1st time with W/C

[bobp53916]

Hi all,
New to all of this so please excuse my ignorance...I injured my
shoulder at work because of my job last May. I reported it to to my
supervisor and health services and sought medical treatment, it took
them a month and a half to figure out what was wrong and the whole
time they were paying me for medical leave which was 60% of my
average earnings and my medical insurance was paying for the doctor
bills. I scheduled the surgery for the beginning of August, we had
planned on moving to North Dakota at the beginning of september and
2 weeks before the surgery the doctor went over the surgery with me
and told me I could be off up to 6 months with more than likely no use
of my should for a month or two so I opted to wait to have surgery
after I moved. I've been putting it off afraid of getting behind on bills,
now I am laid off and want to have the surgery, I went to an ortho-
pedic surgeon today and gave him the rundown and he's getting the
files from the doctor in the previous state, I forget to mention is
Wisconsin. I asked him if I needed to do anything with the W/C part of
it and he said that his assisstant will have some paperwork for me to
fill out next week concerning that. I guess my concern is, Am I going
about this the right way or am I doing something wrong? I have never
dealt with W/C before, my medical insurance was paying for everything
so had no need to...Any advise or comments would be greatly
appreciated...TIA, Bob

[tweety00]

http://www.workerscompensation.com/regul...=wisconsin


Here are your state laws

[1171]

your post is confusing. workers compensation is a totallly different system then your health care coverage. you seem to be unclear which system you are under and which system is paying your benefits. You are either under one or the other but not both.
do you know whether workers comp or your health insurance has been providing for your medical care?
if you've moved you need to get approval from the work comp carrier to transfer treatment to another physician.
some state work comp systems have medical fee schedules that may be difficult for an out of state doctor to accept.
If you are having surgery you maybe entitled to some disability payments even though you've been laid off.
you'll need to contact the work comp carrier and get this clarified.

[Lilly]

Hi....Strange, I never had any say in when my surgeries would take place! WC wanted them done ASAP and would bug the scheduler to death trying to get a sooner date!! I have a feeling like 1171....that you may be using work medical insurance...and not WC. Are you receiving monetary benifits weekly since you are off work? Did your work even turn in your injury to WC?
My other question is, what type of surgery do you have to have...or what is your injury? How can you help move with a shoulder injury?
Take care, Lilly

[Still in Limbo]

I'm with the Others on this, it Sounds as if a W/C Claim was Never Submitted, and You are trying to add them now! I'm not Sure that is going to Work, You only have so Much Time to Report to the W/C Commission when You are Injured, and if Your Employer did not do this, You May have a Lot of Difficulty trying to Add them Now! Please Clarify Your Position with W/C, so You May receive the Correct Answers.

[fairycatz]

I am amazed that your Health Insurance carrier didn't balk at paying for something that should have been covered by WC! My take is that you are lucky that your HI is paying as WC may not pick up at this late date if paperwork not filed at beginning! If you have difficulty, you may have an issue to take up with former employer not filing properly. People on here would know more about the legalitities of that, or even if you would have a case, as ignorance is not bliss when it comes to WC. The people and this site are great! I have learned SO MUCH from here, and the most important thing I've learned is to BE INFORMED! Best of LUck to you! Maura in CT

[bobp53916]

While I was still working for the company where I was injured our medical insurance was paying for everything while they were trying to
find out what was wrong with my shoulder. They didnt balk about it
because its a company medical insurance, its not anything like Blue
Cross, etc. The company has their own medical insurance division.
They basically pay all their employees medical bills. I told them it
happened as a result of my job and also told the doctors the same.
I had scheduled a surgery while under medical insurance and the
doctor told me I would be off for up to 6 months. We were planning
on moving out of state so I opted to wait with the surgery. I resigned
from my job and we moved to North Dakota. The injury is a torn
Labrum(if thats how its spelled) and theres a lump next to the tear
which they figure is fluid leaking from the joint through the tear.
I'm recieving unemployment benefits right now and to be honest and
not worried about getting any payment for lost work in the past, I
would just like to have the surgery taken care of and if they find I'm
going to be partially disabled in that shoulder, which the surgeon said
I may, I would like partial disability...

[1171]

if it was decided that the injury was not work related and treatment would be continued under health insurance then you have no coverage since you've been laid off.
If the conclusion was to accept the condition as work related then the work comp would have to reimburse the health carrier for costs and then pick up treatment and any disability.
Hopefully you have the later situation.

[bobp53916]

The orthopedic surgeon that was going to do the surgery in WI said
the injury was clearly caused by my job. The company doctor they
had me see said that he didnt think it was but was going to take a
look at the job I was doing before he said for sure, I never heard
anything back from him...

[1171]

Hopefully you'll find out about the status of your claim when the new doctor tries to get approval to treat.