Could use some Workman's Comp assist...

lilsister · 06-27-2004, 04:26 PM

My brother, Jim, won his worker's comp suit but we are having problems. I was wondering if any of you had experience with worker's comp and would be willing to share? One of the issues that I am having with them is that they are giving out his medical record without permission. Also they want a nurse to come to our house to check on us on a regular basis--is that the norm? Will they be doing skin checks? Making sure he's in a w/c? They demand only agency care, only NA. Of course agencies won't allow PCA's to give insulin. This will not be much relief to me, since Jim is diabetic and requires sliding scale insulin injections 3-4 times/day, as well as regular mealtimes and special meals. If any are willing to share, but not online, my e-mail is dazeigel@msn.com. Mainly, I just don't know if this is normal procedure. Yes, we have a lawyer, but is not being very helpful, and is back in Wisconsin, so distance makes it hard. Thanks, Deb

SCI-Nurse · 06-27-2004, 07:28 PM

Get a different lawyer (one who specializes in only wc cases), don't agree to anything without your lawyer's input and agreement.

The nurse case manager is the norm, but this person may or may not know much about SCI, and usually does not do any hands on care. This position has some essential conflict of interest, as they work for the WC insurance company (ie, expected to save them as much money as possible) but are supposed to be the patient's advocate too. Hold him/her to this latter moral and ethical standard...confront on this directly. If necessary, ask for a change in nurse case manager.

Don't give in to them limiting his care only to NAs. You need to hold them to the standard of the care they would provide if he had no family to assist at all...after all, you or other family could get ill, disabled yourself, or die at any time and he would still need care.

(KLD)

lilsister · 06-27-2004, 09:11 PM

Thank you KDL, you have confirmed my thoughts. His WC lawyer was actually very good and won a difficult case, he is a WC specialist. Jim had been seeing clients (juvenile delinquents) on home visits and was hit by a Mexican tourist. Because his status changed to on-call and he was on his way home from the last client, it was a landmark case, I was told. He had worked 26 years for the juvenile court system and his department stood up for him.
The lawyer says they have the leverage and that I have to be willing to let him be institutionalized, so that they will realize THAT cost. I feel that would be extremely dangerous, to say nothing of cruel. I have researched and sent them the cost of different situations,ie-nursing home, RN, PCA. I am willing to train PCA on insulin dependent diabetes, as well as other cares and realize this is a long process. Because I am only too cognizant of what would happen if I should become ill. We have his money invested and in a trust for that reason. I guess I just have to keep on the lawyer and WC.
Thank you very much for your help and insight. It isn't the day-today physical care that gets me down, it's the constant haggling and time-consuming insurance battles that stress me. I am grateful for your expertise. Debra

06-27-2004, 04:26 PM	#1
lilsister Senior Member Join Date: Jan 2003 Location: Madison,Wisconsin, USA Posts: 1,481	Could use some Workman's Comp assist... My brother, Jim, won his worker's comp suit but we are having problems. I was wondering if any of you had experience with worker's comp and would be willing to share? One of the issues that I am having with them is that they are giving out his medical record without permission. Also they want a nurse to come to our house to check on us on a regular basis--is that the norm? Will they be doing skin checks? Making sure he's in a w/c? They demand only agency care, only NA. Of course agencies won't allow PCA's to give insulin. This will not be much relief to me, since Jim is diabetic and requires sliding scale insulin injections 3-4 times/day, as well as regular mealtimes and special meals. If any are willing to share, but not online, my e-mail is dazeigel@msn.com. Mainly, I just don't know if this is normal procedure. Yes, we have a lawyer, but is not being very helpful, and is back in Wisconsin, so distance makes it hard. Thanks, Deb

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06-27-2004, 07:28 PM	#2
SCI-Nurse Moderator Join Date: Jul 2001 Location: USA Posts: 41,325	Get a different lawyer (one who specializes in only wc cases), don't agree to anything without your lawyer's input and agreement. The nurse case manager is the norm, but this person may or may not know much about SCI, and usually does not do any hands on care. This position has some essential conflict of interest, as they work for the WC insurance company (ie, expected to save them as much money as possible) but are supposed to be the patient's advocate too. Hold him/her to this latter moral and ethical standard...confront on this directly. If necessary, ask for a change in nurse case manager. Don't give in to them limiting his care only to NAs. You need to hold them to the standard of the care they would provide if he had no family to assist at all...after all, you or other family could get ill, disabled yourself, or die at any time and he would still need care. (KLD)

06-27-2004, 09:11 PM	#3
lilsister Senior Member Join Date: Jan 2003 Location: Madison,Wisconsin, USA Posts: 1,481	Thank you KDL, you have confirmed my thoughts. His WC lawyer was actually very good and won a difficult case, he is a WC specialist. Jim had been seeing clients (juvenile delinquents) on home visits and was hit by a Mexican tourist. Because his status changed to on-call and he was on his way home from the last client, it was a landmark case, I was told. He had worked 26 years for the juvenile court system and his department stood up for him. The lawyer says they have the leverage and that I have to be willing to let him be institutionalized, so that they will realize THAT cost. I feel that would be extremely dangerous, to say nothing of cruel. I have researched and sent them the cost of different situations,ie-nursing home, RN, PCA. I am willing to train PCA on insulin dependent diabetes, as well as other cares and realize this is a long process. Because I am only too cognizant of what would happen if I should become ill. We have his money invested and in a trust for that reason. I guess I just have to keep on the lawyer and WC. Thank you very much for your help and insight. It isn't the day-today physical care that gets me down, it's the constant haggling and time-consuming insurance battles that stress me. I am grateful for your expertise. Debra