what do i do when the doctor asks for surgery and the worker comp adjuster denies approval?
went to surgen that doc scheduled me for.. turns out it was the wrong surgern and now workers comp is denying me for further care because my lawyer has put in for demand settlement. my doc is mad because he want me to see a surgern for my job related injueries on my back. please help my doctor says his hands are tied and he gave me a very high ppd rating and then he put me on reg duty and to go back to work. what do i do now
Appeal it! They have to have a way to appeal the adjuster’s decision. Also, you might want to see ANOTHER doctor. Your DR sending you back to work with a back injury sounds too strange to me. Good Luck!
I hate to say this, but, just live with it. I was making $50,000 as a nursing assistant and now my back aches all the time and my leg gets weak. the QME gave me 25% for lifting plus 50% for standing, bending. this came out to $17,000. they paid it, I am still in pain and cannot return to my old job. how could he give you a high ppd rating and say go back to work?
that does not seem right?
Do NOT waste time thinking of “Appealing” the adjuster’s decision. That will only allow more time to pass. I would request a Hearing.
AS LONG AS your settlement is NOT a full compromise (where you surrender future benefits), THEN you should STILL be entitled to your medical benefits (unless your state stops your medical benefits after you reach MMI because you were rated).
Ask your attorney to petition for a Hearing. I do not know how badly you need the surgery. IF you are in a lot of pain, then you / your attorney could request an EMERGENCY HEARING.
It appears that your surgery was ALREADY APPROVED BEFORE? THEN the adjuster withdrew the approval?
If so, this may ALSO be a basis for a Bad Faith lawsuit.
Sure wish I knew what state your claim is in. You can also contact the State Workers Comp Board. Ask if they have an Ombudsman. The Ombudsman’s job is to help guide Injured Workers. (They cannot give legal advice tho’).
If you want to check out a Forum type discussion panel that is hosted by attorneys, check out http://www.Prairielaw.com
If you want to check out workers comp resources, then check out http://www.GettingWorkersComp.com
Good luck.
KandiM… please stay in your own state when providing info to
other Iw’s.. .what you posted here is mostly BS. OP, you have a
attorney, you can’t use an ombudsman at the WC court. You will have
to file for a hearing/appeal to the CA’s decision. You haven’t
actually provided enough info here to determine what your issues
are. You can’t blame a CA for denying a surgery request when you
were seen by the wrong Dr to begin with. (?) How would the CA know
what was being authorized? HOW is your Dr rating you if you have
not reached a stable condition and been declared MMI/Max Medical
Improvement. You should be directing your questions to a attorney,
not a message board where the responders don’t have all the
information.