Pa workers comp changed surgery date

[mikeyb1968]

Hello all and thanks for the informative site. I have an open workers comp case in Pa. and my question is can the claims adjuster move up a scheduled surgery date witout my permission? I set up the origanal date with the doctor and the adjuster called and moved it up 2 months sooner. I moved it back to the first date and they then filed a petition because I refused reasonable medical treatment. I'll add more details when asked...Thanks.

[1171]

generally the carrier has medical control.
but they also don't have to pay disability if the worker is intentionally prolonging disability.
whether it is or not is up to the comp court.
maybe you can offer a compromise: accept the later date but allow them to stop disability payments during the interval.

[admin]

I'm curious. Why would you prefer to delay treatment?

[Bummer Knees]

Admin sometimes there are other things going on in an injured worker's life that takes priority.

At one point in my case I delayed medical treatment for a very good reason.
During the course of treatment by the wc doctor I received the Dx of skin cancer and felt it was more important to have the tumor removed, so medical treatment for the work injuries was delayed.

I was honest with the wc doctor and never had a problem with the insurance company.

[admin]

Bummer, I understand that completely. Just curious as to what the particulars in this case are.

[johnnyvick]

just because you get approval for the surgery doesn't mean you have to have it do you? i always took as its now available if that the way you want to go

[1171]

if you change your mind and decide against surgery generally it'll be determined that you've reached maximum medical improvement and disability changes.

[Timothy Belt]

In PA reaching MMI alone does not change your disability status.

As to the original question, if it has been more than 90 days since your injury, you are able to pick and choose who you treat with and what treatment you receive. That being said, if you fail to follow through on medical treatment that presents minimal risk and possesses a high likelihood of increasing your ability to return to work, a WCJ does have authority to grant a petition to suspend your benefits until you receive the treatment.

Since a petition has already been filed, this is about to get messy. If you do not have a lawyer, you will be at a serious disadvantage.

(12-21-2010 07:36 PM)1171' paid='129808 Wrote:if you change your mind and decide against surgery generally it'll be determined that you've reached maximum medical improvement and disability changes.

[mikeyb1968]

I did not want to overload with my first post, so I will give more details as to why I "delayed" my surgery date. This surgery was my 3rd for my injury. I have had 2 shoulder operations and my doctor recomended not having a 3rd surgery for my elbow. (Injury was left wrist, left elbow, left shoulder and broken coller bone). After an IME, that doctor recomended surgery on the elbow. He stated that this would NOT get to pre injury status because of my other injuries including never being able to gain full capacity of my left shoulder due to the unstable type II SLAP repair, but would I POSSABLY gain some ROM from the surgery. The claims adjuster called my house after I received a copy of the IME report and was really upset with me because I had not set up a surgery date. I told him I was not sure the surgery was the way to go. He made an appointment for me to see my doctor. I went and the doctor said we would do the surgery but there was a GLARING POSSABILATY that there would be NO improvement. The doctor said If Iwanted to have the surgery he would do it, but HE recomended I try some special physical therapy to improve muscle around the injured elbow for 5 months and at that point if I had no improvement and still wanted the surgery, he would do it. We set up the surgery for 4 1/2 months later. The claims adjuster got the date, called the hospitol and changed the date with the scheduling dept. They made it 2 months sooner. I called and told them why the surgery date was when it was and he said he did not care about any of that. I retained an attorney the next day, he told me move it back to the original date. I did, they filed a petition for refusing medical treatment. I had the surgery before we could even get in for a hearing. Thanks, Mike.

[jayne]

so the insurance adjuster went against medical advice?