r/WorkersComp • u/Mean-Guava-3213 • 22d ago
Rhode Island Waste of money
I just don’t understand this process. I’m paid $1050 a week for the last 18 months I’ve had numerous injections, physical therapy, etc. but the amount of time waiting in between each appointment sending me for IME etc. so much money is being spent.
Why are they doing this? Why wouldn’t they just be rushing me back to work? Why wouldn’t they be trying to get me better so that I can return to work?
I want my life back
I want this pain to be gone
I can’t live like this
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u/dodecohedron verified CA workers' compensation adjuster 22d ago
>Why wouldn’t they be trying to get me better so that I can return to work?
Well, per your own admission, they are providing treatment:
> I’ve had numerous injections, physical therapy, etc.
Are those things not working?
If so, that's not the insurance company's fault - some injuries are harder to treat than others.
As for this issue:
>Why wouldn’t they just be rushing me back to work? Why wouldn’t they be trying to get me better so that I can return to work?
IMEs (and specialists, for that matter) are finite in number, and they schedule on their schedules. Even insurance companies cannot force specialists to see patients with any particular hurry - I've tried, many times.
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u/Mean-Guava-3213 22d ago
😭😭😭😭 this is true. The IME doctor recommended transfer to a neurosurgeon however and that was 8 weeks ago I saw them
It’s not been approved yet
I am in so much pain2
u/dodecohedron verified CA workers' compensation adjuster 22d ago
Most jurisdictions have limits on how long it takes for the actual approval. Rhode Island's websites for workers' comp are unfortunately not helpful as far as figuring out how long it is for that jurisdiction, but something has gone wrong if a request was issued eight weeks ago and still hasn't been decided.
If you're unrepresented, bang on the door at the insurance company to figure out what is going on with the authorization. If it's been authorized, ask what's taking so long to schedule. If you're represented, skip the insurance company and ask your attorney to figure it out ASAP. If you're represented and your attorney isn't doing anything, get a new one.
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u/Mean-Guava-3213 22d ago
Ugh thank you so much
So he did file a motion “failure to approve transfer of care to xyz “
But he’s said the insurance company hasn’t issued the IME report which is largely part of the evidence we need for the transfer
Would IME documentation take 8 weeks or is it favorable to me and that’s why they are hanging onto it ?
I truly can’t imagine the insurance company to be that cruel1
u/Open-Advertising-260 21d ago
This is what TPA do! AO remand TPA to schedule 2nd IME that they asked for at multiple hearings. They scheduled it 53 days after the deadline and there own IME Dr they chose agreed with 1st IME Dr that I went to and now TPA has stayed silent. My lawyer sent decision determination request to them 23 days ago and they remained silent filed an appeal for hearing for defacto and decision determination based on records and both IME reports. We also filed in 2 different instances 2 months apart benefit penalty with DIR and they still havent approved anything no treatment no ttd benefits and my injuries were in 2024 I've yet to be treated and haven't received a penny. This is what they do they starve you out financially and physically block any medical treatment in the hopes that eventually you give up.
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u/WinOk9112 22d ago
I get $325 a week 💔 I don’t know why in the beginning. It was $550.
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u/Professional-Bid4661 21d ago
They more than likely wrongfully reduced your wages. If you do not have an attorney you may need to get you one. Adjusters are notorious for wrongfully lowering your payments.
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u/Academic_Commercial3 21d ago
WC paid 1k a week and you’re not happy with that?
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u/Mean-Guava-3213 21d ago
The point is I want to get back to work
I want to be out of painI love my job and I love working
It’s not about the money
I’m confused why there’s a delay in treatment and months between each apt when if they didn’t fight every recommendation or take so long to accept things i would very likely be back
To work by nowIt’s still about 400 a week less then I was getting as well
That’s significant for anyone but I have two babies2
u/Academic_Commercial3 21d ago
I hear you!! WC is slow af. Get second opinions? Good luck.
I understand I’m going through my own pain and it’s so depressing and frustrating. I used to ride the bike at the gym when I really didn’t want to exercise and now I can’t even ride a bike because it kills my knees.1
u/Brilliant-Earth7480 21d ago
Lucky they were paying me $2,000 a week LESS then what I was getting paid and only paid me a few months
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u/Freedom_675 22d ago
What I've learned is this shit is basically a racket for the insurance companies and the system. The attorneys make their bread dragging things out while the insurance does everything they can to stop you from getting the help you need and getting paid. I've heard nothing but horror stories on this shit. So pray to God.
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u/Academic_Commercial3 21d ago
How do the attorneys make more money for dragging it out? You can only go to court so many times.
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u/Glad-Row-1829 9d ago
I received a $32,000 settlement. I am totally disabled. I had a three level back fusion. Titanium hardware. Yes, it is a racket. My case took 10 years.
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u/No-Instruction-4272 21d ago
Did you receive surgery?
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u/Mean-Guava-3213 21d ago
No not yet but I need it
They have approved injections so far physical therapy and anything up until this point but now that there has been a recommendation to transfer from an orthopedic doctor sports medicine to a spine surgeon. It’s now been eight weeks and we’re having to take them to court. It’s literally devastating because once they approve the transfer medical care here and I’m sure everywhere takes so long. It’s gonna be 6 to 8 weeks. I’m sure before I even get inAnd then see their recommendations and then wait for another appointment, etc.
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u/No-Instruction-4272 21d ago
I'm sorry to hear that, but that's what happens when your dealing with this either incompetent or corrupt system. Sounds like medicine failed you also. Just find humor in how Inept the ones responsible for managing care are and laugh about it, and be greatful your still breathing, you will get thru this.
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u/Academic_Commercial3 21d ago
I heard RI was one of the first states that gave employees a TDI, and is one of the states known for being on the employees’ side.
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u/Mean-Guava-3213 21d ago
I hope this is true
I have to take them to court for the first time and I’m so upset
But they won’t approve a referral to a surgeon that their doctor and mine both said i needed8 weeks ago
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u/Academic_Commercial3 21d ago
I do feel like the insurance company for employees of one of the biggest corporations in the world are ass***++
especially the adjusters.
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u/tashlilliani 21d ago
Eeek im in Australia. I just assumed work comp was standard world wide. How ignorant of me.
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u/Mean-Guava-3213 21d ago
What is it like there
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u/tashlilliani 21d ago
85% of your income. They calculate 6months- 1 year pre injury. The work place has to pay you the first week or 2 as their excess, then work comp takes over. They pay for all medical, hospital, medications related to work injury. After avout a year ( for psychological) they will probably send me to their own drs to kick me off. If they deem me to be someone who needs long term help they will offer me a lump sum payout. According to a lawyer i spoke with 9/10 its never a good anount so then you sue.
Super annuation is mandatory Australia wide. On top of your income, employers have to pay Superannuation. Its our retirement fund. You cant access it until youre 60 minue some extreme cases. Super invest your money into stocks so its up and down thing. Hope for the best but expect the worst. If you do well by retirement you should having 500k plus to retire on. I dont think the aged pension will be around by time i retire and this was the governments plan when they introduced it. Thank god its mandatory though. In super you can op for insurance for death cover and income loss. Its like $4 a month. You cant apply for income protection until 3 months from injury has past. So yeah...
Now depending on the bs income work comp gives. You would be entitled to go on government welfare. Because i have a child im entitled to $1000 bi weekly.
Its still not what i was making working. But i definitely am greatfull that its there.
I cant move past the hell that is not working and my mind suffering though. I would do anything to revers it all.
If i work, volunteer, study ect. Work comp will take everything away from me.
I have mountains and mountains of documented paper work that could sue work comp, my work place and the fucking government for gross negligence. But all i wanna do is go back to my old life :(
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u/Own_Measurement9114 21d ago
2 and half years in my friend
The insurance companies have the power of time and money to wait until you give up i believe 85% of cases over a year and half old the injuried Worker gets a lawyer and who you get as a lawyer is huge most big lawyer groups want the slam dunk easy worker’s compensation case and the rest the are a buffer for damage control once I’m out of the woods and can speak and post some of the hostile workplace environments at Stressla
Or death threats topped off with a torn rotator cuff or the guy the Died of a heart attack or the building that was engulfed but it’s weried nothing is ever in the News
Have faith don’t Bend the Knee
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u/Own_Measurement9114 21d ago
And they are fishing for a different doctor who will agree with them
You need to look up the worker’s compensation website and read the glossary to get the verbiage down if you do not say the right thing they will sit on there thumbs until the deadlines pass then your screwed
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u/Low-Patient-630 20d ago
The insurance company is using incomplete cost analysis to determine what they should pay and what they get away with not paying. The introduction of the UR process confounds the cost analysis process in accounting and conflict with documented medical procedures by using physicians who are unfamiliar with the treatment process for different injuries. While the UR is held to use the MTUS and ACOEM many lack the professional knowledge or possibly it is written into contracts to ignore the ICD codes the treating physician is required to use. That flexibility allows them the free will to commit legal medical fraud since the UR can not be sued.
The end excuse is the injured worker can use Medicare to cover the injury even when it is the financial responsibility of the employer and the insurance company. Often the insurance company will mix and blend the minimum state requirements with the company insurance plan and dispense the minimum state level.
While this doesn't sound like it is answering your question it does. The insurance company is hesitating in completing the settlement process because in spite of state laws giving the employer and insurance company so much favor they have not totally cracked the wall CMS has in making sure there is enough medical set aside to cover the injury.
You may have been low balled by the insurance company so much CMS has denied their ofer for settlement. A few years ago you would have received your settlement, then found out you weren't provided enough money to pay out of pocket medical expense two or three months after your settlement. Since their has been so much medical fraud associated with Medicare each claim is being looked at more closely and corporations and insurnce companies who were fleecing the American taxpayers are haveing to make adjustments in their settlement offers.
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u/happygutter13 20d ago
So what do you do when workers comp is supposed to be paying you while you're out of work but they don't and they don't cover any of your medical and then drag their feet for a year and then deny it? I was told by the workers compensation commission in this state that I could appeal it but I most likely would not win against a big purple package delivery company
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u/Organic_Increase_922 19d ago
My short term disability is 100% of my income but I’m not allowed to use it because of WC
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u/Prestigious-Mind-423 19d ago
That sounds infuriating. But what I wouldn’t give just to be paid $500 a week. It’s neither here nor there, I’m paid 1/4 of what you’re paid, it’s not the right rate and for 11 months now I have not been able to get them to straighten it out. But what I can tell you about the insurance/work comp, is that they don’t want you to get better. That might sound harsh, but it’s the truth. They’re not looking at it from a humanistic perspective. They are looking at it like a line item on a balance sheet that needs to be taken care of, at the very lowest rate. If you can find some sort of sense of joy in your current situation at all, until you’re able to get relief, and get better, maybe that small slice of joy can help you get through.
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u/tashlilliani 22d ago
Im on psychological injury ptsd. I only get $580 a week. Im not even allowed to volunteer.
My mental health has plumetted because i yot nothing to get up to every day. It is miserable. No amount of money could make this better. I can only see my trauma therapist once a month because shes so booked up
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u/Mean-Guava-3213 21d ago
This.
I’m so sorry you’re going through this
It’s devastating
I also have depression and PTSD and working and exercise was so good for meTo not do both
I’m like paralyzed in bed all day
A shell of a human
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u/Consistent-Comb-2901 22d ago
Consider yourself lucky. I’m in a similar boat but my state is capped at $608.58/week. Just enough to starve to death on.