What About Insurance Companies?

My headache was with Workers Compensation benefits.

Insurance Companies are the thorn in my side. They do not understand Chronic Pain nor do they care. We have had to fight from the very beginning. They started by cutting him from his medications. Saying he was addicted to the pain killers and that is what he wanted the medication for. They said "They are not medically necessary".

They would not listen to him or his doctors. We had to pay for the medications out of our pocket and still do. We contacted the Board of Insurance to file a complaint. We filed a grievance with them. We were given several telephone numbers to call this person and that person. No one could give us an answer. I gave up on them because they gave me the run-around. My next step was to ask for a Medical Review. His (MMI) Maximum Medical Improvement was too low for any long term benefits. You see, because he was evaluated on Pain alone, he was denied.

They do not recognize pain as a reason for a higher MMI. This particular doctor that issued the low MMI had only seen him twice and only briefly both times. Because he could bend over some they decided he was not hurt that badly. Talk about anger...

He can not hold a job. No one would hire someone that could not stand or sit for very long. Sometimes the pain keeps him in bed most of the day.

To get anywhere with the Insurance Companies you better be ready to fight.

In order to get anything filed or done with them you have to fill out this form or that one. If you do not have the right form filled out you have to come back later with the right form. It must be completely filled out or they will not see you.

More Frustration! Everything the doctor requested had to go through Workers Compensation for their approval. Most of the time they were denied. Not once, but many times.

Finally, after many submissions they would be granted. They still were in denial of there being any injury.

We are still butting our head against a wall. How did he make that assessment with so little contact.

One other tip--- I advise you to question your Ombudsman.

Little did we know ours was working for the Insurance Company or so we felt. She was all full of information but it was all to benefit the Insurance Company. Her advice was misleading, one sided, and not to our benefit at all. We were told that a second opinion was not necessary. That was when a red flag went up. I no longer trusted her and she was fired.

WATCH YOUR BACK!

Finally, after seven years of pure hell we found a doctor with a backbone. He had a nurse in the office that handled Workers Comp.cases. Things started to happen. They still had to file several times to get procedures to go through the insurance but they finally succeeded.

Still the insurance company didn't pay for his medications.

Just don't give up. Make it your quest not to let up on them. They will either give in or keep going with their denial.

Be tenacious! Who cares if they like you.


More to come on this subject... Return To Home Page From Insurance Companies