Pa workers comp changed surgery date

[mikeyb1968]

(12-22-2010 11:34 AM)jayne Wrote:  so the insurance adjuster went against medical advice?

Yes Jayne. The scheduling dept. had a date open and gave it to them. The Physicians Asst. that was not at my appointment said she saw the opening and assumed it was ok.

[jayne]

yes well maybe your lawyer can explain what "assume" does

[mikeyb1968]

I'm sure he will Jayne. I am not to worried about the outcome, after all...I had the surgery and I think the judge will see it that way and quash the petition. But the ones you think are sure things....are often the ones that come up and bite you! My attorney is going after unreasonable contest to get his fees from them. His thinking is they plain and simple interfered with my medical and should have never been able to just change my surgery date. (the hospitol willingly changed the date because the adjuster made it sound like thats what I wanted!!!)
Thanks...MIKE.

[Bummer Knees]

Mike in my opinion the hospital cooperated with the adjuster because it is the insurance company who pays the bill.

Three different times I've had my doctor's appointments changed or cancelled because the case manager said the knee was not covered by work comp.

At the last appointment in which was for the MMI and rating, I called the office the day before the appointment and the office manager told me, "I am sorry your knee is not covered by work comp"

I told the lady that is odd, your doctor did a knee replacement on this knee and work comp paid for it, the court order I have in my hand and signed by the judge says the knee is covered.

Well the lady said she would make some phone calls, and 6:00 that evening I received a phone call from the office manager apologizing for the mistake, she had called the case manaager, they called the adjuster and learned there was a court order for medical treatment.

I missed 2 doctor appointments after the surgery because of this BS.

[mikeyb1968]

I understand the Insurance co. has some say, but when my doctor explained why the date was when it was...they still filed a petition. To me, I don't understand how any adjuster can say "no doc...I don't care if you the DOCTOR think he needs therapy before the surgery...I the claims adjuster, want him to have it sooner". And on top of all this, ALL doctors (6) including the IME, said having the surgery would NOT get back to pre injury status and improvement from the surgery would be minimal. I would gain SOME pain releif and SOME ROM.
Thanks, MIKE.