11-23-2010, 05:00 AM
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.
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.
