Once upon a time, during 1995-2004, CT. WC commissioners ensured that the laws were enforced, and they never showed favoritism, to either claimant or insurance company.
I had a back surgery in 1998, after several incidents with clients in group homes, and lifting those bedridden, while on shift alone.
It led to severe retaliation and discrimination. I filed a 31-290(a) claim and the commissioner punished the employer for denying me light duty positions, I was qualified for. They would not even let me interview for them. The insurance company then, was Berkley, and they had to pay me 100% instead of 75%. (thanks commissioner Miles)
I ended up back in a group home with ambulatory clients, but the hostile work environment continued, and I filed with the CHRO/EEOC.
They found reasonable cause, for several disability violations and after my car (AT WORK) was grafittied with death threats, and racial epithets. Ketchup to look like blood, and writing everywhere.
This was when it all came to a head, because it was on the news.
I settled with them out of court, but they also made sure, I NEVER would work for the state of CT, ever again. It was very traumatic, after the car incident and I was diagnosed with PTSD. DMR accepted it, and reimbursed the time I used, from my vacation time.
I did not release liability for, pending workers compensation claims as I was still being treated.
Dr. Kost moved form Bristol to W. Hartford, and became so busy, he ended up referring me to another pain clinic for radio frequency.
I had several S-I joint injections prior to the RFA. The claim adjuster denied it, so the pain doctor had to work harder to get this approved.
I finally had it done, and ended up in a wheel chair for 30+ days and the ER, because the post procedure pain, was intolerable. I also had spaghetti legs. I could not be left alone for a solid month.
I had to have a hearing to change treaters, because there was no point getting needles anymore. The relief did not last very long.
Gallagher Bassett came into the picture and the whole WC system in CONNECTICUT, went down the toilet. The WC book with the statutes, quickly became obsolete. NONE of the laws matter anymore.
Gallagher Bassett called the pharmacist and had him tell me, “WC is no longer paying for your medications”. No FORMS IN THE MAIL…nothing…they were never allowed to do that before.
Now the claim adjuster has her foot in their lap, during each hearing.
It is VERY clear, that there are “sides” now, and NOBODY is on our’s anymore. (Do not think your attorney is either)
I address, 31-279-9(e) @ the hearing and ask why they cut me off of narcotic medication, without notification?
The LYING GALLAGHER BASSETT rep says> “The doctor is out of network.”
I had been seeing him for (2) years, and they paid the whole time.
I did get the commissioner to approve me seeing an osteopath, so I was glad for that. He actually showed up to my hearing which was great. They were obviously angry when he came in the door.
On the way out the door, this commissioner, makes a snide remark about my CHRO/EEOC complaint, as he had seen it all play out on the news. He told me to “make sure you spell my name right when you go back on the news.” (RETALIATION all over again)
I went home and found this “secret WC physician list”.
The doctor WAS IN NETWORK, so GALAGHER BASSETT can lie, and do whatever they want, as long as they get there way, and get rid of you.
I went back for another hearing, because now the claim adjuster is telling me, I used up all (12) visits. NOT TRUE, but I go back anyway.
I get this new woman commissioner, who had exparte’ communication, prior to me entering the room. It was very obvious, because she was all set to attack, and that same BLOND LIAR from GB was sitting right next to this “person” who thinks she is doing the right thing.
I bring up the LIE, and I also have a letter finally, saying the denial was because, “I cannot see (2) doctors at the same time”.
This female commissioner, now says, “the medications were not approved”. I ask her…”Is that your final answer?” I mean seriously, the excuses change from day to day, and there is NOTHING IN THE WC BOOK under this statute, that says anything about medications being DC because they were not approved. DR KOST prescribed these for 10 years, and he is on the WORKERS COMPENSATION BOARD & he is on the Dept, Of CONSUMER PROTECTION BOARD for medical marijuana. (busy guy)
Clearly, the book is now useless as are the laws to which were upheld so fairly, long ago. I do not know how these people can sit there, knowing, they put my life in jeopardy, because I was taking (2) muscle relaxants and (2) narcotics, prescribed by their “IN-NETWORK” doctor for TWO YEARS. My primary care doctor agreed it was reckless and I could have had a seizure of worse. They do not care at all…hoping i would go die I am sure.
If a doctor did that, he would be in front of the health dept.
Because they have a pencil pushing, claim adjuster making these calls, NOTHING happens. She did not even look over at her and tell her, “next time, make sure you send out the correct contesting form”.NOTHING….the system is the MOST corrupt EVER!
Meanwhile, EVERYONE is telling me that billing my private insurance for WC meds, is insurance FRAUD. I tell her that too, and all she says is, “its fine”. I ask her where is the law that supports this? Again…”its perfectly fine”
I tell her I am there to get (12) more osteopath appointments approved, because I was told I could not go back because I used up, all (12). That was another LIE, that floated by like a fart in the wind.
This commissioner says, “they paid for (4)”…..I am there because I WAS TOLD I HAD NONE LEFT. I knew I only used (4). What a waste of time.
She still says NOTHING to the lying, time consuming, DEVILS, that work for this inhumane insurance company.
Now, I have to pay the doctor out of pocket, submit the bill to the new claim adjuster, ( the other one got fired) and then GB reimburses me. (I hope)
I am lucky my primary care doctor, helped me wean down to just one narcotic and half the dose, and he kept prescribing the muscle relaxants, and medication for the PTSD. (It has a claim # and they are still fighting me on that one)
I am there to let them know, that these medications have been prescribed all along, and if I have to pay for the visit to my primary care doctor, then they should cover the medication. NOPE.
“THEY ARE NOT AUTHORIZED”..What the hell is that?
Every time, I pull out PROOF, and start to show it, I am cut off and they change the subject. Talk about vicious!
I also have a back up plan. I had researched and found another osteopath, that has a billing dept. The one I had been seeing, is a one man office and he cannot do the billing the way they want it, so I was ready. They had told me I could not see him, because he did not have a billing dept. Now, suddenly, this is ok with them.
I told them Dr Waddington is “in-network” and he has a billing dept, so no way can you ignore that. The osteopath I had been having amazing pain relief from, is NOT IN NETWORK, but they are allowing me to see him.
See how stupid this all is?
Lied about the prescriber being “out of network”, when he was “in network”, all along. Meanwhile they are approving me to see an osteopath who is “OUT OF NETWORK” because they called and negotiated a price they like. Its ALL ABOUT THEM.
Next, this woman commissioner tells me, that I am “refusing medical treatment” if I refuse to get another injection. Mind you, I had been ENDURING them for 15 years….and she calls that a “refusal”. WOW!
I then have the document the “fired claim adjuster” sent back to the pain clinic for the RFA. She would NOT approve it! He had to fight Gallagher Bassett to get it approved…this commissioner is now really looking lost, because I had to point out the obvious.
First you & GALLAGHER BASSETT, were against it, before you were FOR IT…so which is it?”
These people are insane and KARMA is going to catch them.
I do not have to continue sticking needles in me, if it does not work!
There is no WC law that forces anyone to endure a treatment that makes them feel worse, before they feel better, Oops, I forgot, there are no rules or statutes anymore…my bad.
My primary care doctor and the osteopath, all told me to “never do radio frequency ablation again.” FYI: INJECTIONS (ESI) are not FDA approved nor is RFA. They use it as an “off label use”, so they are allowed to tell us this. (this was on Dr. Oz…he is teaching us all this!)
I told her I ended up in a wheel chair and I am suppose to get a fusion, at some point. DR KOST referred me to DR. AFERZON because he was the doctor who first stated, “you will eventually need a fusion”.
Now, I get her to agree, that the osteopath can refer me to Dr. Aferzon, “when he feels his treatment is not longer helping me.”
I want it in writing still, because I am seeing how random and out of order this whole WC-Kangaroo court it in 2015.
I remind her that I am taking a medication for PTSD and the “STATE OF CT/CHRO, already did their investigation, and found in my favor.” NO need for a hearing on something already DECIDED by the STATE OF CT. (a logical person would agree)
She is still not convinced even though I am reading off the settlement, that has a “gag-order” on it, because of the media attention. She wants, a person sitting on an ice pack, with their leg on another chair, with PTSD to come back for a pre-formal hearing, without ANY COUNSEL. She says she is bringing in the AG’s office.
NOBODY will represent ANY injured worker whose claim is this old.
I called many attorneys and they all said it was not worth their time.
I left teary and feeling defeated by these corrupt state employees and that HORRIBLE GALLAGHER BASSETT, “decider”.
I went home, and made some calls to get past billing for the medications, directly from Dr Kosts medical records dept. They are sending me 2000-2005, so they can SEE, even though they already know they paid for them. (It’s a very silly, stupid, BIASED system)
They know they paid for, Dr Kost and Dr Brodys prescriptions for YEARS. Now they want me to go get the proof, just to be mean.
I called back and said I was calling my insurance to let them know that you are forcing me to put WC medications on my private insurance. I already tried, so time for the actual insurance company to come in and fight for themselves. There can be a LIEN for them to pay them back. I have recorded proof of the 2012 & 2013 hearings on record, so its not like I did nothing.
Moral here is. CONNECTICUT has turned into the most corrupt, and WC laws no longer hold any weight in a WC forum.
GALLAGER BASSETT are lying thieves, everyone hates them, they have ruined many lives and families, and now they have taken over a system, that use to work very fairly.
If you GOOGLE CT. WATCH DOG – Workers Comp, you can read the article about the WC system and how it fails the injured. There is also a letter from AFL-CIO UNION PRESIDENT, stating what we all know. The corruption and fraud is not as prevalent in the injured worker as it is in the system that is suppose to be there, for us.
Deflecting, is a classic CONNECTICUT move….do not pay attention to what we are doing…they always point the finger at the victim.