Thank you for the interesting discussion on work comp and the costs & problems associated with it.
Miguel was correct. I was referring to my own health insurance that I was working hard to pay for- but was then denied the right to use when I became injured at work.
I don’t care what administrative problems there are with WC- (Those problems should NOT be my problems) and I should have had the right to use my own health insurance to resolve my injuries; instead of being literally forced into a system that I knew nothing about and was most certainly (automatically) going to be targeted and treated as a fraud for using.
I found out just recently that because the private investigator couldn’t locate me, his report to the co. literally set the ball in motion for them to use every resource they had to screw me.
Let me tell you something guys. I am screwed. I have a young daughter who is very ill, who I cannot allow to have a lapse in her (Let’s please focus on one word from now on, okay? Because therein lies the entire problem.)
The companies are in business to MAKE A PROFIT. Not to “ensure” you a damn thing, except certain misery.
So, I have now been fired from my job, my back hurts terribly, the co. has denied my temporary income benefits because I was supposedly “fired for reasons unrelated to my injury” which is total crap. I am now having to pay (with NO income mind you) $620.00/mo for COBRA and supposedly (until all is resolved with the carrier, I cannot qualify for unemployment either.
I am literally facing bankruptcy now and I am having to use the only little pittance of savings I was ever able to save (my daughter’s college education savings which she is/was still hoping to use) to survive a little longer and to feed to the COBRA company.
I can’t work because I am still under doctor’s restrictions, I am in constant pain and constantly at the mercy of the company to get their omnipotent approval for my medications (which they love to drag their feet on every month, so that I have to do without them for 1 and 1/2 to 3 weeks at a time,) and I am now depressed out of my mind.
I am a single, working mother- oh- correction- I WAS a single, working mother, who’s ex-husband is disabled (double bilateral amputee) and so I receive absolutely no help from him either. I am literally fighting every day to stay alive and believe me, I don’t want to. I hurt. I can no longer provide for my child or myself and I cannot fight this ridiculous battle any longer with the huge corporate company.
(Now stop for just a second. Just imagine if you will, that for the first time in your LIFE, you cannot provide for yourself or your children. Let that thought settle on you for second. How will you feed them? How will you buy gas for their transportation? How do you even look them in the eye any more? It’s really hard to imagine having absolutely no money, when you’ve had it and/or the ability to make it all your life. But this is reality mow. It’s unimaginably painful, so don’t discount this very human side of the problem, okay?)
Now, back to what I was saying. It is often a battle each day, just to try and find the strength to want to live. Living is nothing but pain to me now.
I was found GUILTY before any assumption of innocence. I have been made into a failure. A fraud. A common criminal- all on the word, without a shred of evidence or proof, of the all-powerful (God-forsaken) company.
My car needed new tires six months ago. My child’s car is smoking and I don’t know why and I don’t have the money to deal with either problem (or a host of others). At this point, were it not for the generosity of friends, my sick child and I would most probably be sleeping under an overpass somewhere and we may still be headed there for all I know. THINK about that! Can you really even imagine it? I know I could not have- not before this incident occurred in my life.
All this as a result of my getting hurt at work and instead of being treated as an injured HUMAN BEING, a criminal. The company was my judge, jury and executioner, before I ever even realized what was going on. And, as I have come to understand it, most injured employees are treated exactly as I am. It is just as criminal for companies to be allowed to get away with destroying people’s lives as it is for those who seek to take advantage of the WC system.
So- where does that leave the situation? It should be obvious. The concept of simply DOES NOT work, either in practice or in theory. Let’s wake up, shall we?
We need socialized medicine such as Australia has, so that our health and our lives are not being controlled and driven by those who only seek a better profit margin and by those who seek to take advantage of the profit makers.
And please! Don’t speak to me about those poor crocodile tears of the companies. What a bunch of hoooey! Sure- I’m sure those supposed “ten to one” fraudulent claims are costing big bucks (and I’m truly sorry about that) but don’t fool yourselves. Those companies would not still be flourishing if they weren’t making huge profits and nice, big fat salaries for all.
And therein lies the problem! It’s a vicious circle with NO SOLUTION. It’s a “who’s on first” play of commerce. The only way to win “the game” is NOT to play!
We have got to get rid of these companies and socialize our healthcare so that people are truly receiving the care they need without ANYONE grabbing an extra dime from it. So that, we can once again be treated like human beings, injured and/or sick patients and actually getting help so that we can get back to our lives and our jobs. So that we won’t be treated like common criminals so Mr. & Mrs. Corporate America can’t make a wad of cash off of our pain and suffering and then leave us for dead under a bridge somewhere!
Everyone really needs to wake up and smell the coffee on these issues. People’s lives are being RUINED as I type this. My and my child’s life is being irreversibly damaged as I type this and there is a very simple solution. Get rid of this dysfunctional system! Period.
Now- to address your comments on Chiropractors, once again, I hear your entire argument is based on what? Money. Not the doctor and the care and expertise he/she gives. Certainly not the patient or his/her needs. But your argument is based solely on the money and the assumption that Chiropractic doesn’t work.
Dear- anything that large corporations are loosing money on will be found to be fruitless by lots of fancy studies and statistics, all laid out on very colorful, compelling graphs. Please. Don’t tought trumped-up studies, reports and graphs. Any “study” can be fudged to lean in any direction. You don’t have to take my word for it. Ask any MD or a scientist.
Use your heart and your mind to form your opinions. Go to a popular Chiropractor’s office. Sit your actual back-side in a chair in the waiting room and talk to some of the people who are there to see their Chiropractor.
Ask them if they get the help and relief they need. I guarantee you, the majority of his/her patients will give you a positive review and some will tell you how they couldn’t live without him or her. That’s because Chiropractors seek to help you without slicing you open and without pumping you full of harmful drugs. Sometimes they can help, sometimes they can’t- no different from any other doctor.
Every human being’s body is different and unique in some way. Some can be helped palliatively and some cannot- but damn-it, at least a Chiropractor will TRY to help you without harming you first.
And I don’t give a damn what it costs and if you were in my shoes (and millions of others like me), you wouldn’t either. My Chiropractor has done more to alleviate my pain than the pain mgt. specialist or the surgeon or the drugs. He has also done more to help me regain my physical strength than any other doctor I’ve seen.
Equally important, he avails himself to me and actually listens to me and makes a great effort to help me in whatever way he can. He has also been the only sympathetic ear I have had throughout this entire, life-crushing ordeal, (because he sees it all the time) and he knows what happens to his work comp. patients.
He hates it, but has no power to do anything about it except try to keep his patients from becoming suicidal over it. I am not sure I would still be here, had I not had my Chiropractor’s support throughout this nightmare.
So Sam- you can say all you want and be a hater of Chiropractors and what they supposedly cost “the precious system” – but until you’ve actually walked the walk, you might at least consider another view. Especially one that does not entail a coin, but a heart instead.
Thanks for listening. Take care guys. For me, it’s just one day at a time. (I pray).
I am truly sorry for your loss. I am sure it is a very tough time for you.
If I were going to give any advice, not that I am the expert here, I would say go after your ex-employer and WC. Personal health insurance was never set up to pay for any work related injury…you are going to hit a brick wall everytime there.
Personally, I would talk to an attorney to see what your options are. I think the WC system is failing you, although it sounds like it’s paying for something since you are currently seeing a chiropractor. You said you were in alot of pain everyday, even though you praise the chiropractor?? Maybe it’s time to see a physician or a different one if the you have seen one already. Going after your employer may not be a bad idea either…if you were truly let go for some other reason than you were injured and they did n’t want you..the burden of proof is on them to show that.
I am knocking the chiropractors because out of the 2 that I have seen personally, neither one has helped me at all. One of them even used fake x-rays to run up the bill..but that’s another discussion.
Thanks for your kind words. I have already retained an attorney and have a hearing date set with Texas Wrokers Compensation Commission. (For all the good it will do me- which is probably none.)
The real problem is, “the system” isn’t failing me in the way you think. “The system” is actually doing exactly what it is designed to do. It’s working like a charm!
That’s how Employee Health people and insurance adjusters get bonuses and incentives- to reduce the costs of their “files.” Unfortunately, I am their “file.” They know exactly what they are doing and my case is not unique in any way.
Don’t you see? They’d rather spend money on persuing you as though you are a fraudulent claimant, than helping you medically or financially. It’s much less expensive that way. And, it’s really pretty easy to turn a situation around and make it appear as though it is something that it’s not. It’s just like putting words in someone’s mouth- twisting what they say (or do) to make it play against you. It is not difficult for work comp. insurance companies to make you appear as a fraud.
And when they do- did you know that they have a right to turn around and sue you? Whether you’re injured or not?
No Sam- the system is doing exactly what our lawmakers have allowed them to do. The insurance companies are out of control and there is no limit (that I have found) to what they can or will go, in order to try and show that you’re a fraud. And anyway, it doesn’t matter what they can or cannot prove. They still have the right to drive you insane and into the poor house while everything is tied up in red tape.
They do it every day to every claimant they want. It’s just business as usual. In the mean time, Texas workers have no rights or protection of any kind.
Case in point? I tell you for a fact that I was fired for reporting (and requesting) the fact that my wages were being underpaid and under-reported. (It was saving the work comp. insurance company money.) But as soon as I started requesting that they fix the errors and pay me correctly (I was working at the time too- just not full time yet), my company fired me for making a copy of my wage statement, that proved they were underpaying me.
Now you tell me- fire a wonderful, hard-working, award winning employee for making a copy? But that’s what they did. Because my company and the insurance co. saw me as nothing but a liability, once I was injured. End of story.
It’s just business as usual. The lawmakers allow it and the new bills being considered will give workers even fewer options and fewer rights and even more power to the work comp. insurance companies.
At the very least, EVERY worker in Texas should be given a detailed outline of exactly what the work comp. insurance company can do to you, (if you use the insurance) BEFORE you are forced into their nasty, life-destroying system.
And ya’ know what? I should have had the right to use my own health and accident insurance no matter where I was or what I was doing. I payed for it- I should have had the right to use it. Period.
As I’ve said- the problem is truly that so long as big corporations stand to gain financially from your pain and suffering- the injured party has no chance for real help.
And yes- my Chiropractor has done the most for me in so far as helping to relieve my pain. Really sorry to hear about your experience with your Chiropractors. There are good and bad ones, just like medical doctors, I suppose.
Lastly, in the work comp. system, it’s not so easy to just go see another doctor. It’s a whole process of paperwork and red tape AND you have leave the primary doctor you’ve been seeing. You loose again. You can’t just go get a second opinion or try someone new. Are you kidding? That would cost them money.
Our system is: Insurance Co. = Win / Employer = Win / Injured Worker = Loose (everything).
I hope everything works out for you. Let me assure you that not all insurance companies are the same. I don’t know which one you have, and maybe it’s best not to say who on this blog. I will say that you probably caused a fairly expensive audit for your employer with the Workers’ Comp insurance carrier. Your employer’s WC premiums are based on payroll and if the carrier finds out that they are reporting incorrectly, well…you get the idea.
Good luck!
Pippin, I have read all of your posts and believe me I feel your pain. I too was fired for a B/S reason after notifying my company that I would be needing an indefinite period of time off from work in order to participate in an agressive physical rehab program prescribed by my doctor. I was fired on what would have been my last day before rehab. In six years w/ the co. I had never missed a day of work and had received MVP awards, was well thought of by my supervisors and known by all as a dependable employee.
The sad thing is that in my great desire to heal without taking time off, and without drawing W/C disability pay, I had voluntarily been working at a much less physically demanding job (albeit on prescribed narcotics) for six months and for half the pay I was accustomed to(I would have made more by NOT working). Lazy I’m not.
After my firing, sans health care (who can afford Cobra), I entered the wonderful world of the W/C system along with all of it’s “benefits”- a vindictive ex-employer, lying supervisors afraid of their own firing no doubt, insurance carrier willing to do anything and everything to keep me from seeing one dime of their money, heartless adjusters, highly experienced carrier attorneys, incompetent TWCC ombudsmen, hearings, denial after denial, appeals, and on and on ad nauseum.
I called attorneys from all over the state and none would help unless there was death or dismemberment. It seems “there is no money in it”
After appealing the decision of my last hearing where the TWCC “judge” found in favor of the carrier, the appeals panel up-held the “no disability” ruling (thus no money for my time off from work) but found that I had properly reported my injury and had seen the company doctor (who grossly misdiagnosed my injury) so therefor I am entitled to “lifetime medical benefits. Yeah, right!
I was able to see a spine specialist who was able to properly diagnose my injury. Unfortunately it is inoperable due to four level disc involvement. After years on powerfull narcotics that gave little relief-fentanyl, oxycontin, etc.- he prescribed a morphine pump which Crawford and Company promptly denied. Then he submitted for a spinal cord stimulator trial which was also promptly denied.
Shortly after denying the need for these expensive procedures Crawford and Co. insisted that I see a carrier assigned doctor. He had to travel ninety miles from Dallas to Tyler where I met him at a local doctors office. He saw me for all of ten minutes and declared me fit to resume full time employment and no longer in need of pain medications. The carrier promptly stopped all further treatment.
I thought the doctor was a nut but clearly he is in the carriers hip pocket. Why else would they send a Dr. all this way when we have some of the best spine specialists in the state. My doctor’s W/C liason later told me that they are quite familiar with the guy and his modus operandi. Since that day the carrier won’t even approve an office visit. As far as they are concerned my “lifetime benefits” are over.
Since then I have been in excruciating pain almost daily. I sleep very little and have regularly occuring anxiety attacks. I have spent all of my retirement, savings accounts, and depleted my 401k over the last 4 years. My wife has a decent job but we are living hand to mouth. If our 23 year marriage lasts another year it will be a miracle. The stress is just too much.
I begged with my adjuster recently asking merely for an office visit with my or any other doctor if she prefered. I was hoping perhaps for some pain meds if only for a little relief( I’ve not had any in nine months). I calmly expressed to her my desperation. I told her that I felt I was at the end of my rope and if I had to go another agonizing day I might well just jump off a bridge or otherwise end my life.I was not saying so for effect. At the time I meant it. A man can only suffer so much. The adjuster told me that I should probably do so if that’s what I want to do but she could not help me.
I have been working daily since then to
get something done as she actually motivated me to NOT give up. Those criminals at Crawford took the premiums and damn it they need to live up to their end!
Every time I seem to make progress in getting the treatment I need and they were paid for it seems they are able to sqirm out of their obligations.
I have not even come close here to relating all of my experience with the current W/C system. To do so would require a fair sized book and besides I can only sit for about 15 minutes at a time.
I do know that the current system is broken and the insurance carriers are getting richer by the pain of those they contracted with to help
Yes Miss Pippin-criminal is an appropriate characterization.
Jimmer-
Indeed my heart goes out to you as well. This is exactly what I’ve been trying to convey to the others on this blog. That worker’s pain and suffering is literally marketed as business as usual for the work comp. insurance companies, employers and TWCC as well.
I am going to write to Gov. Rick Perry and David Dewhurst. I’ve already written to Lamar Smith (Congressman), with no response yet. Would you mind if I added your story to my letters?
Also- can you think of any way to contact other work comp. fodder of Texas (such as our selves) so that we may begin a petition to put an end to this travesty?
I think it’s high time (and almost too late) to let our representatives know that they are grossly failing Texas workers. Don’t you?
(I cannot give my real name yet – I assure you I have one though – as my case is just coming into litigation.)
I’ve done some research since no one commented on my comment. According to the TWCC almost 40% of the employers in Texas do not subscribe to Texas W/C. Why is that? I would imagine the reasons they don’t, all of you have explained very well with your grief.
Also, every article I’ve read about work related injury & benefits not being paid, fraud, etc., it’s not about those employees working for a company who has opted out, but about those employees whose companies who have W/C.
Health insurance companies are never going to pay for work related injuries because that is the responsibility of the employer. Ya can’t get paid twice for a claim. Fraud would go through the roof.
Socialized medicine is NOT the answer. Every Tom, Dick & Harry gets in line to see a doctor for valid & invalid reasons. In some countries it takes months to see a doctor especially a specialist. Free enterprise while not perfect (like democracy)but it’s still the best system. A health insurance company just like a bad restaurant will eventually go out of business if it does not provide promised services.
Still have problems? Get an attorney. Find one who will take a valid case on contingency. Many, many do.
Also, did you know an employee can INDIVIDUALLY opt out of Texas W/C? The catch 22 is you must do it within 5 days of your hire date.
Pippin,
You are so right about “business as usual”. The majority of insurance carriers don’t give a damn that injured workers are watching their (and their families) hopes and dreams go down the toilet. I know that many carriers, not just mine, behave in the same criminal manner. I know this from my conversations with doctors and their staff as well as with the numerous patients I have spoken with during my many hours spent in waiting rooms.
Of course the greater portion of workers claims are not for such debilitating injuries as yours and mine. They never experience the frustration and discouragement that we continue to experience. Perhaps that is a part of the problem in obtaining significant reform to a blatantly insensitive system. While the majority of injured workers are inconvenienced, they are not brought to ruin as many of us are.
I haven’t been able to work in any capacity (and I have tried many times) in three and a half years. I am convinced that if the insurance company had acted in good faith I could have been capable of performing some type of work or started retraining within six months. Instead I have only gotten worse.
The insurance company’s consistent denials of virtually every physician requested procedure has resulted in my having to appeal and appeal ad nauseam. The greed and callous disregard of my well-being by my carrier has resulted in dragging this out seemingly endlessly while I watch my future slowly disintegrate.
I loved my job and wanted to retire from the company I was with. I really felt I had life by the horns. My family life was great. I made an above average salary and had alot of time off to spend with my wife and son and to pursue my hobbies. We had recently build our dream house. Our vehicles and boat were paid for. We had money in the bank and on and on.
We’re still clinging to the house and my wifes’ now worn out car but the rest is gone. I suppose one could surmise I’m a bit bitter. I’m fortunate to have what I do have but now that all of our financial reserves are depleted and our expendable assets are gone are I really don’t see how we can hang on much longer. Perhaps Miss Pippin we shall meet under a bridge someday. :-(
Well, enough self pity for one day.
In answer to your questions- feel free to use my post in any manner that you like. As far as contacting others I don’t have any bright ideas. Medical privacy these days is such that it will be a challenge to get that type of info. Perhaps an internet posting somewhere would elicit some response.
I assume you are in Texas. Have you contacted the Texas Rehabilitation Commision? Now-a-days they are called Texas Department of Assistive and Rehabilitative Services. (WWW.DARS.state.us)
They will pay medical costs and pay for school, both College and Trade, for injured or handicapped workers. The medical cost thing is a little ticky though as in my case they will pay for the morphine pump (@ $50,000)but as I understand it I would have to release the W/C carrier from any future obligation. Even if I could get the pump without releasing the carrier you and I both know that I would be opening a can of worms that would make any future treatment impossible to obtain through W/C.
If the pump needed to come out for any reason I wouldn’t have a snowballs chance in hell of W/C helping out when they are the ones that should be paying for it to begin with!
I don’t know your particulars but maybe you could gain some benefit by contacting them. If I’m not mistaken they will also provide assistive living benefits if you qualify. In my case I really don’t know what good school would be right now as how do I make a sustainable living while attending school.
As I’m not getting anywhere with W/C I recently hired a law firm to pursue a Social Security Disability claim. My doctor has proclaimed me too disabled to work so I guess I’m going to be forced into that route. Just another strain on the American taxpayer compliments of a failed workers compensation system.
I haven’t read the actual bill that the governor signed, only what I’ve read about it on this site and heard on the news so I’m not yet qualified to opine on the subject but from the little I’ve read it sounds as if there is going to be even less oversite. As I understand it the goal is to spend even less money! I quess we’ll find out soon enough.
Pippin I wish you well. I hope that you will soon get the help that you need and were promised. Maybe, just maybe, HB7 will bring the much needed change to get folks like us the help we deserve from a system designed to help injured workers but in reality merely lines the pockets of greedy, insideous insurance companies. I’m not gonna hold my breathe but I will certainly be staying attuned to the situation.
It’s been a pleasure Pippin. Again, best of luck to you and your family,
Sam, In your exact words……..
“If my company whether in insurance or not was losing large sums of money every year on fraud..you can bet I would have an extensive procedure that all clients had to go thru to minimize fraud. Now, that may not be too appetizing to my customers..but it’s alot better than making them pay 10-30% more next year to make up for the loss due to the fraudulent customers. Maybe this can temporarily slow or even stop medical attention and prescriptions…but this is the way the carriers choose to protect themselves.
Pal, I dare you to experience a reportable injury and then still spew the above garbage….
If the police department handled every 911 call in the same way that you and the WC insurance companys handle their calls….well after your injury the cops would write YOU a ticket for murder and then the judge would require YOU to write a check that you could not possibly cover to the supposed victims family.
Clamping down on fraud is good and well but denying people with X-ray and MRI confirmed injuries simply because spine injuries are often expensive to treat is a abomination.
Don’t worry Sam ole boy….. YOUR company is secure.By the way….Excellent research!!!! YOU MUST HAVE LOOKED AT WELL OVER 1-2 DOCUMENTS!!!! You weeny….don’t you know that “temporarily blocking prescriptions”…..YOUR WORDS…. can result in death or extreme neurologic reactions???????????
I don’t actually expect you to come back to this site so I am not expecting a response. Besides if I were you I’d be too
embarassed to show my silly uneducated ignorant to the subject face around here.
I still love ya tho……..
God bless you pippin and jimmer…..
T>B>
This is not a blog for calling people names, Terry. It’s seems you have had a claim that was denied or something has upset you. I am sure your circumstances are unfortunate…let’s not lower ourselves to insults.
I am not saying the WC system or the carriers are perfect…nor are all the claimants, but Terry, which never ending pot of gold do you think is going to pay every claim the second it happens without any basic fraud prevention? You are kidding yourself if you think it should happen that way. Yes, some will be put in a bad spot, but the idea is for the carrier to stay in business so YOUR claim can be paid. What happens when YOU find out that YOUR claim won’t be paid because a few hundred people took the carrier for big $$$ by working the system, getting a paycheck, running up huge medical bills for therapy and what not, even suing the carrier if they didn’t think they got enough money? I can assure you that your attitude would change.
It’s ironic, all we see on these types of blogs are people who have a claim go bad. I would bet that this is an overwhelming minority of the entire system.
And Terry, I appologize, my “silly, uneducated, ignorant to the subject face” was speaking a little off the subject of this Bill by answering your concerns with my opinions. Oh yeah..we did have a subject..it was about this Bill taking away chiropractors from the approved doctors list.
Let’s see..if that did happen, maybe the fraud would be lower, maybe you would be able to see a doctor, maybe prescriptions would be a little easier to get…just maybe…but one thing is obvious…the way it is now isn’t working…
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Sam & Miguel,
Thank you for the interesting discussion on work comp and the costs & problems associated with it.
Miguel was correct. I was referring to my own health insurance that I was working hard to pay for- but was then denied the right to use when I became injured at work.
I don’t care what administrative problems there are with WC- (Those problems should NOT be my problems) and I should have had the right to use my own health insurance to resolve my injuries; instead of being literally forced into a system that I knew nothing about and was most certainly (automatically) going to be targeted and treated as a fraud for using.
I found out just recently that because the private investigator couldn’t locate me, his report to the co. literally set the ball in motion for them to use every resource they had to screw me.
Let me tell you something guys. I am screwed. I have a young daughter who is very ill, who I cannot allow to have a lapse in her (Let’s please focus on one word from now on, okay? Because therein lies the entire problem.)
The companies are in business to MAKE A PROFIT. Not to “ensure” you a damn thing, except certain misery.
So, I have now been fired from my job, my back hurts terribly, the co. has denied my temporary income benefits because I was supposedly “fired for reasons unrelated to my injury” which is total crap. I am now having to pay (with NO income mind you) $620.00/mo for COBRA and supposedly (until all is resolved with the carrier, I cannot qualify for unemployment either.
I am literally facing bankruptcy now and I am having to use the only little pittance of savings I was ever able to save (my daughter’s college education savings which she is/was still hoping to use) to survive a little longer and to feed to the COBRA company.
I can’t work because I am still under doctor’s restrictions, I am in constant pain and constantly at the mercy of the company to get their omnipotent approval for my medications (which they love to drag their feet on every month, so that I have to do without them for 1 and 1/2 to 3 weeks at a time,) and I am now depressed out of my mind.
I am a single, working mother- oh- correction- I WAS a single, working mother, who’s ex-husband is disabled (double bilateral amputee) and so I receive absolutely no help from him either. I am literally fighting every day to stay alive and believe me, I don’t want to. I hurt. I can no longer provide for my child or myself and I cannot fight this ridiculous battle any longer with the huge corporate company.
(Now stop for just a second. Just imagine if you will, that for the first time in your LIFE, you cannot provide for yourself or your children. Let that thought settle on you for second. How will you feed them? How will you buy gas for their transportation? How do you even look them in the eye any more? It’s really hard to imagine having absolutely no money, when you’ve had it and/or the ability to make it all your life. But this is reality mow. It’s unimaginably painful, so don’t discount this very human side of the problem, okay?)
Now, back to what I was saying. It is often a battle each day, just to try and find the strength to want to live. Living is nothing but pain to me now.
I was found GUILTY before any assumption of innocence. I have been made into a failure. A fraud. A common criminal- all on the word, without a shred of evidence or proof, of the all-powerful (God-forsaken) company.
My car needed new tires six months ago. My child’s car is smoking and I don’t know why and I don’t have the money to deal with either problem (or a host of others). At this point, were it not for the generosity of friends, my sick child and I would most probably be sleeping under an overpass somewhere and we may still be headed there for all I know. THINK about that! Can you really even imagine it? I know I could not have- not before this incident occurred in my life.
All this as a result of my getting hurt at work and instead of being treated as an injured HUMAN BEING, a criminal. The company was my judge, jury and executioner, before I ever even realized what was going on. And, as I have come to understand it, most injured employees are treated exactly as I am. It is just as criminal for companies to be allowed to get away with destroying people’s lives as it is for those who seek to take advantage of the WC system.
So- where does that leave the situation? It should be obvious. The concept of simply DOES NOT work, either in practice or in theory. Let’s wake up, shall we?
We need socialized medicine such as Australia has, so that our health and our lives are not being controlled and driven by those who only seek a better profit margin and by those who seek to take advantage of the profit makers.
And please! Don’t speak to me about those poor crocodile tears of the companies. What a bunch of hoooey! Sure- I’m sure those supposed “ten to one” fraudulent claims are costing big bucks (and I’m truly sorry about that) but don’t fool yourselves. Those companies would not still be flourishing if they weren’t making huge profits and nice, big fat salaries for all.
And therein lies the problem! It’s a vicious circle with NO SOLUTION. It’s a “who’s on first” play of commerce. The only way to win “the game” is NOT to play!
We have got to get rid of these companies and socialize our healthcare so that people are truly receiving the care they need without ANYONE grabbing an extra dime from it. So that, we can once again be treated like human beings, injured and/or sick patients and actually getting help so that we can get back to our lives and our jobs. So that we won’t be treated like common criminals so Mr. & Mrs. Corporate America can’t make a wad of cash off of our pain and suffering and then leave us for dead under a bridge somewhere!
Everyone really needs to wake up and smell the coffee on these issues. People’s lives are being RUINED as I type this. My and my child’s life is being irreversibly damaged as I type this and there is a very simple solution. Get rid of this dysfunctional system! Period.
Now- to address your comments on Chiropractors, once again, I hear your entire argument is based on what? Money. Not the doctor and the care and expertise he/she gives. Certainly not the patient or his/her needs. But your argument is based solely on the money and the assumption that Chiropractic doesn’t work.
Dear- anything that large corporations are loosing money on will be found to be fruitless by lots of fancy studies and statistics, all laid out on very colorful, compelling graphs. Please. Don’t tought trumped-up studies, reports and graphs. Any “study” can be fudged to lean in any direction. You don’t have to take my word for it. Ask any MD or a scientist.
Use your heart and your mind to form your opinions. Go to a popular Chiropractor’s office. Sit your actual back-side in a chair in the waiting room and talk to some of the people who are there to see their Chiropractor.
Ask them if they get the help and relief they need. I guarantee you, the majority of his/her patients will give you a positive review and some will tell you how they couldn’t live without him or her. That’s because Chiropractors seek to help you without slicing you open and without pumping you full of harmful drugs. Sometimes they can help, sometimes they can’t- no different from any other doctor.
Every human being’s body is different and unique in some way. Some can be helped palliatively and some cannot- but damn-it, at least a Chiropractor will TRY to help you without harming you first.
And I don’t give a damn what it costs and if you were in my shoes (and millions of others like me), you wouldn’t either. My Chiropractor has done more to alleviate my pain than the pain mgt. specialist or the surgeon or the drugs. He has also done more to help me regain my physical strength than any other doctor I’ve seen.
Equally important, he avails himself to me and actually listens to me and makes a great effort to help me in whatever way he can. He has also been the only sympathetic ear I have had throughout this entire, life-crushing ordeal, (because he sees it all the time) and he knows what happens to his work comp. patients.
He hates it, but has no power to do anything about it except try to keep his patients from becoming suicidal over it. I am not sure I would still be here, had I not had my Chiropractor’s support throughout this nightmare.
So Sam- you can say all you want and be a hater of Chiropractors and what they supposedly cost “the precious system” – but until you’ve actually walked the walk, you might at least consider another view. Especially one that does not entail a coin, but a heart instead.
Thanks for listening. Take care guys. For me, it’s just one day at a time. (I pray).
Little Miss Pippin
Miss Pippin,
I am truly sorry for your loss. I am sure it is a very tough time for you.
If I were going to give any advice, not that I am the expert here, I would say go after your ex-employer and WC. Personal health insurance was never set up to pay for any work related injury…you are going to hit a brick wall everytime there.
Personally, I would talk to an attorney to see what your options are. I think the WC system is failing you, although it sounds like it’s paying for something since you are currently seeing a chiropractor. You said you were in alot of pain everyday, even though you praise the chiropractor?? Maybe it’s time to see a physician or a different one if the you have seen one already. Going after your employer may not be a bad idea either…if you were truly let go for some other reason than you were injured and they did n’t want you..the burden of proof is on them to show that.
I am knocking the chiropractors because out of the 2 that I have seen personally, neither one has helped me at all. One of them even used fake x-rays to run up the bill..but that’s another discussion.
Good luck to you.
Hi Sam,
Thanks for your kind words. I have already retained an attorney and have a hearing date set with Texas Wrokers Compensation Commission. (For all the good it will do me- which is probably none.)
The real problem is, “the system” isn’t failing me in the way you think. “The system” is actually doing exactly what it is designed to do. It’s working like a charm!
That’s how Employee Health people and insurance adjusters get bonuses and incentives- to reduce the costs of their “files.” Unfortunately, I am their “file.” They know exactly what they are doing and my case is not unique in any way.
Don’t you see? They’d rather spend money on persuing you as though you are a fraudulent claimant, than helping you medically or financially. It’s much less expensive that way. And, it’s really pretty easy to turn a situation around and make it appear as though it is something that it’s not. It’s just like putting words in someone’s mouth- twisting what they say (or do) to make it play against you. It is not difficult for work comp. insurance companies to make you appear as a fraud.
And when they do- did you know that they have a right to turn around and sue you? Whether you’re injured or not?
No Sam- the system is doing exactly what our lawmakers have allowed them to do. The insurance companies are out of control and there is no limit (that I have found) to what they can or will go, in order to try and show that you’re a fraud. And anyway, it doesn’t matter what they can or cannot prove. They still have the right to drive you insane and into the poor house while everything is tied up in red tape.
They do it every day to every claimant they want. It’s just business as usual. In the mean time, Texas workers have no rights or protection of any kind.
Case in point? I tell you for a fact that I was fired for reporting (and requesting) the fact that my wages were being underpaid and under-reported. (It was saving the work comp. insurance company money.) But as soon as I started requesting that they fix the errors and pay me correctly (I was working at the time too- just not full time yet), my company fired me for making a copy of my wage statement, that proved they were underpaying me.
Now you tell me- fire a wonderful, hard-working, award winning employee for making a copy? But that’s what they did. Because my company and the insurance co. saw me as nothing but a liability, once I was injured. End of story.
It’s just business as usual. The lawmakers allow it and the new bills being considered will give workers even fewer options and fewer rights and even more power to the work comp. insurance companies.
At the very least, EVERY worker in Texas should be given a detailed outline of exactly what the work comp. insurance company can do to you, (if you use the insurance) BEFORE you are forced into their nasty, life-destroying system.
And ya’ know what? I should have had the right to use my own health and accident insurance no matter where I was or what I was doing. I payed for it- I should have had the right to use it. Period.
As I’ve said- the problem is truly that so long as big corporations stand to gain financially from your pain and suffering- the injured party has no chance for real help.
And yes- my Chiropractor has done the most for me in so far as helping to relieve my pain. Really sorry to hear about your experience with your Chiropractors. There are good and bad ones, just like medical doctors, I suppose.
Lastly, in the work comp. system, it’s not so easy to just go see another doctor. It’s a whole process of paperwork and red tape AND you have leave the primary doctor you’ve been seeing. You loose again. You can’t just go get a second opinion or try someone new. Are you kidding? That would cost them money.
Our system is: Insurance Co. = Win / Employer = Win / Injured Worker = Loose (everything).
Take care,
Little Miss Pippin
I hope everything works out for you. Let me assure you that not all insurance companies are the same. I don’t know which one you have, and maybe it’s best not to say who on this blog. I will say that you probably caused a fairly expensive audit for your employer with the Workers’ Comp insurance carrier. Your employer’s WC premiums are based on payroll and if the carrier finds out that they are reporting incorrectly, well…you get the idea.
Good luck!
Pippin, I have read all of your posts and believe me I feel your pain. I too was fired for a B/S reason after notifying my company that I would be needing an indefinite period of time off from work in order to participate in an agressive physical rehab program prescribed by my doctor. I was fired on what would have been my last day before rehab. In six years w/ the co. I had never missed a day of work and had received MVP awards, was well thought of by my supervisors and known by all as a dependable employee.
The sad thing is that in my great desire to heal without taking time off, and without drawing W/C disability pay, I had voluntarily been working at a much less physically demanding job (albeit on prescribed narcotics) for six months and for half the pay I was accustomed to(I would have made more by NOT working). Lazy I’m not.
After my firing, sans health care (who can afford Cobra), I entered the wonderful world of the W/C system along with all of it’s “benefits”- a vindictive ex-employer, lying supervisors afraid of their own firing no doubt, insurance carrier willing to do anything and everything to keep me from seeing one dime of their money, heartless adjusters, highly experienced carrier attorneys, incompetent TWCC ombudsmen, hearings, denial after denial, appeals, and on and on ad nauseum.
I called attorneys from all over the state and none would help unless there was death or dismemberment. It seems “there is no money in it”
After appealing the decision of my last hearing where the TWCC “judge” found in favor of the carrier, the appeals panel up-held the “no disability” ruling (thus no money for my time off from work) but found that I had properly reported my injury and had seen the company doctor (who grossly misdiagnosed my injury) so therefor I am entitled to “lifetime medical benefits. Yeah, right!
I was able to see a spine specialist who was able to properly diagnose my injury. Unfortunately it is inoperable due to four level disc involvement. After years on powerfull narcotics that gave little relief-fentanyl, oxycontin, etc.- he prescribed a morphine pump which Crawford and Company promptly denied. Then he submitted for a spinal cord stimulator trial which was also promptly denied.
Shortly after denying the need for these expensive procedures Crawford and Co. insisted that I see a carrier assigned doctor. He had to travel ninety miles from Dallas to Tyler where I met him at a local doctors office. He saw me for all of ten minutes and declared me fit to resume full time employment and no longer in need of pain medications. The carrier promptly stopped all further treatment.
I thought the doctor was a nut but clearly he is in the carriers hip pocket. Why else would they send a Dr. all this way when we have some of the best spine specialists in the state. My doctor’s W/C liason later told me that they are quite familiar with the guy and his modus operandi. Since that day the carrier won’t even approve an office visit. As far as they are concerned my “lifetime benefits” are over.
Since then I have been in excruciating pain almost daily. I sleep very little and have regularly occuring anxiety attacks. I have spent all of my retirement, savings accounts, and depleted my 401k over the last 4 years. My wife has a decent job but we are living hand to mouth. If our 23 year marriage lasts another year it will be a miracle. The stress is just too much.
I begged with my adjuster recently asking merely for an office visit with my or any other doctor if she prefered. I was hoping perhaps for some pain meds if only for a little relief( I’ve not had any in nine months). I calmly expressed to her my desperation. I told her that I felt I was at the end of my rope and if I had to go another agonizing day I might well just jump off a bridge or otherwise end my life.I was not saying so for effect. At the time I meant it. A man can only suffer so much. The adjuster told me that I should probably do so if that’s what I want to do but she could not help me.
I have been working daily since then to
get something done as she actually motivated me to NOT give up. Those criminals at Crawford took the premiums and damn it they need to live up to their end!
Every time I seem to make progress in getting the treatment I need and they were paid for it seems they are able to sqirm out of their obligations.
I have not even come close here to relating all of my experience with the current W/C system. To do so would require a fair sized book and besides I can only sit for about 15 minutes at a time.
I do know that the current system is broken and the insurance carriers are getting richer by the pain of those they contracted with to help
Yes Miss Pippin-criminal is an appropriate characterization.
Jimmer-
Indeed my heart goes out to you as well. This is exactly what I’ve been trying to convey to the others on this blog. That worker’s pain and suffering is literally marketed as business as usual for the work comp. insurance companies, employers and TWCC as well.
I am going to write to Gov. Rick Perry and David Dewhurst. I’ve already written to Lamar Smith (Congressman), with no response yet. Would you mind if I added your story to my letters?
Also- can you think of any way to contact other work comp. fodder of Texas (such as our selves) so that we may begin a petition to put an end to this travesty?
I think it’s high time (and almost too late) to let our representatives know that they are grossly failing Texas workers. Don’t you?
(I cannot give my real name yet – I assure you I have one though – as my case is just coming into litigation.)
Sincerely,
Little Miss Pippin
I’ve done some research since no one commented on my comment. According to the TWCC almost 40% of the employers in Texas do not subscribe to Texas W/C. Why is that? I would imagine the reasons they don’t, all of you have explained very well with your grief.
Also, every article I’ve read about work related injury & benefits not being paid, fraud, etc., it’s not about those employees working for a company who has opted out, but about those employees whose companies who have W/C.
Health insurance companies are never going to pay for work related injuries because that is the responsibility of the employer. Ya can’t get paid twice for a claim. Fraud would go through the roof.
Socialized medicine is NOT the answer. Every Tom, Dick & Harry gets in line to see a doctor for valid & invalid reasons. In some countries it takes months to see a doctor especially a specialist. Free enterprise while not perfect (like democracy)but it’s still the best system. A health insurance company just like a bad restaurant will eventually go out of business if it does not provide promised services.
Still have problems? Get an attorney. Find one who will take a valid case on contingency. Many, many do.
Also, did you know an employee can INDIVIDUALLY opt out of Texas W/C? The catch 22 is you must do it within 5 days of your hire date.
Pippin,
You are so right about “business as usual”. The majority of insurance carriers don’t give a damn that injured workers are watching their (and their families) hopes and dreams go down the toilet. I know that many carriers, not just mine, behave in the same criminal manner. I know this from my conversations with doctors and their staff as well as with the numerous patients I have spoken with during my many hours spent in waiting rooms.
Of course the greater portion of workers claims are not for such debilitating injuries as yours and mine. They never experience the frustration and discouragement that we continue to experience. Perhaps that is a part of the problem in obtaining significant reform to a blatantly insensitive system. While the majority of injured workers are inconvenienced, they are not brought to ruin as many of us are.
I haven’t been able to work in any capacity (and I have tried many times) in three and a half years. I am convinced that if the insurance company had acted in good faith I could have been capable of performing some type of work or started retraining within six months. Instead I have only gotten worse.
The insurance company’s consistent denials of virtually every physician requested procedure has resulted in my having to appeal and appeal ad nauseam. The greed and callous disregard of my well-being by my carrier has resulted in dragging this out seemingly endlessly while I watch my future slowly disintegrate.
I loved my job and wanted to retire from the company I was with. I really felt I had life by the horns. My family life was great. I made an above average salary and had alot of time off to spend with my wife and son and to pursue my hobbies. We had recently build our dream house. Our vehicles and boat were paid for. We had money in the bank and on and on.
We’re still clinging to the house and my wifes’ now worn out car but the rest is gone. I suppose one could surmise I’m a bit bitter. I’m fortunate to have what I do have but now that all of our financial reserves are depleted and our expendable assets are gone are I really don’t see how we can hang on much longer. Perhaps Miss Pippin we shall meet under a bridge someday. :-(
Well, enough self pity for one day.
In answer to your questions- feel free to use my post in any manner that you like. As far as contacting others I don’t have any bright ideas. Medical privacy these days is such that it will be a challenge to get that type of info. Perhaps an internet posting somewhere would elicit some response.
I assume you are in Texas. Have you contacted the Texas Rehabilitation Commision? Now-a-days they are called Texas Department of Assistive and Rehabilitative Services. (WWW.DARS.state.us)
They will pay medical costs and pay for school, both College and Trade, for injured or handicapped workers. The medical cost thing is a little ticky though as in my case they will pay for the morphine pump (@ $50,000)but as I understand it I would have to release the W/C carrier from any future obligation. Even if I could get the pump without releasing the carrier you and I both know that I would be opening a can of worms that would make any future treatment impossible to obtain through W/C.
If the pump needed to come out for any reason I wouldn’t have a snowballs chance in hell of W/C helping out when they are the ones that should be paying for it to begin with!
I don’t know your particulars but maybe you could gain some benefit by contacting them. If I’m not mistaken they will also provide assistive living benefits if you qualify. In my case I really don’t know what good school would be right now as how do I make a sustainable living while attending school.
As I’m not getting anywhere with W/C I recently hired a law firm to pursue a Social Security Disability claim. My doctor has proclaimed me too disabled to work so I guess I’m going to be forced into that route. Just another strain on the American taxpayer compliments of a failed workers compensation system.
I haven’t read the actual bill that the governor signed, only what I’ve read about it on this site and heard on the news so I’m not yet qualified to opine on the subject but from the little I’ve read it sounds as if there is going to be even less oversite. As I understand it the goal is to spend even less money! I quess we’ll find out soon enough.
Pippin I wish you well. I hope that you will soon get the help that you need and were promised. Maybe, just maybe, HB7 will bring the much needed change to get folks like us the help we deserve from a system designed to help injured workers but in reality merely lines the pockets of greedy, insideous insurance companies. I’m not gonna hold my breathe but I will certainly be staying attuned to the situation.
It’s been a pleasure Pippin. Again, best of luck to you and your family,
Jimmer
Sam, In your exact words……..
“If my company whether in insurance or not was losing large sums of money every year on fraud..you can bet I would have an extensive procedure that all clients had to go thru to minimize fraud. Now, that may not be too appetizing to my customers..but it’s alot better than making them pay 10-30% more next year to make up for the loss due to the fraudulent customers. Maybe this can temporarily slow or even stop medical attention and prescriptions…but this is the way the carriers choose to protect themselves.
Pal, I dare you to experience a reportable injury and then still spew the above garbage….
If the police department handled every 911 call in the same way that you and the WC insurance companys handle their calls….well after your injury the cops would write YOU a ticket for murder and then the judge would require YOU to write a check that you could not possibly cover to the supposed victims family.
Clamping down on fraud is good and well but denying people with X-ray and MRI confirmed injuries simply because spine injuries are often expensive to treat is a abomination.
Don’t worry Sam ole boy….. YOUR company is secure.By the way….Excellent research!!!! YOU MUST HAVE LOOKED AT WELL OVER 1-2 DOCUMENTS!!!! You weeny….don’t you know that “temporarily blocking prescriptions”…..YOUR WORDS…. can result in death or extreme neurologic reactions???????????
I don’t actually expect you to come back to this site so I am not expecting a response. Besides if I were you I’d be too
embarassed to show my silly uneducated ignorant to the subject face around here.
I still love ya tho……..
God bless you pippin and jimmer…..
T>B>
This is not a blog for calling people names, Terry. It’s seems you have had a claim that was denied or something has upset you. I am sure your circumstances are unfortunate…let’s not lower ourselves to insults.
I am not saying the WC system or the carriers are perfect…nor are all the claimants, but Terry, which never ending pot of gold do you think is going to pay every claim the second it happens without any basic fraud prevention? You are kidding yourself if you think it should happen that way. Yes, some will be put in a bad spot, but the idea is for the carrier to stay in business so YOUR claim can be paid. What happens when YOU find out that YOUR claim won’t be paid because a few hundred people took the carrier for big $$$ by working the system, getting a paycheck, running up huge medical bills for therapy and what not, even suing the carrier if they didn’t think they got enough money? I can assure you that your attitude would change.
It’s ironic, all we see on these types of blogs are people who have a claim go bad. I would bet that this is an overwhelming minority of the entire system.
And Terry, I appologize, my “silly, uneducated, ignorant to the subject face” was speaking a little off the subject of this Bill by answering your concerns with my opinions. Oh yeah..we did have a subject..it was about this Bill taking away chiropractors from the approved doctors list.
Let’s see..if that did happen, maybe the fraud would be lower, maybe you would be able to see a doctor, maybe prescriptions would be a little easier to get…just maybe…but one thing is obvious…the way it is now isn’t working…
Have a great day!