Hi, my name is .... well... Summer. That's not my real name, of course (names changed to protect the innocent) but I am a real person who is really on DC Workers' Compensation and receiving medical treatment. You may be wondering, is it really as difficult and challenging as they say? The answer is yes, and my case is very straightforward and uncomplicated. Even for someone like me who really couldn't foresee any bumps in the road, I have had my share of frustrations which means that if you have been seriously injured and out of work, you will experience frustrations too.
My case is what they call "medical only," which simply means that I'm not missing any work due to my injury; but I am receiving medical treatment. My treatment is called "vestibular physical therapy" and it is addressing the concussion that I got during work last fall. It's not a serious concussion, but I have had concussions before and so the injury was a decent-sized deal and has (and will) require substantial follow-up care.
So, I ran into my first question to be considered right away; does a previous injury disqualify you from receiving care for a subsequent, aggravated injury? The answer, is NO.
If you have read Frank Kearney's PREMIER book on DC Workers' Compensation, you will know that a previous injury doesn't disqualify you from receving medical treatment for a work injury. In fact, he says on page 20 of "Protect Your Rights: the Ultimate Guide to Workers' Compensation" that "[i]n the District of Columbia, an aggravation of a prior condition is considered a compensable work injury." So, I knew I was on the right track.
But here's the big trick. Most workers' compensation insurance adjusters will use their bag of tricks right up front to discourage people from pursuing their claims. They can make pursuit just frustrating enough so that the claimant doesn't want to bother (trust me, when they first starting putting up hurdles for me I wanted to give up. Good thing I read Mr. Kearney's book)...
So, when I first started they denied my medical treatment because they wanted me to fill out a form authorizing them to gather all of my medical records (also known as a HIPAA release or medical release). Because I read Mr. Kearney's book, I knew better than to do that because I knew that they would just use my previous history as a reason to deny me further medical treatment. I went to a few doctor's visits, and physical therapy, paying on my own because I knew how important it was to get medical care. Following the recommendations found in Protect Your Rights, I filed for an informal conference so that I could challenge their decision to deny my medical care.
I was nervous, but I also believed I was on the side of right. And I felt comfortable because Mr.Kearney's book had covered everything
that I needed to know for these situations.
When we got to the informal conference I realized that there was nothing to be afraid of. The informal conference was truly very informal; a friendly mediator (claims examiner) and a small conference room. The attorney for the other side wasn't very friendly, but he was professional and pretty easy to work with. I was what they call pro se (no attorney) which I wouldn't recommend for anyone with a serious injury and/or big case, but was fine for me.
We worked it out so I would sign a limited medical release (only certain records) and they in turn authorized my treatment. Everything has been going well for the past few months. But, the other day I did get a terse-sounding email from the attorney on the other side, wondering why I hadn't "shown up" for my independent medical exam (IME). I had never even received an email or any type of notification that I had been scheduled for an IME, so you can imagine my confusion.
Okay, don't even get me started on IMEs. They are mostly a waste of time for the claimant because the doctor is going to find in favor of the insurance company. These doctors are paid by the insurance company so can you guess how that will turn out? I'm betting he or she will say something to the effect of my medical treatment is uncessary, blah blah blah. Still I have to go to it, because they are allowed by law to set up IMEs (again, check out Mr. Kearney's book).
You may be wondering: what happens if they do deny my medical treatment?
It hasn't been rescheduled yet, so stay tuned for what's next.......and learn to Protect Your Rights today by ordering Mr. Kearney's book! You won't be sorry - that's a promise.