When lifetime medical means nothing.

I worked long and hard to win the battle in my workers’ compensation case.  After years of battling I was awarded lifetime medical.  Finally, I thought I would be able to work toward healing without stress of the huge financial burden I had been under for so long.  I would submit my self-procured medical expenses and I would be reimbursed.

I had no idea how long things take in the workers’ compensation world.  I would submit my bills in a timely fashion once a month only to wait months and sometimes nearly a year to get reimbursed.  I had hope because I was awarded the medical and would just have to wait and fight to get reimbursed on time.  Things were starting to go smoothly and wham another obstacle was placed in front of me.  My case had been handed over to a different insurance carrier who decided that they shouldn’t have to pay for all the things the previous insurance carrier covered.  We fought again and again.

It wasn’t too long after that  when yet another insurance carrier now had my claim and was refusing just about everything at that point.  We fought and fought utilization review with letters and fought in court.  Finally we agreed for me to see an AME (authorized medical examiner).  This doctor would review my records and meet with me.  He would become the final say in my treatment and if the insurance carrier denied anything, it would be sent to him for approval.  My treatment expenses would no longer have to go to utilization review and it would save time in getting  me reimbursed.

That was the final blow to me regarding my lifetime medical care.  This doctor denied my seeing my environmental doctors and he denied my seeing my ENT who has been in charge of a lot of my care since I first became ill.  I was then told that I needed to see a traditional doctor who was board certified in allergy and immunology, possibly an infectious disease doctor, a different ENT, and as you might suspect a psychiatrist.

What this all boils down to is that if I want to continue my LDA (low dose antigen) therapy, continue seeing my environmental doctors, continue seeing my ENT, doing my B12 injections and Vitamin IV’s and quit speaking to my therapist in lieu of a psychiatrist or clinical psychologist, I must foot these bills  myself without expectation of any reimbursement.

So lifetime medical now only means lifetime medical if I give up what is making me well in exchange for what the AME wants me to do.  Tough decisions are going to have to be made and I am still deciding what I am going to do.

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6 responses to “When lifetime medical means nothing.

  1. Kathy, I do so empathize and agonize with you both in regard to your situation and in regard to my own. As you know we did not get any medical treatment from our W/C case at all in regard to the future. And other than what we paid for out of pocket at the first of our injuries for conventional medical tests and treatments, our W/C insurance carrier also made the 4 of us pay for all the alternative medical charges that we managed to pay out of pocket while out of work with no insurance. So yes…..as you stated what made us begin to heal and feel better they did not pay, which meant had we of gotten lifetime medical as you did….we’d have still been in the same place you and I are now in….footing the bill for the damages the toxic mold did to our health.

    In looking back, I would say for myself, and I stress I specifically mean only myself…..am in no way suggesting this is the answer for anyone else reading this blog, I would have been far better off going for civil litigation against the owner of the building where I worked instead of persuing the Work Comp case.

    I chose the wrong fight because I was so ignorant of “the Workman’s Compensation world” and how it worked. If I had had the benefit that this blog offers others of seeing what could possibly be ahead of me so that I could of based my decision on fact instead of my false assumptions, I would have made better choices for my self…..

    I believe that is what Kathy is trying to do here for us…..educate us on what might me ahead of us so that we can make the right choices for ourselves.

  2. Workers’ Compensation was my only viable option. I had no way of proving that the employer had knowledge of the mold in the office. I guess I have to be glad for what has been recovered and move on. I do have lifetime disability while it does not amount to what I was making when I was actually working. You and I have had enough stress to last many lifetimes in our fights and I am trying very hard to keep my stress as minimal as I can. More stress equals a weaker immune system.

    I am just blessed to have such a wonderful attorney. If not for him, I wouldn’t even have what I have or gotten what I did get.

    You are right about trying to make a point. It is a tough fight. Is it worth it, for me the answer is still yes. I got vindication for what I had been trying to tell everyone from the beginning; my office was making me sick.

  3. Thank you for sharing this. It’s not easy but we will make it!

    • Yes we will. We are SURVIVORS.

      • Yes, we even have a theme song: I will survive! You know that one?

      • Yes I know the song. When I was still in my workplace and so sick someone had emailed me a funny clip version of the song: Alien I will survive. Your post reminded me of it and I found it today on you tube. I played it and it brought back memories of trying to work while so sick making me a little sad but the song still reminds me that I am a survivor.

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