Q: As an injured worker from 03 & 05 with future medical. My former employer rep has not notify my request for medical.
In March 2022, I contacted my lawyer who rep my case and the insurance company to get medical help with my injured back from 2003 and 2005. My rep has been inconsistence in returning my calls and/or not returning my request for medical advice. The one response I received from my lawyer was "Former employer insurance company has not given authorization for medical care." This was back in early April.
My question is "What course of action do I need to take to get the medical care given to me? I used my insurance from my current employer to receive needed care as my back injury is progressive in severity of pain, duration, and frequency. Additionally, As an educator I was non-elected several times after my injuring occurred. Each time it was based on performance in the year I was to receive tenure. But the first year I received Satisfactory performance. Is there a Statute of Limitations on my case?
A:
what I do in these older cases when I have medical treatment issues is as follows.
1) Document all doctor visits. If there is no treatment for some time request an appointment with the doctor in writing. Document the response. If the doctor is no longer in practice, go back to the MPN and find a new doctor. See if the MPN doctor is taking new patients, as it can be difficult with older claims. If so, then move forward.
2) Designate the new doctor as the primary treating physician and ask the carrier for authorization for treatment by sending the designation letter with a proof of service.
3) Wait 20 days. If the adjuster has not authorized treatment or held up treatment by not forwarding a copy of the medical file, file a penalty petition under LC 5814. Serve the carrier the doctor designation, Penalty Petition with a new proof of service noting everything and send a cover saying if the new doctor is not authorized within 15 days, you will file for a hearing at the WCAB.
One really big issue is medical records, Carriers will send authorization but no file and the new doctor will not schedule an appointment until receipt of your file. Often upon receipt of the file the doctor will decline your case. Nothing you can do if the doctor will not accept treatment but complain to the AD about the MPN. If there is no doctor in the MPN to treat, that is another issue.
Your attorney can bill the carrier at the standard hourly rate under LC 5814.5 for efforts to enforce an award.
Keep good records. Good luck.
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