RIGHT TO THIRD OPINION - Printable Version
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RIGHT TO THIRD OPINION - HAPPYHIPCIN05 - 08-20-2009 11:21 AM
HELP!!!! I REALLY DON'T NEED TO TELL MY WHOLE STORY RIGHT NOW , BUT I'M AT THAT CRUTIAL "STARTING TO JERK ME AROUND" POINT IN MY CLAIM PROCESS. I GOT HURT ON OCT 6., 2008. FELL ON CONCRETE BACKWORDS ON TO MY ARM AND HEAD TO THE LEFT . INJURED MY SHOULDER AND NECK. I HAD SHOULDER SURGERY IN JAN 09....BESIDES HEALING PAIN AND PAIN IN MY ARM RELATED TO MY NECK, MY SHOULDER IS DOING BETTER. THE PROBLEM IS MY NECK. I HAVE BEEN DIAGNOSED WITH 2 PROTRUDING DISCS AT C5-6 AND C6-7. AFTER TRYING MONTHS OF PT AND HOME EXCERCISES, TENS UNIT, PAIN MEDS AND ANTI-INFLAMATORIES, I WAS REFERRED TO A SURGEON IN "THEIR" PANEL. HE, AFTER THE INITIAL VISIT, A NEW MRI AND RETURN VISIT, ADVISED ME THAT SURGERY WOULD GIVE ME 90% RELIEF OF PAIN AND FIX MY PROBLEM. THAT MY PROBLEM WAS A BLATENT RESULT OF MY FALL. DURING ALL OF THE TESTS, I HAVE BEEN CONTINUALLY TOLD I HAVE ARTHITIS IN MY NECK. THAT I HAVE DEGENERATIVE DISCS... I HAVE NEVER EVER HAD ISSUES WITH MY NECK TIL I FELL. I WAS TOLD THAT IS VERY COMMON THAT ARTHITIS WILL NOT FLARE UP UNTIL THERE IS AN INJURY. .. BUT ASSURED BY FIRST SURGEON THAT THE DISC ISSUE WAS NOT FROM THE ARTHRITIS . HE , IN WRITING RECOMMENDED SURGERY AND GAVE ME A VERY OPTIMISTIC OUTLOOK ON MY FUTURE WITHOUT PAIN AND REGAIN USE OF MY NECK... I WAS HOPEFUL.
1 MONTH LATER, AFTER PATIENTLY, PAINFULLY WAITING FOR THE APPROVAL, I GOT A CALL, OR I CALLED MY REP, AND WAS TOLD THAT I HAD TO GET A SECOND OPINION. I WAS THEN SET UP WITH A SECOND SURGEON OF "THEIR" CHOICE. HE, AFTER ADMITTING TO NOT READING MY HISTORY OR GIVING A GOOD LOOK AT THE CURRENT MRI AND XRAYS, AND WITH OUT EXAMINING ME EXCEPT FOR SQUEAZING MY FINGERS TOGETHER, TOLD ME AND MADE A REPORT THAT SURGERY WOULD NOT BENEFIT ME. I WAS NOT GIVEN A COPY OF HIS REPORT. AFTER 7 WEEKS AND A PHONE CALL ONCE A WEEK TO MY REP, AND ONE PHONE CALL TO HER SUPERVISOR, I GOT A CALL FROM MY REP STATING THAT THEY WERE DECLINING THE NEEDED SURGERY AND TAKING THE SECOND OPINION, NOT THE FIRST. I NEEDLESS TO SAY , WAS DEVASTATED AT THE THOUGHT OF SPENDING MY LIFE IN THIS LEVEL OF PAIN.
I LEFT OUT THE FACT THAT I HAVE SENT LETTERS, MADE EVERY SINGLE THERAPY, DR APPT, FOLLOWED EVERY RESTRICTION, AND WENT BACK TO FULL TIME WORK 4 WKS AFTER SHOULDER SURGERY AND STILL FUNCTIONING AT A 7-8 PAIN LEVEL EVERY DAY.
MY QUESTION... DO I HAVE THE RIGHT TO A 3RD OPINION AND HAVE W/C PAY FOR IT? I ASKED FOR THAT AND MY REP DECLINED IT. I NEED TO KNOW MY RIGHTS. I HATE TO GET A LAWYER BUT FEEL THAT PERHAPS THEY ARE FORCING ME TO DO THAT...
THIS IS A FUNNY THING TOO.... IN A VOICE MAIL, MY REP SAID THAT THEY WERE DENYING SURGERY BUT THAT IF I "WANTED" THE SURGERY, I COULD HAVE MY HEALTH INS COVER IT !!! OMG... HOW STUPID. NO INS COMPANY IS GOING TO COVER A PREEXISTING INJURY THAT IS DOCUMENTED EVERYWHERE THAT IT IS A "WORK" INJURY!! WHY WOULD SHE SAY SUCH A RIDICULOUS THING ?
I AM BEYOND FRUSTRATED... AND IN TREMENDOUS PAIN EVERY MOMENT... AND WORKING AND TRYING TO KEEP MY LIFE AND RELATIONSHIPS GOING AS USUAL. PAIN CONSUMES AND TAKES OVER IF YOU ARE NOT CAREFUL.... SO PLEASE HELP LET ME KNOW WHAT MY NEXT STEP SHOULD BE ... THANKS TO ALL
RE: RIGHT TO THIRD OPINION - Bad Boy Bad Boy - 08-20-2009 12:36 PM
You can have a medical opinion performed from a doctor of your choice. But, you will have to pay for it.
Other then that, you then may wish to see a work comp attorney for other help.
RE: RIGHT TO THIRD OPINION - chrischris - 08-20-2009 01:18 PM
Generally, one doesn't need an attorney until a medical procedure is denied. You might consider this as an option.
Educate yourself on the laws of your state. you didn't mention where you are from. Go to the top of this page and pull down "state info". Depending on where you are from, you may be able to call either an I&A officer, or an ombudsmen for assistance before you hire an attorney.
Hope this helps a little.
RE: RIGHT TO THIRD OPINION - HAPPYHIPCIN05 - 08-21-2009 10:26 AM
chrischris Wrote:I AM FROM TENNESSEE ... I WILL CHECK IN TO THE LAWS HERE.... IF ONE DOES PAY FOR A THIRD OPINION, IS W/C OBLIGATED TO ACKNOWLEDGE THE OPINION OF THE 3RD DOCTOR AND RECONSIDER? I DONT "WANT" SURGERY BUT I WANT FIXED!!! WHY IS THAT HARD FOR THE PEOPLE IN CONTROL OF YOUR WELL BEING TO UNDERSTAND?
RE: RIGHT TO THIRD OPINION - jayne - 08-21-2009 10:32 AM
Keep that voicemail
RE: RIGHT TO THIRD OPINION - HAPPYHIPCIN05 - 08-21-2009 10:57 AM
jayne Wrote:I LOCKED AND SAVED THAT MESSAGE FOR SURE
RE: RIGHT TO THIRD OPINION - Still in Limbo - 08-21-2009 11:13 AM
You are at a Very Pivotal Point in Your Case, and You Desperately need and Attorney that Deals in w/c to join Your Battle! Petitions are going to have to be Filed, Possible Depositions of ALL Dr.'s Involved, and much More than I can Print Here! Spinal Injuries for the Most Part don't go away over Time, and Care needs to be Taken on the Treatment of Such! Best of Luck, but to Continue Your Battle, (Which their shouldn't even be One, I know) You need Help from the Legal Community!!
RE: RIGHT TO THIRD OPINION - HAPPYHIPCIN05 - 08-21-2009 11:54 AM
Still in Limbo Wrote:THANKYOU FOR YOUR ADVISE... I AM HEADING THAT DIRECTION NOW .... I KNOW MY BODY BETTER THAN ANYONE, AND I KNOW I CANT HEAL ON MY OWN. I NEED TREATMENT AND SHOULDNT HAVE TO FIGHT FOR IT. I GUESS THATS THE GAME THO... I HAVE NEVER EVER HAD A WORK INJURY, IM ONLY 48 AND VERY HEALTHY, I AM NOT A TROUBLEMAKER OR FIGHTER, BUT WHEN IT COMES TO MY OWN WELL BEING OR THAT OF MY FAMILIES, I WILL FIGHT... WHY DOES IT HAVE TO BE THIS WAY? ANOTHER QUESTION? DO I HAVE THE RIGHT TO REQUEST A COPY OF ALL DR REPORTS IN MY FILE OR SHOULD I JUST LET A LAWYER HANDLE THAT?
RE: RIGHT TO THIRD OPINION - Manley2 - 08-21-2009 12:01 PM
This is all good advise, an lawyer is going to be in your future for sure unless they decide to just fix your problems. A 3rd opinion, although at your own expense might get the job done without a lawyer. Living in pain every day is never fun and the faster you get something done the better off you will be but believe me nothing is fast in WC once they start denying anything. When you have one doctor telling you he thinks you will be 90% better after surgury and another doctor telling you surgury will not help it's hard to know what to believe. With the 2nd doctor being one they sent you to it's a pretty good bet he is just telling you what the company wants him to, and that is sad. If you can find a good doctor that will give you his true opinion this will help you to know what is your best road. And it might sway WC to giving what you need and it may take a lawyer and a hearing to get the job done. It;s just too hard to say what it will take. What you need to do is learn as much as you can about the laws, listen to what ours are telling you on here, and then do what you think is best.