Need Help...Please got to have help...

[scoobydee71]

Hi from Texas.. here is what is going on. Sorry so long
My hubby (35) got hurt at work after being there for 13 years 11 months on 06/13/12 he is a scale technician in which he installs, services and maintains all types and sizes of scales ranging from small deli style scales to food production scales to grain silo ones all the way up to truck and train scales. He uses weights all day every day from one 50lb weight to many and he may slide, carry, crawl or any number of different ways to move these to get them to where the scale is. This was how he hurt his right shoulder, arm hand and knee and his left hand and knee.
Well the day it was done his job sent him to the only place near them in Dallas they could find to take W/C he was a chiropractor and hubby liked him he did x-rays on his shoulder and was going to send him near his office for a MRI , but he was too far from our home and since they picked him we looked closer to our home.
I found a dr and a clinic just down the road from us that seemed liked a good choice. So we made an appt. The first bad feeling i had was that they made us fill out the 041-form then and there or they would not be able to see my hubby. Not sure what that was about but we did it. We go see the dr he asks what hurts and how bad..mind you my hubby has a high tolerance of pain and he is hurting. He physically checks him out not a major check but of some of the areas he stated.
We had the x rays from the chiro with us and gave them to the nurse when we got there so the Dr had them and kinda looked at one of them while we were there,next he writes something down on his file and then says we need more X rays and schedules an appt for that and then something on there appointment sheet called PPE. He then gives him a Rx for tramadol and muscle relaxers. and we get our Dr status report and on our way they send us.
We go to the x ray appt,, no x ray on shoulder mind you.. and then two days later to the PPE which about killed him the next day, they used a machine and had him push, pull,lean against it, the another dr came in and measured him i think it was for range of motion cause he had him try to touch his toes and measured him at the neck and waist and bend forward and backward then we waited and then saw dr. he said the testing showed something to the extent that it was not good.
Well we knew that. We did have to have him change the tramadol cause it caused hubby to have rapid heart beat and sweating and it was not easing the pain. He at least did that..That is when he actually physically examined hubby's shoulder and had him grab and hold his fingers as he pulled and hubby's right hand could not hold on much at all. He is right handed and was very strong, not anymore.
Next he just gave us Rx for new pain med and said we will see you on 07/11. I am thinking WHAT??? no pt or anything being scheduled?

We have been to this dr our choice of treating dr twice as of 06/27/12 and I am questioning what he is going to do to help hubby I say this because as of this visit I realize he may not still understand how difficult hubbys job position is most of the time.

Again I say this because after taking more x-rays and having him do the PPE he said that the test said he apparently has problems. Then he finally actually paid attention to his right shoulder problems and pain. Only now has he looked at and figured out he had lost and was still losing strength in his hand and whole arm. This was written down on all forms with all the other original effected parts but only now being addressed.
I am questioning him because as of the last visit on 06/27/12 he only made a future appt. for 2 weeks from the then for the 11 Th of July, no mention of any physical therapy at this time,we did ask about getting an MRI for the shoulder because the chiro that his job sent me to first said that is what he needed to make sure there were no underlying issues that an x-ray could not tell him. This Dr said well we will have to wait because WC will not agree right now even though there might be a possible surgery needed???. And this I believe is just putting hubby off from getting the help needed to get back work.
HELP>>HELP ..HELP
So what can I do about seeking a MRI for more information on the injuries?
Can I get him to send hubby somewhere else?

[jayc123]

Do you have an attorney? I'm not pushing one but they'll get an mri. You could call your WC adjuster and remind them of the reccomendation of it. Physical therapy may make it worse at this point so he's giving him a little more time to see if he makes any progress or not before the next appt. But he really needs an mri, good luck

[hurt back]

I agree with jayc. Get an attorney, if you don't already have one.

I had to do physical therapy before my MRI, and it about killed me.. Then after my MRI, they found that I had a herniated disc, and the nerve was " compressed " and all the PT did was make my pain worse.

But an attorney will get you going if you get no response from the workers comp adjuster. Plus when you get an atty most of them won't talk to you only your attorney which is better that way no story gets " twisted "..

Tell you husband I wish him a speedy recovery, but keep in mind workers compensation claims are SLOW...

[scoobydee71]

thank you both for the answers.. no we don't have an attorney yet ..this is uncharted territory and i just wanted to see if anyone else had this go on with them ... and about calling the WC adjuster, would that be the lady that works for the WC insurance that called the other day about him getting paid now that he has been off over the 8 days required ? or someone else...we will call her if that is the right person. I was just worried he was going to lose more strength in his right arm before they get an mri or do some kind of massage therapy at least for that. again thanks...

[jayc123]

Yes the adjuster is the lady assigned to your husbands case and makes all the appointments and paychecks. Just remember they like to act like your friend but they're out to gather info to use against you no matter how nice they seem, its they're job. She will start to stall at making appts and try to frustrate your husband into giving up on his case. As soon as that happened with me i got a lawyer and appts started getting made. Everything with WC is extremely slow. It took me 11 months to get the surgery that i was told i needed in the first month of my injury, so don't hold your breath. Its very strenuous.

[AQA]

Well I guess I will add my two sence.

As far as getting an attorney. "NO". An attorney is not going to be able to speed up the process.

As far as calling the IC. "NO". He/she can not speed up the processes on this issue.

To get an MRI. It is going to take a drs request to the IC. If memory serves me, the IC will have three working days to determine if a mri is a "medical necessity". If approved or denied. You should receive a letter from the IC explaining why. If denied, the request can be made again. If denied the second time, then you or your dr can request an IRO for final dissision. With all that said, It starts with a request from the dr.

As far as your husband recieving monitary benifits. At this point they are called TIBS. Which is 70% of your husband's weekly wages, up to a maximum which I do not recall.

Most drs take the most conservative route when treating patients and build from there. The return visit with the dr. is to see what has changed since the last visit. At this point and time the dr. has a base line in reference to your husband's condition. He/she knows the human body will try and heal it's self. If the condition has not changed or gotten worse. I would expect for the dr to recommend some type of testing wether it me an mri, ct scan, emg/ncv or something along those lines.

Basiclly, all he can do at this point and time is wait.

From what you have said, The IC has nothing wrong; hence; the reason I see no need for the attorney.

[1171]

(07-04-2012 08:19 PM)AQA Wrote:  Well I guess I will add my two sence.

As far as getting an attorney. "NO". An attorney is not going to be able to speed up the process.

As far as calling the IC. "NO". He/she can not speed up the processes on this issue.

To get an MRI. It is going to take a drs request to the IC. If memory serves me, the IC will have three working days to determine if a mri is a "medical necessity". If approved or denied. You should receive a letter from the IC explaining why. If denied, the request can be made again. If denied the second time, then you or your dr can request an IRO for final dissision. With all that said, It starts with a request from the dr.

As far as your husband recieving monitary benifits. At this point they are called TIBS. Which is 70% of your husband's weekly wages, up to a maximum which I do not recall.

Most drs take the most conservative route when treating patients and build from there. The return visit with the dr. is to see what has changed since the last visit. At this point and time the dr. has a base line in reference to your husband's condition. He/she knows the human body will try and heal it's self. If the condition has not changed or gotten worse. I would expect for the dr to recommend some type of testing wether it me an mri, ct scan, emg/ncv or something along those lines.

Basiclly, all he can do at this point and time is wait.

From what you have said, The IC has nothing wrong; hence; the reason I see no need for the attorney.

very matter of fact and logical. obviously you have had much firsthand experience with the Texas system.

good job and have a Grand 4th!!!

[scoobydee71]

Thank you for answering all..
Well after i posted yesterday and just after i got to work last night apparently the Dr's office well part of the office called. The message said that my hubby had been approved for 9 rehab appts.
This was out of the blue..the last dr visit he actually asked have you been to rehab ? uh no ... and you have not mentioned any thing about requesting any either.
So i guess we will try to call to set up the first appt tomorrow. Not sure what they are gonna want him to do and for how long..anyone know what they might have him doing since for this i prob won't be able to go in with him like i have for dr's appt's and he is a little worried.

What i do know is this is hard not knowing when he will get paid again, like i am sure most of you have gone through and since i only have a part time job since that was all that was offered, his paycheck is what keeps up above water.. and like i said his job cut us a check for the last two week pay period and that went to the mortgage and one bill and left us 200.00 for the time being..but not sure who is going to actually pay us or when even though the case manager said when she called to get the other dr's name and addy that they had all the paperwork to get monies.

But then his work mentioned that they were going to pay for his regular insurance and they would talk about it whenever he actually got back to work..which worries me. We barely make it some pay periods paying bills and now they might want us to pay them back for the ins. payments?.. not sure how we will do that...

Another question: i was reading that they look at the last 13 weeks and include overtime in that equation... i am hoping that is true because he usually has at least 5 hours of OT each paycheck if not more sometimes and he does get time and a half for that...

[AQA]

1171, Thank You. Unfortunatly I do have some knowledge about the system in texas. I truely don't understand how you are able to know about all the states you do. I would truely enjoy having your mind.

Scoobydee71, his tibs will be 70% of the 13 week average. In my case it equal my weekly take home. I received a check for 104 weeks, weekly.

[jayc123]

Here in florida attys do speed things up, it happened to me first hand. Texas ins comps must actually follow laws. That would be nice.