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+--- Thread: Denied by Workers Comp (/showthread.php?tid=13578)
Denied by Workers Comp - gthe3 - 05-05-2012 09:38 AM
I have a couple of things going on here. I have been out of work since 12/8/11 due to a left shoulder dislocation. I am out of work and im on workers comp. I have been doing four months of physical therapy and my range of motion has not improved at all. I received an mri and nothing was seen as torn or broken. My doctor gave a cortizone shot and nothing doing. So, my physical therapist requested more sessions and workers comp denied it saying that it was not working and that I needed a better plan of action from the doctor. So, I went back to the doctor and he recommended surgey. Workers comp denied it saying that they will not approve any surgery until i receive 6 months of physical therapy and this is after they denied me more physical therapy. Now I have been out of physical therapy for a month now and waiting on what my doctor is going to. I have called them a number of times and they have not returned my call. And im still out of work. I just feel that nobody is making any decisions and draging this out because the insurance company does not want to pay for surgery. If anybody can provide some help that would be great. Oh I live in Mass.
Thanks,
RE: Denied by Workers Comp - 1171 - 05-05-2012 11:48 AM
sounds like you need to take the treatment denials to the comp court and have the judge decide.
you can get an atty or do it yourself.
more information here on handling disputes
http://www.mass.gov/lwd/workers-compensation/injured-workers/denial-of-claim.html
RE: Denied by Workers Comp - PainandSmiles - 05-05-2012 08:34 PM
Im confused. If nothing is showing up on MRI, what's the surgery going to fix?
RE: Denied by Workers Comp - AQA - 05-05-2012 10:43 PM
Painandsmiles,
Not to take away from the original point of the thread, but I will answer your question.
Not everything shows up on an MRI. It doesn't matter whether it is a closed or open MRI. That is what led to my third surgery. The request to the IC stated the surgey was "exploritory surgery".
RE: Denied by Workers Comp - ssauer - 05-05-2012 11:20 PM
I went through H and back with WC. Get a lawyer. I don't know how they go about payment where you live, but here they can't charge more than about $5,000, and that comes out of your settlement.
I went through H and back with WC. Get a lawyer. I don't know how they go about payment where you live, but here they can't charge more than about $5,000, and that comes out of your settlement.
RE: Denied by Workers Comp - hurt back - 06-08-2012 07:13 PM
Sounds to me like you should get a lawyer and let him handle the insurance company. My atty has helped me thru it all so far. I pray that you get this resolved. Sound like they should either approve the PT or the surgery, but either way sounds like you need some legal help.