FACTS: MY INJURIES: FROM MY ACCIDENT OF 10/3/1989 both immediate and resulting
Surgeries: Cervical Fusions: C3-4, C4-5, C5-6; Thoracic Fusion: T7-8
Lumbar Fusions: L2 -S1 with Titanium Rods
TMJ: bi-lateral - need splint for grinding and pain
Carpal Tunnel - bilateral
Additional Diagnosis: lDegenerative Disk Disease, Fibromyalgia, Partial Paralized Vocal Cord
Cauda Equina Syndrome, Hypertension,Anemia of Chronic Pain,
Chronic Pain, Reflux, Shortness of Breath,
Bulging Disks Cervical-Thoracic
The Power of Delay
One of the best tactics that someone in power can use is delay. Not to say NO. There is no denial. There is no approval. Nothing to argue against. Just non-responsive.
That is what the Adjustor has been using as a tactic. Or perhaps she will say that she has been just too overwhelmed with work that she cannot get to my case. It is such a big case and requires such effort and she is unable to find time to get to work on it.
What I know is that she has managed to become both Physician and Judge in the process. I needed refills on my medications that were able to be renewed. My Adjustor denied those renewals. With those denials of medications for blood pressure she put my life in danger and since my hypertension had actually been adjudicated as related to the accident, she placed herself in denial of the judical decision as well.
Presently she had approved treatment with a therapist, from a written RX by my primary Physician, and has not paid that therapist for the over 7 months of treatments. Apparently she has not been willing to speak with her own attorney about this as well, because it is understood that she approved of the therapy prior to inception.
Again, the power of refusal is merely a play for delay with use of money. The money is owed. AIG has another win, yes - they are the biggest in the world - for worker's compensation. The biggest at hurting the ones who are hurting already.
Saturday, August 2, 2008
Friday, May 2, 2008
MAY 2, 2008
ANOTHER TRIAL PENDING - WITH TWO IME 'S BEFORE THEN
I had started this post some time ago -three months, to be exact. I will keep it here because it does have some particular information.
For definition: IME is an Independent Medical Examination. The Insurance Carrier (AIG in my case) hires a Physician in a particular field that will examine me at one appointment only. This appointment generally takes one to one and one-half hours and will mean that this Physician will not be able to treat me at any other time. Because he/she is hired by AIG it also generally means that the findings will almost always be favorable to the Carrier. (I know you are surprised to hear this, but it is true.) Typically they have a large amount of business generated by the Insurance Company which pays them handsomely, so it is understandable that their report is one-sided.
This Physician's report will be used at trial as evidence on behalf of the Carrier. My attorney has the opportunity to depose the Physician prior to the trial, after receiving the report, which give us the benefit of asking some pertinent questions the can be favorable to my case.
However, I am now going to a Psychiatrist for an IME. Why a Psychiatrist, you ask?
That is another interesting thing. I was seeing a Psychologist. He was nice, capable for part of the time - Dr. Hoogerman - but he was retiring this year. He was getting a boat and sailing/boating away into the sunset.
Robin, the Adjustor, decided that even though AIG had been paying his bills consistently for several years, (and the Psychologist before him for even more years) that I would not be allowed to continue with counseling, unless a Judge approved it.
I found another Psychologist, and started therapy with her. Because Robbin and AIG refused, I had to pay for the counseling. Robin also decided that she would put into place a company at the expense of AIG (I do not know what the cost of this company is, but it is most definitely in addition to Robin's salary and the cost of their Attorney, Jake Smith.
The company, ProMed, is a "cost containment" company, at the expense of AIG has sent letters to every single physician that I see, asking for a complete list of all medications, treatments and plans on my behalf, in detail, which will then be sent to a doctor of their choice (not necessarily a doctor of the same specialty, incidentally - my Primary Care Family Practice Physician was reviewed by a Pulmonary Specialist)
and again - there is almost a given disagreement with the treating Physician. More money paid out by AIG to now have an IME!!!
It is almost one year since Dr. Hoogerman left, I have not had approval for another Psychologist. I paid the final amount due to the new Psychologist just recently and will not have access to a new counselor until I can meet with one I am comfortable with - and I will have to pay for that counselor until the trial determines if I am to have access to counseling.
Understand, in the almost 19 years since the auto accident, I have had several IMEs. I have not had a Judge take away my medical providers. I am not faking. I am not trying to rake AIG.
Why - why would I want to have 5 spine surgeries, I ask again? Is this my choice in life.
One of those ProMed questionaires went to my specialist for the splint that I wear.
I don't think I described the players in this group.
Claimant:
First there is me - I did mention that. I am the Claimant! I am the one who had the accident. I am the injured party. I am the really bad person who needs to take money away from the big Insurance Company who does not want to part with any money at all. No matter what!
I do not have to have an attorney. I choose to or I can choose not to. My choice to have an attorney came from having a civil case against the trucking company that owned the truck that hit and totaled my automobile. I had 5 attorneys going through that process and even went through a three day miss-trial before settling that case. That left worker's compensation, which was very confusing process to me.
I actually fired four attorneys in worker's compensation as well. I wasn't ready to settle, I didn't want to go to social security disability - I didn't know what was wrong with me, even though I did believe something WAS wrong.
Attorney:
There is now my Attorney, a bright young woman who has experience and knowledge.
Insurance Carrier:
In my case (AIG) - The Insurance Company who held the insurance policy that covered any possible injuries or illness that related to the company that I worked for at the time of injury/illness -10/3/1989.
Adjustor:
The Insurance Carrier (AIG) has their representative, who is an Adjustor. Her name is Robin Walker and she has an interesting approach to her job. It is to keep from paying out any money from AIG whenever possible. ALWAYS! If it is going to be necessary to pay out money, delay the payment. Perhaps it is the dictated job description, but it is absolutely against my best interests.
I cannot understand that. Because it is for medical care, it would be far better to resolve the medical problem promptly before it becomes a bigger and more costly issue. That is a financially sound approach. The better treatment will mean less treatment over time and thus less of expense over all to AIG.
Carrier Attorney:
The Attorney hired by the Insurance Carrier to handle the legal work that would be involved in the larger cases like mine. Generally he would work closely with the Adjustor and communicate with the opposing Attorney (my Attorney) over disputed issues. An example: When an IME is ordered, it is done through the court system, but my attorney is notified that it will be set up. Because I now live out-of-state, the Adjustor had initially set the appointment with a Physician in Florida (the state where the accident occured - not where I live (NC). This made it difficult for me, especially since it was in the middle of the state - 2 hours away from the location of the trial and on the day of the trial and at the time of the trial.
My attorney informed me, we replied that it was impossible to keep the appointment. The Carrier Attorney had to have the Adjustor cancel the appointment. Surprisingly she was able to find one in NC after all at a later date. Of course the trial was delayed. The trial has been delayed now three times due to her actions.
The trial has affected money due me and medical care I am to receive. There is no recourse in law to force action.
In fact, the Insurance Companies have lobbied and had laws passed to stop payment if actions have not been taken within a reasonable amount of time. It is interesting when they are the ones that have delayed the very actions that should have been taken.
Insurance Companies are very powerful! They advertise how powerful and strong that they are. AIG is noted in the 2008 list of FORBES as the 20th largest Company in the world.
I had started this post some time ago -three months, to be exact. I will keep it here because it does have some particular information.
For definition: IME is an Independent Medical Examination. The Insurance Carrier (AIG in my case) hires a Physician in a particular field that will examine me at one appointment only. This appointment generally takes one to one and one-half hours and will mean that this Physician will not be able to treat me at any other time. Because he/she is hired by AIG it also generally means that the findings will almost always be favorable to the Carrier. (I know you are surprised to hear this, but it is true.) Typically they have a large amount of business generated by the Insurance Company which pays them handsomely, so it is understandable that their report is one-sided.
This Physician's report will be used at trial as evidence on behalf of the Carrier. My attorney has the opportunity to depose the Physician prior to the trial, after receiving the report, which give us the benefit of asking some pertinent questions the can be favorable to my case.
However, I am now going to a Psychiatrist for an IME. Why a Psychiatrist, you ask?
That is another interesting thing. I was seeing a Psychologist. He was nice, capable for part of the time - Dr. Hoogerman - but he was retiring this year. He was getting a boat and sailing/boating away into the sunset.
Robin, the Adjustor, decided that even though AIG had been paying his bills consistently for several years, (and the Psychologist before him for even more years) that I would not be allowed to continue with counseling, unless a Judge approved it.
I found another Psychologist, and started therapy with her. Because Robbin and AIG refused, I had to pay for the counseling. Robin also decided that she would put into place a company at the expense of AIG (I do not know what the cost of this company is, but it is most definitely in addition to Robin's salary and the cost of their Attorney, Jake Smith.
The company, ProMed, is a "cost containment" company, at the expense of AIG has sent letters to every single physician that I see, asking for a complete list of all medications, treatments and plans on my behalf, in detail, which will then be sent to a doctor of their choice (not necessarily a doctor of the same specialty, incidentally - my Primary Care Family Practice Physician was reviewed by a Pulmonary Specialist)
and again - there is almost a given disagreement with the treating Physician. More money paid out by AIG to now have an IME!!!
It is almost one year since Dr. Hoogerman left, I have not had approval for another Psychologist. I paid the final amount due to the new Psychologist just recently and will not have access to a new counselor until I can meet with one I am comfortable with - and I will have to pay for that counselor until the trial determines if I am to have access to counseling.
Understand, in the almost 19 years since the auto accident, I have had several IMEs. I have not had a Judge take away my medical providers. I am not faking. I am not trying to rake AIG.
Why - why would I want to have 5 spine surgeries, I ask again? Is this my choice in life.
One of those ProMed questionaires went to my specialist for the splint that I wear.
I don't think I described the players in this group.
Claimant:
First there is me - I did mention that. I am the Claimant! I am the one who had the accident. I am the injured party. I am the really bad person who needs to take money away from the big Insurance Company who does not want to part with any money at all. No matter what!
I do not have to have an attorney. I choose to or I can choose not to. My choice to have an attorney came from having a civil case against the trucking company that owned the truck that hit and totaled my automobile. I had 5 attorneys going through that process and even went through a three day miss-trial before settling that case. That left worker's compensation, which was very confusing process to me.
I actually fired four attorneys in worker's compensation as well. I wasn't ready to settle, I didn't want to go to social security disability - I didn't know what was wrong with me, even though I did believe something WAS wrong.
Attorney:
There is now my Attorney, a bright young woman who has experience and knowledge.
Insurance Carrier:
In my case (AIG) - The Insurance Company who held the insurance policy that covered any possible injuries or illness that related to the company that I worked for at the time of injury/illness -10/3/1989.
Adjustor:
The Insurance Carrier (AIG) has their representative, who is an Adjustor. Her name is Robin Walker and she has an interesting approach to her job. It is to keep from paying out any money from AIG whenever possible. ALWAYS! If it is going to be necessary to pay out money, delay the payment. Perhaps it is the dictated job description, but it is absolutely against my best interests.
I cannot understand that. Because it is for medical care, it would be far better to resolve the medical problem promptly before it becomes a bigger and more costly issue. That is a financially sound approach. The better treatment will mean less treatment over time and thus less of expense over all to AIG.
Carrier Attorney:
The Attorney hired by the Insurance Carrier to handle the legal work that would be involved in the larger cases like mine. Generally he would work closely with the Adjustor and communicate with the opposing Attorney (my Attorney) over disputed issues. An example: When an IME is ordered, it is done through the court system, but my attorney is notified that it will be set up. Because I now live out-of-state, the Adjustor had initially set the appointment with a Physician in Florida (the state where the accident occured - not where I live (NC). This made it difficult for me, especially since it was in the middle of the state - 2 hours away from the location of the trial and on the day of the trial and at the time of the trial.
My attorney informed me, we replied that it was impossible to keep the appointment. The Carrier Attorney had to have the Adjustor cancel the appointment. Surprisingly she was able to find one in NC after all at a later date. Of course the trial was delayed. The trial has been delayed now three times due to her actions.
The trial has affected money due me and medical care I am to receive. There is no recourse in law to force action.
In fact, the Insurance Companies have lobbied and had laws passed to stop payment if actions have not been taken within a reasonable amount of time. It is interesting when they are the ones that have delayed the very actions that should have been taken.
Insurance Companies are very powerful! They advertise how powerful and strong that they are. AIG is noted in the 2008 list of FORBES as the 20th largest Company in the world.
Saturday, November 17, 2007
Chapter One: Claimant #082-00053670
Quote:
I am Claimant #082-00053670, now for 18 years. That means that for more than 18 years I have had to deal with American International Group (AIG) for my medical care and treatment that is causally related to the work related accident where I was injured on October 3, 1989.
I have had some fantastic medical care. The surgeons were excellent and recognized for their expertise. My primary care physicians have been knowledgeable, and willing to stand up for my medical care and treatment.
Not because AIG has had my best interests at hear and wanted me to receive health care that would give me as much of my pre-accident life back as possible. NO SIR, I have had to fight for every bit of care that I have received.
RIGHT NOW I want to make it clear that there is one very widely accepted by greatly mistaken accumption in the world of workers' compensation.
It is NOT TRUE THAT MOST WORKER'S COMPENSATION PATIENTS ARE CHEATING, LYING, WORKING THE SYSTEM, FAKING, OR TRYING TO GET SOMETHING FOR NOTHING - OR ANY OF THE OTHER COMMONLY atttached remarks to those trying to get help from large insurance company because of injuries incurred while working.
There may be some. In fact, I am sure there are.
In FACT, it would be ignorant to believe that those wealthy, gigantic and powerful, lobby-smart adjustor-rich insurance companies are being outsmarted year after year by individuals that are injured, in pain, unable to work, generally low-income earners without a backup financial plan in place, and assisted only by health care providers of companies that have already been reducing any coverage of regular medical care.
Even with a financial backing of some type of insurance, or a good bank account and some savings, that can be totally wiped out within a very short time by the delaying tactics used by the insurance company. You have to have approval prior to getting care. You have to see one of the insurance company physicians, who will, I can assure you, tell you that you are not sick, do not need medication, treatment or any type of care.
If you are fortunate enough to see a physician who does find that you need treatment or medication, again there has to be approval by the adjustor prior to any action taken. The adjustor frequently loses the prescription and needs a duplicate. There can be questions about the dosage, or the type of treatment, or the appropriate cost of the treatment which will require another conference call with the physician with the physician before the adjustor can make the approval.
I am not sure that the average person can realize what this process above can mean. Right now there would have been multiple delays. The adjustor would be accurate in saying that there was no denial of service, there were reasons that a decision could not be made.
There is a law in the state of Florida that says that a medical prescription from a physician must be provided within ? days by the carrier (AIG - the BIG Insurance Company)There is NO law that punishes the carrier when they do not do their job.
I want to tell you some true facts that will perhaps let you know that it is time to talk to your Senator and House Representative about changing the laws that allow the system to work in favor of those BIG COMPANIES.
I have been fortunate in many ways. I am at least able to fight for myself - and have actually fired four attorneys before finding a fifth that has been capable and willing to stand firm for me. I still keep in close contact and actions are only taken when I agree to them, but are taken when I want them to be.
I saw 57 doctors before it was determined that my entire spine was injured. The reason that was determined was because I demanded an entire spinal MRI after 3 1/2 years. I subsequently had three more spinal surgeries, two in that year and one the following year.
I had two Doctors approve and recommend TMJ surgery, the third was an AIG Physician. At the appointment with the third Doctor, he had me fill out a complete medical form using 7 colored pencils and 5 different marks for types of pain. I was to take 45 minutes to complete the form, which I did. When I entered his office (Dr. C, ENT in Tampa,FL)he wheeled over to me, put down his circle viewer, took out his stethescope and listened to the clicking at my jaw joints. "Oh, yes, I can hear that even without the stethescope", he stated. "Not to worry, we can do surgery easily, and clear that right up - it is a breeze. We can take care of it right away and it won't be any problem at all. I'll see what my schedule looks like."
He then picked up my chart, opened it up - saw that I was "WORKER'S COMPENSATION" and said " um, well, not all TMJ needs surgery, there are times that we just don't need to operate every time. I'm sure that if we wait this will get better." I am here to tell you that his office notes absolutely did NOT mention that he suggested surgery first!
I was fortunate. Two Doctors out-weighed the Insurance Company Doctor. I had my surgery, and I was given the gift of a tremendous relief of pain in my head and neck. It did not stop the pain. It did not stop the grinding of my teeth to keep the rest of the pain away. I was given a 'splint' that would be adjusted at least every few months to help with the residual pain.
There was more surgery needed, but it would require braces for two plus years, orthonagathic surgery, then more braces - all to be done when I was free from pain, later on. I am not sure when that will be, since I still have head and neck pain constantly.
This pain is at least bearable, as long as I have the splint and keep it adjusted. I have started biting the sides of my cheeks because of some muscle tightening, which is due to increased pain now.
This is just one piece of what happened with a Mack Truck totalling my automobile in 1989. I am still able to walk, talk and live independently. And to care for and play with my grandsons - that is one great gift!
I am Claimant #082-00053670, now for 18 years. That means that for more than 18 years I have had to deal with American International Group (AIG) for my medical care and treatment that is causally related to the work related accident where I was injured on October 3, 1989.
I have had some fantastic medical care. The surgeons were excellent and recognized for their expertise. My primary care physicians have been knowledgeable, and willing to stand up for my medical care and treatment.
Not because AIG has had my best interests at hear and wanted me to receive health care that would give me as much of my pre-accident life back as possible. NO SIR, I have had to fight for every bit of care that I have received.
RIGHT NOW I want to make it clear that there is one very widely accepted by greatly mistaken accumption in the world of workers' compensation.
It is NOT TRUE THAT MOST WORKER'S COMPENSATION PATIENTS ARE CHEATING, LYING, WORKING THE SYSTEM, FAKING, OR TRYING TO GET SOMETHING FOR NOTHING - OR ANY OF THE OTHER COMMONLY atttached remarks to those trying to get help from large insurance company because of injuries incurred while working.
There may be some. In fact, I am sure there are.
In FACT, it would be ignorant to believe that those wealthy, gigantic and powerful, lobby-smart adjustor-rich insurance companies are being outsmarted year after year by individuals that are injured, in pain, unable to work, generally low-income earners without a backup financial plan in place, and assisted only by health care providers of companies that have already been reducing any coverage of regular medical care.
Even with a financial backing of some type of insurance, or a good bank account and some savings, that can be totally wiped out within a very short time by the delaying tactics used by the insurance company. You have to have approval prior to getting care. You have to see one of the insurance company physicians, who will, I can assure you, tell you that you are not sick, do not need medication, treatment or any type of care.
If you are fortunate enough to see a physician who does find that you need treatment or medication, again there has to be approval by the adjustor prior to any action taken. The adjustor frequently loses the prescription and needs a duplicate. There can be questions about the dosage, or the type of treatment, or the appropriate cost of the treatment which will require another conference call with the physician with the physician before the adjustor can make the approval.
I am not sure that the average person can realize what this process above can mean. Right now there would have been multiple delays. The adjustor would be accurate in saying that there was no denial of service, there were reasons that a decision could not be made.
There is a law in the state of Florida that says that a medical prescription from a physician must be provided within ? days by the carrier (AIG - the BIG Insurance Company)There is NO law that punishes the carrier when they do not do their job.
I want to tell you some true facts that will perhaps let you know that it is time to talk to your Senator and House Representative about changing the laws that allow the system to work in favor of those BIG COMPANIES.
I have been fortunate in many ways. I am at least able to fight for myself - and have actually fired four attorneys before finding a fifth that has been capable and willing to stand firm for me. I still keep in close contact and actions are only taken when I agree to them, but are taken when I want them to be.
I saw 57 doctors before it was determined that my entire spine was injured. The reason that was determined was because I demanded an entire spinal MRI after 3 1/2 years. I subsequently had three more spinal surgeries, two in that year and one the following year.
I had two Doctors approve and recommend TMJ surgery, the third was an AIG Physician. At the appointment with the third Doctor, he had me fill out a complete medical form using 7 colored pencils and 5 different marks for types of pain. I was to take 45 minutes to complete the form, which I did. When I entered his office (Dr. C, ENT in Tampa,FL)he wheeled over to me, put down his circle viewer, took out his stethescope and listened to the clicking at my jaw joints. "Oh, yes, I can hear that even without the stethescope", he stated. "Not to worry, we can do surgery easily, and clear that right up - it is a breeze. We can take care of it right away and it won't be any problem at all. I'll see what my schedule looks like."
He then picked up my chart, opened it up - saw that I was "WORKER'S COMPENSATION" and said " um, well, not all TMJ needs surgery, there are times that we just don't need to operate every time. I'm sure that if we wait this will get better." I am here to tell you that his office notes absolutely did NOT mention that he suggested surgery first!
I was fortunate. Two Doctors out-weighed the Insurance Company Doctor. I had my surgery, and I was given the gift of a tremendous relief of pain in my head and neck. It did not stop the pain. It did not stop the grinding of my teeth to keep the rest of the pain away. I was given a 'splint' that would be adjusted at least every few months to help with the residual pain.
There was more surgery needed, but it would require braces for two plus years, orthonagathic surgery, then more braces - all to be done when I was free from pain, later on. I am not sure when that will be, since I still have head and neck pain constantly.
This pain is at least bearable, as long as I have the splint and keep it adjusted. I have started biting the sides of my cheeks because of some muscle tightening, which is due to increased pain now.
This is just one piece of what happened with a Mack Truck totalling my automobile in 1989. I am still able to walk, talk and live independently. And to care for and play with my grandsons - that is one great gift!
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