I fought the state and I won!

[luvmysibe]

To those struggling with CA Workers' Compensation,

After a traumatic work injury on 9/24/04, I was placed on temporary disability. Little did I know that the shooting pains down my legs and up my spine would eventually lead me to battle the state of California for my overall health and well being.

For the first 6 months after my injury I felt completely abandonned by the system and adrift in a sea of regulations. Fortunately, I began contacting health care professionals who practice holistic as well as traditional techniques. Through my continued contact with my work. comp. caseworker and insurance, I formed a bond with a fabulous nurse case manager. This nurse case manager assisted me with the technical aspects including how and where to appeal my claim.

My intial state selected orthopedic surgeon said I was not a surgical candidate and that I should just remain on medication and cope with the pain. My belief was and is that the body is an amazing machine that when given the proper care can heal almost miraculously (I've seen this with my 7 other surgeries). With this in mind, I followed holistic treatments including diet, supplements, massage, water therapy, yoga, etc... while contiuning to forge ahead with the state system.

With support from my nurse case manager, I changed surgeons and immediately became the "ideal" ADR candidate. Now I just had to convince the insurance compnay and the state. My first letter of appeal was denied through utilization review so we decided to stop wasting time and appealed directly to the state. By working as a team with my surgeon, case worker, and nurse case manager, I received an appointment with the state review board orthopedic surgeon, just 2 weeks after our request. After just 5 minutes of face-to-face time with the surgeon, a study of my films, and a few questions, the surgeon completed my paperwork for state board approval! My ADR surgery was scheduled within three weeks after that visit.

One of the keys, I believe to this success was our ability to work as a team, have a unified message, and a clear cut case. I hope this can be an inspiration for anyone else struggling with state approval.

Cheers!
Crystal

L5/SI Charite ADR 7/18/05

[Harrison]

Wow, way to go Crystal! Your helpful message is clear and instructive, thx for sharing it...I am sure it will help others.

What a nice reward for all your hard work -- the right to choose the best health care choice for you!

[luvmysibe]

Thanks for the positive feedback. As a post-script I should mention that I am the first person to have the procedure paid by workers' compensation in Monterey County, CA. There are many others in line for authorization here that were going to settle for fussions. Hopefully, my journey will assist then in further approvals.

Crystal

[ans]

Crystal,

You've had your share of struggles and I'm glad you prevailed.

(Loved living in Monterey yrs. ago).

Allan