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!
