AboutMargot RN BScN GNC Expertise Please feel free to ask anything, but the more specific you are, the easier it is for me. Please share as many details as you are comfortable doing. I do check my Emails daily Monday through Friday so you should receive an answer within 24 hours on most business days. Thanks.
Experience I have 18 years experience as a Small Business Owner-Operator; I own a Nursing Agency so often deal with both employee and client injuries. I would be pleased to offer any assistance I can. If I can not answer your question I'll do my best to direct you to an appropriate resource. Thank you. Experience in the area 20 years of Long Term Care and Community Nursing, specialising in Geriatrics, Gerontology and PalliativeCare.
Education/Credentials Registered Nurse , Certified Gerontological Nurse, Bachelor of Science in Nursing >
Question I just received a copy of the peer review statement by the insurance company after receiving the news that my WC claim was denied and deemed not work-related. I work at a cellphone company and my duties consist of troubleshooting and programming cellphones as well as counting large sums of money. Ever hear of Blackberry Thumb? It is a condition often heard of among users due to the email & text messaging features. I do not have a blackberry, but, I do program these phones among other brands, this consists of pushing tiny buttons repeatedly throughout the day as well as being REQUIRED to demo how to use text messaging to customers as well as other features (like saving numbers into phone book), multiply this by 25+ customers a day on avg and often working 9 hours or more a day, with the exception of Sundays since we are only open a partial day. The peer doctor deemed this (assuming he received this information) as non-work related AND there is no medical evidence supporting there is something wrong with me. My treating physician (who luckily was not only an approved WC doctor, but also my GP!) knows my medical history and I am not one to complain about something if there is "nothing wrong". The insurance sent me to their approved neurologist for a nerve test. That doctor (and I have a copy of the report), verbally told me (and a witness) that there is "definate slowing of the nerves, but it does not meet THEIR CRITERIA for surgery of carpal tunnel". My doctor had initially requested to send me to an orthopedic but it was denied. Anyways, the peer doctor indicated in his report that there was no medical evidence by the ER or other doctors that there is an injury and that I am being prescribed narcotics without medical reason. I am livid at this report - and that is only a little piece of it. The insurance company will not be sending an "official" denial for weeks, and I cannot file an appeal until I receive this letter. Also, I cannot file under my personal insurance until letter is received if I chose to give up, so yet another delay (claim was filed 05/12/06 & word of denial was 9/11/06) for medical attention for a very painful injury while I intake the recommended dose of painkillers to keep me functional. I cannot find a lawyer to take my case. So, I bring up the question: What happens if I were to go to an orthopedic on the pretense that I will not appeal, but based on his recommendation (which I have an unofficial second opinion that I am a prime canidate for surgery based on the nerve tests) that I need surgery for the injury (and confirms injury), will I be able to appeal?
BTW, I have been treated with steroids, anti-inflammitories, & hand exercises to do at home. Because of my gastric bypass, I have to be monitored while taking medications and usually have an adverse reaction to them.
PS My treating doctor is on his honeymoon and has been out of the office for 2 weeks, returning Monday so I have not been able to discuss this with him but am curious to his reaction of me being dependent on narcotics without just cause, mainly because getting me to take meds is like getting a child to eat their least favorite food.
Unfortunately Worker's Comp is like all other Insurance Companies - it is in THEIR best interest to drag things out as long as possible, and usually they hold most of the cards and have the laws on their side. Sadly, this can cost people their jobs, and sometimes their families due to the stress associated with lingering pain and other disabilities; the financial and/or emotional drain can be too much for some people.
It is important to be sure you do everything correctly during your claim period and you don't want to miss out on any payments you may be entitled to now or in the future, so I advise that you consult with a lawyer who does WCB cases and find out exactly what your options are, and what you need to do in your state to cover yourself (WCB regulations do vary state to state).
Get all the info you can on Repetitive Motion Disorders and don't give up, follow he procedures and fight your case if they deny it.
