1171

[chrischris]

Hello,
Now you know I have just recently retired, and started receiving extimated advanced PD. Not MMI yet.

OK, tonight I went to pick up my WC meds for the month, and was told by pharmacist that "adjuster" said my case was CANCELLED. There was even a sticky note attached to my med bag. So without hesitation, Pharmacist put my meds thru reg. medical and I had to pay the co-pays for all of them.

So, this isn't right, is it? My medical will be left open even when my case does close and that comes straight from my WC doctor.

Can I file a complaint to the medical unit? This isn't the first time my medical and/or my meds have been cut off without notice. Granted, I do have regular medical but what if I didn't; like so many others?

Is there any publication/CCR/LC that details what happens when an injured worker retires. I couldn't find anything but I'm kind of out of sorts today/tonight.

Thanks in advance.

[sparkey]

I just wanted to throw in my 2 cents. The same happened to me after I went for a IME and the report came back from the doctor that I did not need any medication for recurring carpal tunnel. This is before they found out I have RSD. My meds were immediatly cut off and I have been paying for them myself since. I did not have a lawyer to fight it. Now I received a letter in the mail to go see some doctor and they do not even say what kind of doctor he is, and they are trying to not pay for a SCS implant.

Whenever they have to pay for something and they do not want to pay for it any longer, they send you to a doctor they hire to say you do not need it anymore etc. It all seems to work the same with almost each case. Of course some work out better than the others. I much rather prefer to use my own insurance for my meds anyways as I do not have to keep waiting on approval from the adjuster. That was a pain.

[1171]

correct. medical treatment coverage doesn't change with your disability or retirement status.
medical is subject to utilization review. every time they fail to observer proper procedures you should file a complaint.
the form is here
http://www.dir.ca.gov/dwc/FORMS/Utilizat...ntform.pdf
send a copy to your atty and you should be filing for penalties. there are heavy fines for frequent abusers.
it wouldn't hurt to send a copy of your complaint form to the claims manager as well.

[chrischris]

1171, Thank you for the confirmation. I get so lost sometimes and what I think is right, gets all twisted around with WC. They have been playing head games with me since the beginning. It's time to fight back and stop getting walked on and taken advantage of.

That is another subject. I find I do get taken advantage of. I have a big heart which has been broken more times than I can count because of work. That is why I sort of stay to myself and don't get too comfy cozy with anyone. It's taken by others that I am a "prude" but if they only knew. I would literally give my shirt to someone in need. I think that's why the games WC plays are so devastating to me. I've never encountered deception and blatant cruelty before I became an injured worker; both by my employer and the Insurance Company Adjuster who pretended to be my "friend".

Just rambling!!!!!!

Sparkey, Thank you for your reply. To me, it's not really the co-pay, the money, or other things I can't seem to remember right now. It's the point! My I/C can't just do whatever they want. They, like me and us, have to abide by the law. And if they don't, they need to be accountable for their actions. Getting hit in your pocket book really hurts an adjuster and penalties and sanctions don't look good on his/her personnel record either.

Take care, and thanks again!!!!

[capricorn]

CC....I know this has nothing to do with your post but I wanted to say I understand the broken heart. I have trusted and been hurt more times then I can tell you.

[1171]

it's human nature to push boundries.
when you appear vulnerable and trusting even saints are tempted to abuse it. you do those who are close to you no favors by allowing them too much freedom with your trust.
Good fences make good neighbors.
keep your fences high and strong and mutual respect will ensure friendships.

ooooops. I got a little preachy this sunday morning.

be well all.

[Lilly]

Save your store reciepts Chris!

Good Luck. Lilly

[capricorn]

Wonderful post...1171. Thank you. It is well put. Closeness is abused at times. I do nice things for people I don't know well enough to call friends. Maybe that's the difference. I don't call everyone my friend. That has to be earned and I guess some think it is sooner than I do. How do you allow freedom with your trust. If there is trust shouldn't it be respected by both? Although I grew up in a big city, am strong, intelligent and sure of myself I am noticing a naive part of me that trusts others and shouldn't. I'll never get dishonestly, phoniness, etc. I'm one of those that wears everything very clearly and honestly. I am who I present myself to be. No guess work. So in reality my honestly and genuine self have been taken for granted or taken advantage of. Not important. I'm just reading myself right now. Thanks for helping me to do that.

[Still in Limbo]

Great Reply 1171, and Cap, I know how You feel, I've done it Myself!! That's Why I say I have Many Acquaintances, and Very Few Friends! When You Learn Something the Hard Way, You are much More Apt to Remember it a lot Longer!!

[chrischris]

1171. Don't get me wrong. I love to help people in need, but then I like to forget about it and go on. I dont lend money or anything else. If I give someone money, it is a gift, and I don't want to speak of it again.

But, lately, I've been taken advantage of by a former co-worker who I "thought" was my friend, and also by the man who does my yardwork. I had no reason to distrust him. He's worked for us for years mowing front and back yards. Sometimes he needs his monthly payment early, and we have had no trouble with that. Recently, I wanted "extra" work done before I retired and didn't have the money. I paid him for supplies in advance, and it was a large amount. He was working well, but one Friday, he came to me and asked if he could get the rest of his salary up front so he could take his family to the coast that weekend, and he would finish the job the following week. Well, for 2 months I didn't see him on this project. Twice I accidently ran into him and he said he would be by the following weekend. Well, last week he came and told me he ran out of money to buy supplies and needed $300 more. Against my feelings, I wrote him a check. He came and worked about 2 hrs. and told me he was done because he was out of money. I told him I was now out of money too, so we will have to leave the job unfinished. My husband was furious and told me to write down all the dates and amounts I paid him and I couldn't believe it myself. It was a very large amount of money for the little work he did. Well, now maybe I shouldn't be handling money anymore. My husband is going to confront this guy when he shows up to do the mowing. I feel so bad that I let this happen. I hope this makes some sort of sense.

I had another co-worker drive me to my physical therapy appts. during the times I was not allowed to drive. My husband picked me up. Anyway the deal was I would fill her tank when she drove me, which was twice a week for 8 weeks. To make a long story short, gas was at it's highest, and it cost me an average of $90 each time she drove me 20 miles; as her tank was empty on those days. I didn't say a word! Again, I thought she was my friend and I never hear from her anymore.

Cap, I know exactly what you are talking about. Thanks for your comments.

Still, I don't see you in this way. You seem so open to everyone.

Lilly, I save all my receipts. I bill my I/C once a month for mileage too. They owe me over $4,000 in mileage. My bills are ignored and they are submitted by my attorney. If he doesn't do anything, what am I supposted to do.