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insurance denying surgery
#1
WC in Texas since 08/17/2016.
Had 2 ESI, 1 RFA ablation several session of PT , 2MRI, 2 XRays, EKGM nerve test.

All 3 Dr's ( Treating Dr, Spine Surgeon, Orthopedic Surgeon ) agree of a spinal fusion at L5S1 and laminectomy at L4 .
Insurance denies surgery, reason Surgeon documented symptoms don't match with the digital image of the damaged injury.
The spine surgeon will appeal with new better-documented report?
Why is the insurance denying if they can see the damaged disc on the MRI?

Also, today I received a call from the TDI-WC saying that I have a DDE appointment for March 20th ( 2nd already ) requested by the Insurance carrier.
Is the Insurance forcing me to a MMI ?

Thank you so much , this has been a roller coaster
 
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#2
adjusters/claims personnel do not interpret radiographic findings; it's outside their expertise.
MMI is determined by a physician; generally costs are reduced the shorter the wage loss period.

a friendly reminder: Insurance & medicine are businesses; all decisions will be business decisions.
........Each state has their own comp system; POST YOUR STATE to get accurate information.........
 
Reply
#3
(02-08-2018, 08:16 PM)1171 Wrote: adjusters/claims personnel do not interpret radiographic findings; it's outside their expertise.
MMI is determined by a physician; generally costs are reduced the shorter the wage loss period.

a friendly reminder: Insurance & medicine are businesses; all decisions will be business decisions.

thank you. I stated Texas
The Insurance Co is denying surgery Not the adjusters
 
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