Legal Question in Workers Comp in California

Hello

I was awarded future medical, all expense paid including housing and in-home care by the State Work Comp Court in May of 07. The primary doctor on my case retired. I was left with the pain management he referred me to. There was new discovery on the injury. The pain management told me the previous doctors were looking in to the wrong areas form my symptoms and instead of seeing a Ortho, I should had been seeing a internist. I was becoming more ill. My insurance was CIGA MPN. I requested a list to select a new Primary physician some years ago and was told I had a Attorney so I would have to go through the attorney who represented me. The would not speak with me. I went to my attorney several times over the years with out any resolution, assistance and I don't have a primary to this day. What can i do to get the Attorney to do to enforce the Court Ordered Award. The insurance refuses anything with out the Attorney. The new discovery came from a non MPN Doctor. Since the insurance got wind of the new discovery my Attorney step forward for the first time insisting I take $15000. for a compromise and release. When I refused he quit speaking and hung the phone up. Now again his office and the insurance refuse to deal with me unless I accept what they want for me. What is available for me to resolve this situation?


Asked on 7/08/11, 1:12 pm

1 Answer from Attorneys
SAPNA SINGH DURARD MCKENNA AND BORG

Your issue is very complicated. It appears that you now need medical treatment, including maybe diagnostic tests, that is not completely covered by your future medical care awarded in your case. If your attorney is not responsive, you can choose to go to court pro per. You are entitled to a primary treating physician from your employer's Medical Provider Network. Any requests for treatment authorization must come from your designated primary care physician. That should be your first step. You can then go back to the AME or panel QME in your case for his or her opinion on whether that treatment request is reasonable and medically necessary. Not all later medical issues stem from the original injury. It remains the applicant's burden to prove the compensability of medical complications that arise after Stipulations and after five years from the date of injury.

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Answered on 7/08/11, 4:20 pm


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