SETMA, Beaumont Texas
Complaint 202446 Details

I had a job related accident. I had a pre-existing injury and surgery On 08/24/2012 to my neck area. I was seen at SETMA on 12/13/2012. I informed them of an accident I had at work 3 months after that surgery and had fully recovered and was released without and retrictions. They told me that they could and would handle to OWCP claim. The Dr. was Dr. Halbert and the lady in charge of handling OWCP claims is named Sandra. I told them of the requirments that would satisfy the OWCP claim and Sandra told me she was aware of these as they have handle hundreds of these in the past. They only things I needed was a statement from the Dr. that an injury existed that could be related to the injury that was reported to them. I also told them I needed a statement from the Dr.showing "Casual Relationship" between the reported injury and the doctor's findings. On 12/13/12, I informed them I needed this information by 01/19/2013 and again on 01/03/2013, by Jan. 19th to provide to the OWCP,becase they would make a decision basised on the Drs. "Medical Opinion" and followed up with them every few days between those dates and 01/19/2013. 01/19/2013 was the last day I had to get this information the the OWCP office and SETMA refused to provide this to me (This only takes a few minutes)which is not a very time consuming process. They began to ignore me. Dr. Halbert's office told me I could get an MRI on my own insurance and have the results sent to him. They even set up the MRI with "ALTUS" in Beaumont and got the results the next day and so they could provide the statements I needed but I had to use my own insurance. I had the MRI done on my own expense and had the results sent to SETMA the following day. I called SETMA and let them know, told me I could use my own insurance to get an MRI and they would set it up for me and render a medical decision. I had to get an MRI at my own expense which cost $389.25 with insurance 01/14/2013, and had that iformation sent to Dr. Halbert by the next day so he could make a medically educated evaluation about my condition. This was done on an expedited bases and the results were sent to his office for his review. However, even after getting the MRI that was sent to him, he never tried to provide a written decision or establish a "Causal relationship" even though I was told by SETMA he would, provide this. Without his written opinion my claim has be denied and I am stuck with basically a broken neck and have to spend more money out of my own pocket to correct this medical conditionally, which I don't have so I will probably die one day when I become paralyzed. Until that time, this accident will also put my own job in jeapordy since I will have to miss work, because this will be deemed as a non-job related accident, and I will have to have medical treament and additional medical expense. SETMA, or at least these people that I dealt with, do not care about the health of the people they are enstrusted. They only care about getting paid.