Workers' Compensation Discussion Forums

I am not one to call a person names, but the adjuster & case manager for the insurance company deserve it!

I had a total knee replacement 1 yr ago today, and tomorrow is the 1 year post surgery appointment with the surgeon.

History:
I was injured 2005 and due to denials & delays the replacement happened 36 months after the injury by court order of the wc judge for medical treatment including a total knee replacement.

At the 6 month scheduled post surgery appointment the insurance company denied medical treatment, so I went home without seeing the doctor.

Tomorrow is the 1 yr post surgery appointment and when I called the doctor's office to make sure the appointment was going to happen I was told the insurance company denied payment of the appointment. The reason given was the appointment is not for the original injury. ( I have a copy of the medical records and the doctor has documented the month I am to return to his office for the 1 yr appointment)

The billing clerk said she would try and get contact the adjuster
again. I gave her my phone number and told her I would contact my attorney.

I plan on going to the appointment in the morning unless told otherwise.

Bummer Knees

I take it you don't want your MMI date delayed.
won't that affect your benefits adversely?

1171

I will be at MMI sooner or later, I really don't care when it happens.

The medical part won't change, I haven't seen the doctor since 2 months after the replacement. The insurance company denied the 6 month appointment.

I am on SSD so I will be okay.

I did go to the appointment this morning and did see the doctor.

It was late yesterday evening when I received the phone call from the medical center with the news the appointment had been authorized by the insurance company.

The billing clerk had to go thru 3 different levels to get approval for this appointment.

When the medical billing clerk first told me this appointment had been denied I threw an Irish tantrum.

I told the clerk the insurance company dose not want to do this, treatment of this knee is under a court order and this is the 2nd time treatment was being denied.
Also told her I would be calling my attorney when I got off the phone.

I will be sending the clerk a thank you card for her help yesterday as she went the extra mile and made the phone calls in seeking authorization.

On the knee I am at MMI and do have permanent restrictions of limited, kneeling, bending, & squatting, limited lifting over 25 lbs. and no lifting over 50 lbs.

The work restrictions will end my job of 13 yrs as the employer refuses to accommodate any restrictions.