WTF? I just got a call from Docs office that TASB denied the surgery. I called TASB rep and he said they only believe a knee strain is work related. WTH is this bullshit?
Idk....we're required to file for any injury while at work. carrying supplies to my class when it happened.
Update on a totally F'ed up waiting game....Four months ago, after I was denied surgery, I filed an appeal on the decision with Texas Division of Insurance. After a small mountain of paperwork and 4 months of waiting, all the while still on crutches, I finally saw TASB's designated doctor who evaluated me for extent of injury and MMI. He examined me and determined that I did need surgery, and now I have to wait 2 weeks for the doctor report and a determination if TASB is going to continue denying services or get me into surgery. 6 months and still waiting!
I'm no saint. I don't understand why they didn't have me see their DD in the first place. Instead, they had their dr evaluate what my dr's report said and make a determination based on that without ever seeing me.
WOW! Tasb's Designated doctor agreed with my ortho surgeon that I needed surgery, but the wc rep wants a second opinion on THEIR F'ING DR! However, my omsbudsman at Tx. Div of Insurance explained that WC must continue to provide all services since their DD said I need the surgery. What a headache!!!
I assume your insurance is through the school district? Is this a Worker's Comp issue or an insurance issue or (since I have no clue about how they work together) a "both" issue. In essence, if it's a worker's comp issue, can you avoid them and just go through insurance?
Its a workers comp issue. I have a feeling that they are hoping to make me wait so long that i just turn it over to my insurance
Considering I am ignorant to these types of situations, what benefit is there to you to go through Worker's comp as opposed to blowing them off and using your insurance?
I had to file an injury report as per school policy. If I went to my personal insurance, I'd have to meet deductible and pay on percentage.The school district raised premiums on us and lowered benefits paid out. I'm not going to pay out of pocket what WC is required to cover. I just have to suck it up and accept that these guys are going to do everything they can to dissuade me from holding them to their obligations.
So, in essence, WC would pay 100% (or close) to the cost, where you might be stuck paying X amount for deductible and a percentage of the final cost? Thanks for taking the time to answer.
Yes, WC must pay for all medical related to the injury, including rehab, and meds. I don't even know if my personal insurance would cover rehab.
Great news! My TDI Ombudsman called and told me that TASB has accepted my Meiniscus tear (after seeing two orthoscopic surgeons and designated doctor, all in agreement about my injury). After paperwork is drawn up and signed, I can schedule my meniscus surgery...after 7 months!!!!
Just got the call that surgery is scheduled for next Wednesday! After seven and a half months, FINALLY!!!!
I had a WC claim about 15 years ago. I was running with Softball kids and foot got caught on the gym floor. I fell forward put my arm out to keep from going head first into a cinder block wall and fractured my elbow. WC didn't take very long to get going and they were pretty good about agreeing with what the doctors said. The issue I had with them is they "forgot" to pay the specialist I saw. I got several past due bills from them even a couple of years later. I turned those over to admin and they finally got it resolved. It wasn't a hassle but it wasn't a smooth process either. I imagine the more severe the issue the more hassle they give you.