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Thread Title: Medical care
Created On Friday January 02, 2009 1:00 PM

juanmunoz
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Friday January 02, 2009 1:00 PM

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I sent my employer my claim form with my side filled out three weeks ago. I did not send it certified mail. Instead my brother mailed it for me. I have not heard from my employer by phone or in writing. Should I re-send my claim form certified mail? Can I go see a doctor on my own? Thank you for your advice.

JM

STEVEPSCA@YAHOO.COM
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Friday January 02, 2009 5:04 PM

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As you did not provide the report to your ER in hand, or cert mail, you now have no proof of service on your claim....

At this point, I think you should contact your ER, and request the information regarding how you access treatment for your injury.
There are rules regarding the ER/IC controlling the medical treatment in a claim. As well as the investigation period (90 days, from receipt of the report).
You have not jeapordized you entitlement to benefits, but you may have stirred the pot somewhat...

Question though... WHAT is the nature of your 'injury' that you have/can wait THREE WEEKS without seeking treatment...???
and WHY are you waiting til now to question the process...?
Where did you get the claim form...?
Have you received ANY treatment for your injury...?

juanmunoz
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Friday January 02, 2009 8:09 PM

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I have been treating with my chiropractor under my group health insurance. My doctor took me off work, and gave me a claim form for my employer. Since my job is 40 miles from my home, I decided to mail it to my employer instead. I have called him but he is not taking my calls. I will send another copy certified mail. I know he received the first copy because the mail clerk told me he gave it to him. Does it make a difference that I predesignated my own doctor at the time I was hired?

Thank you - JM

STEVEPSCA@YAHOO.COM
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Saturday January 03, 2009 7:52 AM

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The provider/chiro can send the bills directly to the ER/IC... the ER is required to provide the billing information to the provider at their request. That would generate a 'first report of injury', even if your ER is ignoring you.

It may be that your ER is not carrying WC coverage, and that could be a big problem for him. You are still covered.

'Does it make a difference that I predesignated my own doctor at the time I was hired?'

Smart wo/man...it means you are within your rights to seek treatment with this doctor, and outside the ER/IC MPN.

'I have been treating with my chiropractor under my group health insurance.'

That is wrong, and your chiro/doctor knows it. Once you provide to the doctor that the treatment is to a work injury, even a presumed work injury, that doctor cannot bill your private health provder, or you for the treatment. S/he must notify the ER, and the ER notify their IC of the claim. The ER/IC is liable for up to 10K in treatment while your claim is investigated...90 days.
If your PTP declares you TTD, you are owed benefits for your inability to perform you job.

Did you file for SDI...?

BTW... as you are/were aware of the ability to pre designate, I would assume you read the posted information at your ER...(?)
If that is the case...you would be aware of the ER Ins company providing the WC benefits...?

gaiassoul1@yahoo.com
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Saturday January 03, 2009 2:06 PM

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if you predesignated your physician, go to that physician and secure care.

Since your employer is not responding, send a certified letter that if they do not respond with in 5 days of receipt you will be filing a claim with the unemployed insurance fund and reporting them to the district attorney for being illegally uninsured.

-------------------------
Ginger

To know how to say what others only know how to think is what makes men poets or sages; and to dare to say what others only dare to think makes men martyrs or
reformers - or both. Elizabeth Charles

juanmunoz
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Monday January 12, 2009 2:16 PM

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I was given a form when I started working that asked me if I had a family doctor I could have him see me in case I was injured at work. I gave him the name of my doctor who has been treating me for colds for the last 10 years. I got a letter from the insurance that says that it doesn't matter that I designated my own doctor because he had to agree to see me in case I was hurt at work.

It says...The physician is not required to sign this form, however, if the physician or designated employee of the physician does not sign, other documentation of the physician's agreement to be predesignated will be required pursuant to Title 8, California Code of Regulations, section 9780.1(a)(3)"

I gave them a statement over the phone but now they are coming to my home to take another statement. The insurance man said it was because my employer wants them to fight it. My boss knew that I was having trouble with my shoulder. I told him and he gave me a card to see his doctor. He told me not to tell them I thought it was from work. My chiropractor told me that if I did not say it was because of work the insurance would pay faster.

JM

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