Hoping I can get some feedback from some folks regarding worker's comp coverage.
I have worker's comp coverage for my lyme. Does worker's comp follow the same or similar coverage practices as regular health insurance companies?
My doctors are always saying they won't prescribe something because insurance might not cover it. I have never been treated with IM bicillin or any IV because of this excuse.
Any ideas?
Posted by bettyg (Member # 6147) on :
are you a member of DISINISSUES where you could ask that in their OFF TOPIC BOARD?
haven't talked to you in ages! how are things going for you? i've missed you.
Posted by lpkayak (Member # 5230) on :
i know of one person who got it-he was a surveyer-but i don't now him well or how to contact him or anything about his tx
i do know many who tried to get it and failed.
they are pretty hard to work with in ny anyway
Posted by riverpatrol (Member # 12182) on :
Thanks Bettyg, I'll look into that. Although it's not really the same as SSDI.
I actually consulted with a worker's comp lawyer about coverage, and he said "they will cover everything". He even said "if your doctor says you need a jacuzzi, the government will pay for it". In terms of a broken arm he's probably right, but we all know that lyme treatment is not so cut and dry.
They are a little difficult to deal with, but I don't think any more so than a regular insurance co. I had to submit a mountain of paperwork to get reimbursed for my out-of-pocket expenses. Some they covered 100% (co-pays, etc), some they covered partial (medical supplies) and some they didn't cover at all (lab tests, supplements).
My LLMD actually enrolled as a worker's comp provider, and is billing them direct. He says they actually pay better than my insurance co was!
I'm just wondering if we can push the envelope with them and prescribe some of the more serious treatment. And I wonder how long they might cover IV if it went that way.
I got covered by worker's comp because I contracted lyme while I was working as a volunteer for the US Forest Service. They didn't even hesitate to cover me, once the paperwork was submitted to them. No questions asked. So I'm covered by the US Department of Labor - deep pockets! I just wonder how deep...
Posted by kam (Member # 3410) on :
I have a workmen's comp claim/case pending. I figure it will be a miracle if it is approved and then not sure how it will help.
I know the others who came down sick when I did and were dx with CFS/fibro aren't getting much help with workmen's comp.
They were approved.
They are seeing a counselor paid by workmens' comp, taking antidepressants and lyrica and the usual meds to cover up symptoms.
It took the one teacher years before she finally got in to see a fibro specialist.
Niether one are willing to step out of the insurance box and be tested for lyme disease or see a LLMD...yet.
My claim has been pending since 2001. The other two mentioned settling and wishing they had settled for more since they are in so much pain and unable to work.
Not sure exactly what that means as far as settling.
Central CA Workmens' comp with the state comp.
The only doctor that makes sense in the reports is my lyme doctor.
I asked my second attorney that I hired how workmen's comp would help and is it even worth going through all of this.
He said it depends on what the AME says. Or IME.
That doctor said I was an enigma and sent me to a ID who said it was not an infectious disease issue.
So, I guess it is back in the AME's or IME"s camp.
I also have sent info to attorney but like the old attorney it looks like it is going into a black hole.
I am considering sending the info as to why I believe this is work related directly to the workmen's comp panel...hopefully soon...before any decisions are made.
Sent request to attorney telling him if I did not hear back from him I was going to send info to panel myself.
It has been 3 weeks or more...have not heard from him and he has been contacted several times.
Posted by luvs2ride (Member # 8090) on :
I was a work comp adjuster in Virginia for 9 yrs. Every state is different and most states have private insurance companies who handle the claims and a couple of states like W.Va. have state run work comp.
I'm not sure about California but what your attorney said about "the state covers everything" sounds right to me. It also sounds like your state might be a "state run" program.
Work Comp was established for the protection of employees. It works NOTHING like health insurance.
There are some conditions that are not covered and again, this is by state. Workers Comp is tightly governed by the state even when it is run by private insurance companies. The company can't deny anything unless the state has already established that "thing" as not being covered by WC.
When I was an adjuster, heart attack was always being contested. The law kept changing and it was a bugger for an adjuster to keep up with the current law. First, no heart attack was covered. Then it was covered for police and fire fighters only, then it was excluded again, etc.
In Virginia, during the years I was an adjuster, no disease was covered but a few exceptions like black lung for miners.
If Lyme is covered, then as your atty said, all treatment deemed necessary by your primary physician should be covered. At least it would be in Va.
Va also had a lifelong medical payout. Lost wages maxed out at 10 yrs but medicine was for life.
I don't know the rules now. I haven't adjusted since 1992.
I do know it works nothing like health insurance.
Posted by riverpatrol (Member # 12182) on :
luvs2ride - thank you very much! That is great information! My worker's comp isn't CA State, it is Federal. Don't know what difference that might make.
Guess I'm going to have to try and enlighten my LLMD!
Posted by lpkayak (Member # 5230) on :
2001!!!! i feel better. i have had 5 claims pending since 2005 and think that is bad. i'm thinking of hiring a lawyer in nh to make my ny lawyer get moving...
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