Emergency room,surgery

[bethsha211]

I am writing once again for my injured friend.Sorry,she doesn't have a computer and has asked me for some help.
She was found MMI on right hand,even though it showed carpal tunnel.The doctor who did IR said she didn't need surgery,so they have denied it.She is appealing and has a hearing in February.She has continued to work.Problem is that her hand has gotten a lot worse.She can't even bend her thumb without it crunching and causing her severe pain.She went to a job on Friday and she is worse than ever and wants to go to emergency room today.She wants me to ask if doing this will hurt her case.Her husband has insurance and she also wants to go ahead and get surgery on his insurance.Her doctor said she needs the surgery.If she wins at the hearing,will WC pay her insurance back or her for any deposits? Just trying to finds some answers for her.
Thanks,Bethsha211

[jayne]

if she has a deny the injury letter her insurance should cover it then when and if WC comes thru they will have to repay.......check with lawyer for your state to make sure I am right...cuz I am in okla and laws are different in each state

[bethsha211]

Jayne,That is good news.I don't see how she can lose.Her hand is really messed up.I think she should go and take care of it now as she is in so much pain.
Thanks for the info,Bethsha211

[AQA]

I had to read the post twice. The issue is not whether a claim has been accepted. The issue is whether surgery is warrented. Your friend has a court date in Febuary. Hmmmm. Why has your friend not requested an IME??? Just curious. Your friend has the same rights as the IC when it comes to am IME. The bottom line is that it will come down to a medical oppinion as to surgery or not.

Whether she is in a network or not she can change Doctors. Non net work can change once. Network can change as often as they want as long as they stay in the network.
The way I see this unfolding is that there will be the oppinion of the treating Dr. the oppinion of an IME and then the oppinion of a Designated Doctor. Unless I am missing something.

Now, as far as the ER.. Before my claim was accepted, I was in the ER and had a surgery. It was when I had been released that the claim was accepted. All the bills and co-pays that I received, I sent to the IC. I also called the hospital, the companies sending the bill, and my personal IC and explained to them what was going on and where to send the bills. When it was all said and done, I was out $10.00 for a co-pay for meds..
Because I lost the reciept. Even after all this time I am still pissed about being out the $10.00. LOL

[1171]

she should make sure she has copies of the emeergency room records and receipts for any payments (make copies) to take to the hearing.

[katicabogar]

Your friend should get surgery if health insurance willing to pay for it. They will recoup it from surgeon anyway after w/c paid(they should pay, it is on the job injury).
She should be careful not to injure her hand further...I had right tendonytis at first but kept going back to work and kept injuring myself more and more. Now after several surgeries for tendonytis, carpal tunnel and trigger finger (thumb) on both hands, I am worse than ever and I don't even work. I can barely fuction, I can't even tie a shoelace. My shoulders are on fire, my arms hurts so bad I can't even raise it above my head. My wrist hurts, can't even open a bottle. Can go on and on what I can't do anymore.
Wish I knew four years ago what I know now to better take care of myself.

[bethsha211]

My friend went to the doctor today.Her surgeon is setting up surgery in January through her insurance.Hopefully they will take care of it.
Thanks for the replies.
Bethsha211

[sparkey]

Kat i have the same trouble with my dominant hand. My shoulder was so bad yesterday that i felt that i broke my shoulder bone on that side. It is strange how some days i feel neck pain all the way into my ear, and it switches sides, and then yesterday the shoulder was bad. I went for my PIR rating on Dec.7th and still have not hear nothing yet. My adjuster said it could take a month. Curious what rating they are giving me. I sure hope it is not a slap in the face, as i gave up the career i loved so dearly. It would break my heart if it came back as low as a 5% rating.

[katicabogar]

Yes, Sparkey, I follow your story and I know we are in same situation.
My rating was so low because two IME doctors rated me, knobody else and they said my shoulders/arms and all fingers except thumb are not work related, so they left them out.
I have atty now and I am glad because they are fighting for me now.
My new AP just ordered physical therapy again, we have to see if w/c approves or not. If not, other fight.

Hope your rating will be reasonable, but I still say, you should consult an attorney no matter how is the rating, they can get higher one for you and charge only for the difference between ratings.
Just think, until you die, you have to use your hands and they are not getting better, they get worse as time goes on. I get so frustrated, sometimes I can't even unbuckle the seat belt in the car, I can't unplug the hair dryer without using both hands. Just a few days ago I tried to cut up a three layer cake, it had chocolate crust on top and I couldn't cut it up.

Have a very Merry Christmas and Happy New Year.
Kate