Dealing with the CWCAB and other agencies

#“Top 5 Issues that Irk me the most out of this are:” #

(Part 1 of ??)

  1. The pain all of this has put my family through.
  2. The effects this has had on my relationships with my kids. I believe my wife has overcome them.
  3. How it affected my work life. This was very positive and negative.
  4. Having to deal with the Workers Compensation Appeals Board and Workers Compensation Insurance (Reason for this blog.)
  5. Having a medical device in me and having to take the medicines I take and hate taking.

Yes, having to deal with the California Workers Compensation Appeals Board (CWCAB) and California Workers Compensation Insurance (CWCI) is no picnic. No matter what any one tells you, “DO NOT BELIEVE THEM,” they will be lying to you out both sides of their mouth. Here’s a quick rework on an old joke, “How do you know when someones telling you that it’s a breeze dealing with Workers Compensation is lying?” Their lips are moving. I can and will only speak about the State of California’s insurance, this blog in no way, shape or form is meant to include any other state workers compensation system. Now, I’m sure many of you are saying, “Wait, this guys been doing this for 20 years, why is he still involved with the system?” Well that the point to all this I am and will be for the rest of my life. Have a seat, grab a hot coco, pull the blanket up over your mouth and get ready for the scariest horror story every. It all began many, many, OK 20 years, 2 months, 1 week, 3 day, 16 hours, etc., etc. ago, on a long stretch of road between Merced and Sacramento when a weary, lone salesman was heading to a meeting and back home to his family, when out of know where his eyes locked onto a driver in his rear view mirror, FastForward to almost three years later when he receives a letter from the CWCAB stating my insurance is calling me in to review my disability claim, which I didn’t know I had one see from three months after the accident I have been back to work and only take time days off when I can schedule a minimum of 2-3 doctor appointments in a day. After calling my layer to see what was going on, I was told because of an update received from my doctor, he suggested I be placed on 10% disability. To cover 20 years, here is how my days go when I am called into the CWCAB, we arrive because they usually want the spouse there and its always good to have a second set of ears for meeting like this. We get there 20 minutes early, wait 3-4 hours for the judge or for one of the attorneys to show, in my case the defense was made up of five different insurance companies. We would be called in, 30 minutes would be spent calling out why we were there and then the judge would rule and we’d be sent home. This would happen about 2-3 times a year and then slowed down in later years to 1-2 times a year and I think now its been 4-5 years since we’ve been. But we had 4-5 hour hearings where the only thing that was argued was who was going to pay a .35 cent postage balance on a letter sent two years ago and it was the defense’s insurance companies do the arguing between themselves. My layer, my wife and I sat there talking the entire time about other non-related items and finally offered to pay the .35 cents just so we could go home. Between the seemingly unnecessary court dates, each of the defense insurance companies needing me to see “THEIR” specialists or their this and their that, its no wonder the system is in shambles funding wise. The state had five different insurance companies splitting the cost of my one policy between them, so at many of the appearances it would be the judge and stenographer, myself and my layer and then there would be 7-8 layers with their assistants across from us on the defenses team. Man did I feel powerful. As for the “we need the following paperwork filled out,” Wait I just did that a month ago! That’s another amazing waste of time, ink, paper and calories.” All fun and games aside, I would highly recommend if you are ever involved in a pretty major workers compensation, on the job related accident, that the first thing you do is purchase (2-3) 4″ binders, (2) reams of printer paper, (1-2) books of “Unlimited” stamps, Black and Red pens, a package of highlighters and a whole lot of snack bars and sodas or energy drinks (the vending machines didn’t work 90% of the time and you cant leave”. KEEP EVERY PIECE OF PAPER you fill out (make a copy), receive, send out, copies of your prescriptions, doctors papers from visits, if a therapists says something and you think its important, write it down somewhere with the persons name, date, heck even the time. I would highly suggest that a least once a month (if you don’t see them that often) send your layer a letter updating them as to what’s happened over the month and any issues you feel need to be addressed. When you send in “copies” of your receipts for them and mileage reimbursement, make copies and add this with the letter to your layer. Here’s why, I have yet to receive reimbursement from my insurance company any sooner that 18-24 months on my expenses. Yes that’s right 18-24 months, minimum and that includes complaining to my layer every quarter about it. # Now onto medications, the insurance companies adjuster, my doctor and my pharmacy. I have now been on the 5 medications I’m on for just about 8-10 years, same meds, same dose (within a few mg +/-), it may change between two meds to keep my body wondering but that only happens maybe one, twice a year. I can walk into the pharmacy with a script, that has two refills on it (standard on all my scripts) and each and every time I go in, no matter if its a new script or a refill on one that’s already been approved, they have to get approval from the insurance company first. With my scripts being workers compensation related this can take, depending on the rotation of the moon and what phase its in, 7-10 days, if the pharmacy has the new adjusters name and contact information available. The insurance company who currently handles my claim has in the past 12 months (No Joke) changed the adjuster in charge, 6 times and of course do they send out a letter, email, carrier pigeon, of course not that would make to much sense. So I have to be very organized when it comes down to news scripts and re-fills. I will usually go every 2nd or 3rd re-fill for 3-5 days without at least one med because the pharmacy can not get the approval needed. This of course requires I call my layer to get them involved, because I have been told by “My Insurance” they will not accept calls from patients, I must go through the pharmacy or my doctor’s office. I have requested my med be refilled 3 days early if possible due to the fact I was going on a 2 week trip to Europe and my refill date fell two days after we left the states and I was hit by the floor, had a piano dropped on me when the pharmacy came back with, “We spoke with your insurance and they said no, they are only allowed to approve your meds 1 day in advance of the refill date.” WAIT, I’m going to be in Europe? The suggestion that I locate a pharmacy in Rome, Italy and have my script refilled there was thrown out, “by my insurance”. It takes 7-10 days to get approval here, what’s the approval time in Europe going to be like? I guess what I am trying to say is, when it comes down to medications and the CWCAB and CWCI approval process, be ready for delay, delay, delay. I would say in a years time I may get all of my scripts approved and refilled when their suppose to be one out of twelve months. This is another one of those cases for, make sure you have every piece of paper work possible, go into your pharmacy with your doctors, layers, insurance adjusters, you may not be able to call them but you still need it so you can give it to the pharmacy in case they don’t have the “Adjuster of the Months” phone number. Everything about the CWCAB and CWCI is about paperwork, who’s in charge of and who’s handling your case this week. Keep as up to date as possible on everything from your insurance adjuster (#1 on the importance list), you layer, you doctors office (even the after hours number) and your pharmacy (choose one that is state wide in case you travel). I have tried two of those “We’ll mail you your meds” pharmacies and had nothing but problems. Medications would arrive 1-2 weeks after the refill date, several came without the correct number of pills (try proving that to someone over the phone who you never meet face to face) and I had an issue with the scripts being left on my doorstep. If they come up missing, to get refills you need a police case number and then a letter from your doctor and that all takes time. Luckily mine was left with a neighbor who was new to the neighborhood at the time, but at first I didn’t know that. So all of these are things I suggest you think about when dealing with the California Workers Compensation Appeals Board and the California Workers Compensation Insurance. It’s not easy but with all the correct information you can hopefully make the process a little bit more bearable. Good luck. stay strong and never, ever back down. . Good Luck and Stay Strong

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