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  1. #1
    Join Date
    Sep 2010
    Posts
    23

    Question Worker's Comp Won't Pay for Prescribed Treatment

    My workers compensation claim was made in the State of: Tennessee

    I have a protruding C6-C7 disc and suffer with continuous pain. My neuro doctor has determined that it's not surgical but referred me to pain management in OCT. Workers comp has denied pain management but the neuro surgeon was under the impression that it was going to be provided and discharged me from his care(I,also, believe he got tired of being bossed around by WC ). Now, I have been hung out to dry. No doctor, no tx, and needing more pain management than my pcp can provide.
    I have been told by WC to return to work the first week of January. I have had to obtain pain medicine from my PCP and was told by WC to see my PCP for pain and the neuro surgeon was told by CM to not prescribe me pain medication because my PCP was handling that. but they refused to take responsibility for the visit or pay for the medication.
    Any ideas on what I need to do? I am expected to follow the MD orders. Why aren't they?

  2. #2
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,021

    Default Re: WC Refusing Tx Ordered by Md

    I have had to obtain pain medicine from my PCP and was told by WC to see my PCP for pain and the neuro surgeon was told by CM to not prescribe me pain medication because my PCP was handling that. but they refused to take responsibility for the visit or pay for the medication.
    Of course the ER/IC is going to try to shift the liability to you and your GHP. Why would they pay if you/GHP are going to ?

    Workers comp has denied pain management but the neuro surgeon was under the impression that it was going to be provided and discharged me from his care(I,also, believe he got tired of being bossed around by WC ).
    Your Dr should not release you until there is an authorization to a referral to another physician. He's basically saying there is nothing more he can offer in treatment, indicating you are "MMI"...

    Your PCP/family Dr shouldn't be treating the work injury, your GHP/Group Health Plan, private health coverage is going to deny payment for those services. Anything related to your work injury is not going to be accepted by the GHP. IF they opt to pay, a lien will be placed on your claim.
    Any ideas on what I need to do? I am expected to follow the MD orders. Why aren't they?
    Workers Compensation is a set of laws/rules that govern the ER's liability for industrial injury. The medical care is but one of those benefits the laws mandate provided. Medical care in WC is not "health coverage" for the EE/IW. The Dr may provide the medical evidence and treatment plan, but it's not "legally'' binding on either party.
    WC is all about liability. No one disputes you are injured, only the degree of benefits required.

    When you are delayed, or denied benefits, you consult with an attorney. That is the advice from here. WC is not generally a "DIY" project.

  3. #3
    Join Date
    Sep 2010
    Posts
    23

    Default Re: WC Refusing Tx Ordered by Md

    Thanks. Really hoping he is worth his weight in diamonds. I agree that he should not have discharged me from the neuro services. After several months of conservative tx and no response, one would think that further investigation of the area would be logical. Another MRI perhaps, to make sure that something wasn't missed or that a good film was produced or it may have completely herniated. That seems like common sense to me. But wait..That might cost the company money...I was told right after my accident by the NP that I saw. Some people you just want to slap.. I have learned that common sense does not apply to anyone involved with WC/IC and getting a speedy recovery through WC/IC is a JOKE.

  4. #4
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,021

    Default Re: WC Refusing Tx Ordered by Md

    As I said, WC is not like your health insurance.
    The ER/IC is not required to keep searching for a source of your pain. If you present with a specific complaint, and source or specific onset/injury, it would be investigated.

    And, yes, it is about the cost to the ER/IC... that's what WC is, liability.
    If you go to your Dr and say "I hurt...", you can have any/all diagnostics you are willing to pay a share of cost to.
    After several months of conservative tx and no response, one would think that further investigation of the area would be logical. Another MRI perhaps, to make sure that something wasn't missed or that a good film was produced or it may have completely herniated.
    It would be up to your treating physician to request a MRI and the medical reasoning to support the request. They aren't going to pay for a "look see"...you can of course, and if there are significant findings... a WC judge would probably order the reimbursement by your ER/IC.

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