DUPED....NOT KNOWING THE MPN RULES...

[inquiringMIND]

today i came across an old email from from my adjuster earlier last year when i first requested to switch providers within the MPN. After apparently being misled, months later I discovered that I did have a CHOICE to switch to a specialist as PTP all along.

feel like i was sucker PUNCHED!! i guess that's part of growing up in the unknown world of WC.

here is the letter which in my opinion shows that when you are not of savvy legal mind, you can be led where "others" want you to go.

ADJUSTER EMAIL: "you need a request from your current doctor for you to see an orthopedist. eventhough the the *******group is in the MPN, they are orthopedic specialists.(true) ANY TRANSFER TO A SPECIALIST (as PTP) MUST BE REQUESTED BY YOUR CURRENT DOCTOR."(false)

Sadly, i BELIEVED IT... HOOK, LINE AND SINKER.. At the time, it took the wind out of my sail. Felt powerless. Months later i learned the truth from another adjuster working for the same company...

Research, know your rights and ask ask ask ask questions. I'm sure most adjusters are strait shooters, some are uninformed but some will lead you astray.

[1171]

I suspect the same happens any time you are dealing outside your own area of expertise: attys, doctors, plumbers, auto repair, religion, politics, internet, websites, marriage, etc.
it's not a problem exclusive to workers compensation. many get duped by not questioning the advice or answers they are given.

[inquiringMIND]

1171~Sooo Soooooo TRUE! AMEN!!

Not just a WC lesson but a LIFE LESSON!

i wonder why it is that sometimes humans feel intimidated by a person who "knows more" about a subject (ie, doctor,lawyer, cop, nurse, adjuster etc) and hesitate to ask questions and dig deeper?

taking responsibility for your own knowledge and having the courage to question advice instead of pointing the finger...hmmm now thats a novel thought..lol!!

[jayne]

and that is why I got a lawyer to handle my WC issues.....

[Woodlawn]

There is relatively high turnover for WC adjusters, so it is entirely possible a noob was assigned to your claim and misunderstood the rules concerning the MPN. Of course, they could also be lying.

Bottom line with MPN's is you have the right to change treating physicians at any time, for any reason so long as the medical provider is an appropriate specialist. You can also change as many times as you want, but should avoid that to avoid appearing to doctor shop.

While a lawyer may assist you with some things, you need to be just as careful with them. I've seen too many people set back because they just had surgery, got an attorney who sends them to a chiropractor or some moron who is unable to provide appropriate treatment.

If something doesn't sound right or you need an answer, start with an I&A officer.

[inquiringMIND]

There is relatively high turnover for WC adjusters, so it is entirely possible a noob was assigned to your claim and misunderstood the rules concerning the MPN. Of course, they could also be lying. guess ill never know..

Bottom line with MPN's is you have the right to change treating physicians at any time, for any reason so long as the medical provider is an appropriate specialist. You can also change as many times as you want, but should avoid that to avoid appearing to doctor shop. its tough when MPN drs show evidence of being 'insurance/company drs". shopping is a waste of time in an MPN. its a great challenge finding an honest dr who will first do no harm and truly have your best interest at heart...

While a lawyer may assist you with some things, you need to be just as careful with them. I've seen too many people set back because they just had surgery, (my lawyer has never referred me to any specific dr. at least not yet. there must be honest drs and attys in this wc system...)got an attorney who sends them to a chiropractor or some moron who is unable to provide appropriate treatment.

If something doesn't sound right or you need an answer, start with an I&A officer. good advice. thank.s


what violated rules by the IC would provide an out for me to get care outside the MPN? how long does the court take to approve? please refer to specific laws. thanks.

[Woodlawn]

(01-27-2012 03:29 PM)inquiringMIND Wrote:  what violated rules by the IC would provide an out for me to get care outside the MPN? how long does the court take to approve? please refer to specific laws. thanks.

The length of time to get a hearing is hard to know. It depends on the board and how long your attorney takes to file for an expedited hearing.

The controlling regulations here are LC 4616.3/3550(e) and California Code Section 9767.12.

Any one violation would not constitute proper notice and enable you to treat outside the MPN.