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Diane Roberts Stoler, EdD, and Barbara Albers Hill, Avery, Penguin Group (page 4 of 5) Page 4 of 5
One thing is more or less constant when dealing with any government agency: Getting adequate care can be difficult because you must meet stringent requirements and deal with a fair amount of red tape and paperwork in order to benefit from government programs. In addition, the coverage provided is limited. In some states, outpatient services in particular are strictly limited. If you encounter problems filling out Medical Assistance or Medicare claims, you or your personal advocate can contact other doctors and medical facilities, a social-service worker, or your state legal-aid service for help in expediting your claim.
Workers' Compensation
"About ten years ago, I got a job as an assistant to a film director and his actress wife. Six years later, while checking the gate where I worked, I fell down onto the driveway. I was taken to the local hospital. My apparent injuries were two teeth protruding through my upper lip. In the weeks that followed, I experienced various symptoms of MTBI, such as smelling phantom smells, feeling cold, and having problems with articulation, memory loss, confusion, and poor judgment. I was contacted by a workers' compensation representative suggested that I go home and rest. After a month, I felt better and attempted to resume working. However, I soon discovered that I could no longer perform the needed duties. I eventually quit my job.
In the years that have followed, I have been assigned several claims adjusters; however, no treatment was provided for my MTBI. I finally realized that I needed to hire an attorney to represent me. After years of waiting, I recently had neuropsychological testing done, but I am still awaiting appropriate rehabilitative treatment for my MTBI.
-Missy
If your MTBI was employment related, you are probably covered by workers' compensation laws. The time and procedure for filing varies from state to state, and the process itself can be tiresome and frustrating, so it is advisable to contact an attorney or a brain injury association advocacy program for assistance. Under workers' compensation law, you may be entitled to receive a percentage of your preinjury earnings as well as payment for medical expenses. Before being approved for benefits, you will probably be required to undergo an evaluation by a specific medical professional under contract to the workers' compensation insurance carrier. This person's opinion may determine whether certain services will be covered and/or if existing services should be continued. If the insurance carrier's physician feels that particular services are not necessary, the carrier may stop paying for those services. If you disagree with the doctor's evaluation, you can get a second opinion and go to court to argue your side. Meanwhile, if you need the service under dispute, you must pay for it yourself or run up a bill.
Even payment for treatment approved under workers' compensation can be delayed, sometimes for long periods. It is not unusual for doctors to refuse to accept workers' compensation patients because of the paperwork, minimal payment, and other obstacles. Don't give up, however. Your local brain injury association should be able to help you locate a qualified practitioner or practitioners who accept such patients.
Victims' Compensation
If your MTBI occurred as a result of a crime or physical assault, you may be entitled to compensation for lost wages and medical expenses through a state victims' compensation fund. Your lawyer, the local legal-aid society, or the office of your state's attorney can tell you whether there is such a fund in your state. The rules and requirements for receiving compensation from victims' funds differ, but in most states, a claim must be filed within a specified period of time. It is therefore important to find out what is needed and to get the necessary forms filled out as soon after your injury as possible.
Disability Insurance
Many companies supply income or disability insurance as part of an employee benefit package. Disability coverage pays a percentage of your previous wages while you are disabled, though exactly what percentage and for how long depends on the individual policy. The maximum dollar amount is not likely to approach the amount you previously earned, but it can help if you are unable to work. If you have this kind of coverage, your employer can advise you of the proper filing procedure. If you are self-employed and have private disability coverage, you will have to file a claim with the insurance company on your own. You may want to ask a family member or your attorney to work on your behalf to obtain the needed compensation.
Practical Suggestions
"I have saved a lot of time ad energy by filling out the personal data section at the top of a blank medical form and then making photocopies of the entire form so that only the date and signature need to be added in the future.”
-Rita
"I highly recommend learning to interview professionals to ensure that you are seeking help from appropriate sources. Also, make photocopies of every application, form, and cover page that you submit to agencies and insurance companies. If you need to reapply or be recertified for benefits in the future, you can simply copy the previous form.”
-Elaine
"I'm fortunate in that I had insurance, and that I'm able to afford my daily bills — unlike many people with MTBI, who have to choose between paying medical bills and feeding their families. To help me cope with seemingly uncaring bureaucratic personnel, I've found comfort within my local brain-injury support group and from my psychotherapist and the many caring friends I've made in cyberspace.
-D.R.S.
The process of filing for compensation for lost wages and medical expenses can be long and frustrating. The suggestions that follow can make things a bit easier:
From Coping with Mild Traumatic Brain Injury by Diane Roberts Stoler, EdD, and Barbara Albers Hill, published by Avery, the Penguin Group. Copyright © 1998. All rights reserved. http://us.penguingroup.com. Dr. Diane Roberts Stoler can be contacted via her website: http://www.drdiane.com/.
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