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Denied Treatment - alg - 05-21-2011

:Hi All,
My brother fell off a ladder (should have locked) at work and broke several ribs. There is possible damage to his back and he is now (after 5 months) having severe balance problems. The doctor is documenting all of this and the possibilities of these problems arising were noted at the initial hospital visit.
However, Workman's Comp is refusing to pay for any additional tests. How can they do this? What do we do next? His doc said that he may have a subdural hematoma. These can show up several weeks after a fall like his. This is an urgent situation. Does anyone have any recommendations?
We are in Texas.

RE: Denied Treatment - bodybuilder1958 - 05-21-2011

Emergency care is not denied to anyone, especially when a subdural hematoma is suspected. Who is to pay can be figured out much later.
I would recommend a lawyer look into his case and help him get the necessary treatment.

But if he's having symptoms, especially balance problems I would just go to an ER and see about treatment. Subdural hematomas are nothing to toy with. If care is urgently needed worry about payment later on, that's what lawyers are for.

Take care,

RE: Denied Treatment - alg - 05-21-2011

Exactly what I thought. I am in another state and cannot be there to take him. My mother is fretting over this but does not understand the gravity of the situation. I think a trip to the ER is in order.
Is a lawyer necessary in many WC cases? I am relatively sure he will be permanently disabled. Does this change things? He is back at work on a limited basis, but not in his previous job as a mechanic.

RE: Denied Treatment - 1171 - 05-22-2011

he can send the denial to his health carrier and they will begin picking up treatment.
if it is a utilization review denial then the treating doctor has to appeal.

RE: Denied Treatment - bronco54501 - 05-22-2011

Most likely if they are denying treatment now, you may need a lawyer.. As far as all wc cases needing lawyers..... Some do and some dont... And yes hemotomas are nothing to mess with, I flatlined because of one....Not pretty.....

RE: Denied Treatment - bodybuilder1958 - 05-22-2011

Bronco you're very lucky, subdural hemotomas have a mortality rate of around 80%.

Get treatment, get it ruled out, worry about treatment later. Denial of care with such a possible diagnosis makes me wonder why the doctor didn't immediately send him off for a full evaluation. Delays make for lawsuits