Unhappy With Work Comp Administrator

[BrokeBackMountain]

Real California Case


Browsing this forum I found quite enlightening. I injured my lower back at work in March of 2007. I went through the Chiro and Physical therapy route for nearly 18 months. My Chiro actually referred me to a Surgeon for his opinion -- which is quite rare as Chiro usually take a different approach to spinal injuries.

Referred surgeon agreed and viewed MRI and X-rays and determined that I have a large bulge at L4 - L5. He recommends spinal fusion.

Gave info to W/C administrator they set me up with a QME who did a very thorough exam and gave his opinion that spinal fusion was in order.

Now the administrator will not return calls and have cut my TD payments off effective early August 08. The Notice Regarding Temporary Disability Benefits Delay -- "I cannot pay you temporary disability benefits for the period XXX through XX at this time because we are unable to ascertain what your current medical status is as we have two conflicting medical reports. I expect to advise you of the status of these benefits by XX08".

That is the last I heard from them other than they are seeking Legal representation at this time....Is this the biggest crock....

What to do???

[Bad Boy Bad Boy]

File for a dispute, or a hearing with your State Work Comp Board. The Insurance Carrier mostly always has an Attorney. They don't need to shop around that much.

[1171]

sounds like you've been released to return to work by another doctor.
ask for a copy of both medical reports - in writing.
contact your local Information & Assistance officer for help in filing an appeal.
http://www.dir.ca.gov/dwc/IandA.html
forms are available online
you can get general information about California's comp from the fact sheet's
http://www.dir.ca.gov/dwc/iwguides.html