Hello There, Guest! Login Register
Index    |     Search    |     Members    |     Help

Thread Rating:
  • 0 Vote(s) - 0 Average
  • 1
  • 2
  • 3
  • 4
  • 5
denied treatment by w/c
#1
I will try and make this short but I need to give all the information.

I injured my back on may 7 2010 and have not worked since. I did a week of PT and then was sent for an MRI. The MRI shows herniated discs at L3-L4, L4-L5, L5-S1. Was sent to a back Dr. by my WC adjustor and he said I need surgery but WC will not approve surgery at first so he recommended an ESI. I was told that DR. was not in the netwrok so I was then sent to a Pain managment Doctor. She put me on the steroid pill for 1 week with no help. She then recommended the ESI but WC denied the treatment. WC wanted an EMG which I received and the test come back normal. I have lots of pain in my lower back, mainly on the left, down my left leg into my ankle. My foot and toes go numb sometimes. My Dr says I probably need surgery but my adjustor did not send me to a surgeon but instead a neurologist. He looked at my MRI and said I was a candidate for an ESI but that would only give temporary relief and that I need surgery. My adjustor then sent me to a neurospine surgeon. He wanted more xrays and the ESI before he would do surgery. I was then sent to another DR for an examination and he too recommended the ESI. Again, WC denied the treatment. In the meantime, my adjustor send me for a designted doctors exam and was given a 5% impairment rating and a 50lb lifting restriction to return to work. My Dr appealed the ESI denial but workmans comp denied the appeal again saying it was not medically neccasary or appropriate. Their reason is they say there is son sign of radiculopathy but 4 doctors that have acctually seen me in person and have seen my MRI said that I have signs of radiculopathy.

I am very frustrated to say the least at this whole process. The delays, prolonging every chance WC gets a chance and the denials. The Designated doctors exam says I am at Medical maximum improvement. How can that be when nothing medically has been done to improve my back.

I have not hired an attorney but have contact the Texas Department of insurance. I have to go through what they call an IRO (independent review organization). Has anyone ever had to go through this process and if so what was it like? What was the outcome and do you have any advise for me?

Thank you very much for any information you might have.
 
Reply
#2
sorry 4 what your going through,but you need to consult with a lawyer like immediately.because you will encounter more problems then u think.
 
Reply
#3
Get a lawyer, this is your life and what they are doing could cause you to be in pain the rest of your life. Now I'm not saying that what they want to do will fix your problems and you will be out of pain but the delay is not a good thing. The one thing What you need to remember is this is your body and your life and YOU are the one that has to look out and take care of it. You need treatment for your injury and not another doctor. They keep delaying things in hopes of finding a doctor that will say there is nothing wrong and in your case it sounds like they are not finding that doc. One thing to remember until you have a lawyer you need to do what they say and go to these appt's but with that said if they return you to work with or without restrictions follow them. Now if it is without restrictions or if something within those restrictions causes pain stop and report this to them and ask to see a doctor or go to the ER. NEVER do anything outside your restrictions. If you return under restrictions they may sound like they will work with them but some times believe it or not they will try to get you to do more. Once they do they will use this to try and show you are not as hurt as you say you are. Be truthful with everybody because they hope to get you to lie so they can use that to. I hope and pray you can get some help because I can tell you the rest of your life with pain is not something I wish on anybody. This is going to be a long road and one that will cost money and that is why they are fighting you. They want to save money and you need to fight for the treatment you need to get back to as normal a life as you can
 
Reply
#4
ybigjt Wrote:sorry 4 what your going through,but you need to consult with a lawyer like immediately.because you will encounter more problems then u think.

Thank you for your reply. You are probably right about attaining the services of a lawyer. I have been hesitant about doing that because I did not want a lawyer going after the company I work for. I am actually a sub contractor and soley do work for that company. They have done a lot for me during this time. They do not have any kind or light duty work since I am not a hired employee. I feared that if I did get a lawyer, this company I sub for would pretty much deny me any jobs. I do have to come to the conclusion that I will probably not ever be able to go back to what I was doing because of the injury and the nature of the job. Which brings me to another issue. Since I was sent for an impairment rating and have this restriction on me, I can not look for the type of work that I normally do. Texas workmans comp does have a job training program for cases like mine but my impairment rating was not high enough to qualify for that benifit. I am in the middle of appealing that rating but all this takes time and especially that now it is right here at the holidays, the people I need to be in contact with are on vacation.
 
Reply
#5
There is nothing for you to do in reference to the IRO. The IRO is a panel of drs. that will look at your medical records and determine if " Medical Nessicity " exsists.

You said "Texas workmans comp does have a job training program for cases like mine but my impairment rating was not high enough to qualify for that benifit." Can you tell me more about that???
8-05, Micro laminectomy/disectomy. 10-05 lumbar fusion L5-S1. 2-07 exploritory surgery. 12-07 medical implant, Spinal Cord Stimulator. now receiving SSDI. After going back to school, I received my degree as a mechanical engineer. What can I say, it was the only way I had to beat the system. 
 
Reply
#6
AQA Wrote:There is nothing for you to do in reference to the IRO. The IRO is a panel of drs. that will look at your medical records and determine if " Medical Nessicity " exsists.

You said "Texas workmans comp does have a job training program for cases like mine but my impairment rating was not high enough to qualify for that benifit." Can you tell me more about that???

I really don't have too much information on that benifit since I did not qualify. I am appealing the 5% rating so maybe if I do qualify I will know more about it. I read a little bit about it. If you are not able to return to your normal job because of restrictions or the injury, there is a program that will train you for a different type of work. Im not sure what impairment rating you must have to qualify.
 
Reply
#7
I was only asking to see if there was something to with retraining in Texas WC that I was not aware of. Meaning something that may have changed in the past three years. I have been dealing with the Texas WC system since 8-05.

The "STATE" has a rehabilitation program. It has nothing to do with WC. I am not sure what all the qualifications are. The system is called DARS.

One of the medical procedures I had, had to go to an IRO. It was resolved in my favor.
8-05, Micro laminectomy/disectomy. 10-05 lumbar fusion L5-S1. 2-07 exploritory surgery. 12-07 medical implant, Spinal Cord Stimulator. now receiving SSDI. After going back to school, I received my degree as a mechanical engineer. What can I say, it was the only way I had to beat the system. 
 
Reply
  


Possibly Related Threads...
Thread Author Replies Views Last Post
  In California 10% of denied treatment is overturned on appeal 1171 1 831 11-16-2016, 02:06 PM
Last Post: California_Help
Question Denied treatment for old injury salvador5266 15 3,699 01-26-2016, 09:25 PM
Last Post: 1171
  Denied Treatment alg 5 4,255 05-22-2011, 09:32 PM
Last Post: bodybuilder1958
  claim denied- still seeking treatment jlarson 0 2,858 03-15-2011, 12:19 AM
Last Post: jlarson
  Depression treatment denied katicabogar 20 12,497 08-15-2008, 04:03 PM
Last Post: Bad Boy Bad Boy

Forum Jump:


Browsing: 1 Guest(s)