be eligible for treatment for this industrial injury under your group health insurance.

    I sent a copy of this letter to "Dr. Green", who wrote to her stating exactly why I'd had my records sent to her, and that he was not a pain management specialist and not my treating physician. The fact that he mentioned medical cannabis seems not to be a problem: the claims adjuster has never mentioned it again, and "Dr. Green" has successfully defended himself and a number of his patients in court.

    All right now, can I fix this?

    • I'm not satisfied with the treatment I've been getting under Workman's Comp; I've changed physicians once already.
    • Is there any point in contacting the claims adjuster and telling her that I made a mistake by invoking the phrase "non-industrial basis"? Because, after all, the work injury is the only reason I got a medical cannabis card in the first place.
    • I don't have a lawyer and haven't had much luck with Legal Aid (out here, they just refer you to lawyers; they don't sit down and talk things over with you). How can I get help prying a decent amount of money out of Workman's Comp without eating up my tiny savings?

    Thanks in advance, everybody - I feel better already.

    gently feral

  • exjdub
    exjdub

    GentlyFeral,

    Don't walk...RUN to a good Worker's Comp Attorney. I have been where you are now and I can tell you that the insurance companies play dirty. I would not contact your claims adjuster again. Let your attorney address matters. As uncomfortable and adversarial as this may sound, it is the only way to protect your interests. It sounded to me like the adjuster is trying to get you to settle short and the response is highly suspicious. The first visit with an attorney is free, so it never hurts to investigate. Keep in mind that it is the claims adjuster's job to get you off of benefits, no matter if it is right or wrong. Good luck!

  • exjdub
    exjdub
    I don't have a lawyer and haven't had much luck with Legal Aid (out here, they just refer you to lawyers; they don't sit down and talk things over with you).

    I don't know where you live, but in New Hampshire, where my claim was, the WC attorneys work on a contingency basis. They will take a part of whatever settlement you make with the insurance company. Although that may not sound great to you, I can assure you that the value that a good attorney brings to the table should more than make up what you lose through trying to do it yourself. You are navigating shark infested waters, so please get to a shark expert quickly before there is any more damage.

  • exjdub
    exjdub

    BTT

  • GentlyFeral
    GentlyFeral

    Thanks, exjdub.

    I pm'd you about this earlier, but I'd like to throw this question open to the entire board:

    Does anyone have advice on finding a good attorney? I don't want to hear "well, there's nothing I can do."

    gently feral

  • jgnat
    jgnat

    What state are you in? Here in Alberta, we have legal students who do pro bono work. Perhaps there is a similar association where you are. Give me a few clues and maybe I can google something up.

  • GentlyFeral
    GentlyFeral

    Bless you all to pieces, jgnat! I'm in California - to be specific, Alameda County.

    gently feral

    (exit singing, "jgnat's in my corner ... everything's gonna be fine ...")

  • jgnat

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