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  1. #1
    Join Date
    Jul 2011
    Posts
    3

    Default Denying Further Medical Treatment

    My workers compensation claim was made in the State of: Nebraska Injured at work I have a hernitated disc. I have done everything possible instructed by my neurosurgeon and nothing has fixed this injury. I am off work until further notice. My surgeon has told workers comp I need surgery. They got their second opinion from a neurosurgeon of their choice who also stated I need surgery. This was a couple months ago and I still have not been scheduled for surgery. I have an attorney and we are discussing suit. Should the insurance company have further compensations due me for denying my medical treatment? My condition is not getting better, only worse. Should I be able to make further claim for unecessary physical and mental pain and suffering? And also my rights being violated for medical treatment? Please respond as to what I can do and how long this should really take. Thanks for any input.

  2. #2
    Join Date
    Mar 2007
    Location
    Georgia
    Posts
    1,928

    Default Re: Denying Further Medical Treatment

    HDI I hate to be the bearer of bad news but you and your AA/attorney are doing about all that can be done. Has you AA asked for a hearing or review before the WC board? Sometimes that is what it takes to get the IC off their dead behinds and get approval for surgery. I had to wait seven months to get my rotator cuff repaired. The first three I stupidly agreed to "conservative treatment", PT, exercises, etc... After there was NOT only NO improvement but I was actually getting worse my orthopedic surgeon made request for the repairs. The IC took FOUR months to get the approval. I ended up having to have an additional surgery several months later and that too took three months for approval.

    As far as seeing any extra benefits for the delays you MOST likely will not. WC is considered your exclusive remedy for industrial injury. I do NOT know of any states that impose a penalty for delaying recommended treatment, be it surgery or otherwise. The only penalties I am aware of is when the IC does NOT pay wage replacement benefits on time. Each state has their own guidelines as to what is considered untimely as well as the amount of penalty.

    Hopefully they will get off their sorry tails and get this approved for you sooner rather than later.
    "He who is his own lawyer has a fool for a client"
    Abraham Lincoln


    Take Care and Be Well.

  3. #3
    Join Date
    Jul 2011
    Posts
    3

    Default Re: Denying Further Medical Treatment

    Wow, that's kinda what I thought I might hear, but i'm not an attorney so I wanted to ask. Also, I have taken a high amount of confidence in my attorney, but other opinions are also good information to reasure I have the right attorney making the right decisions. Thanks

  4. #4
    Join Date
    Oct 2006
    Posts
    9,108

    Default Re: Denying Further Medical Treatment

    they may be open for penalties from the comp court if they have insufficient evidence for their denial.
    you need a hearing on the issue.

  5. #5
    Join Date
    Jan 2010
    Location
    Pennsylvania
    Posts
    609

    Default Re: Denying Further Medical Treatment

    I am not sure about Nebraska but here in PA if the IC actively denies needed treatment ( you go to the Dr., get treatment, they bill IC and IC actively denies and states reason), you can file petitions for penalties. At the time the petition is heard, the judge will consider and make a decision as to if a.) the treatment was work related b.) if the treatment was reasonable and necessary c.) determine if the IC unjustly denied payment (thus denying treatment), and c.) how much of a penalty( if any) they will have to pay. Mind you, they can always appeal. Well, so what. If WC is going to be exclusive remedy and the injury is from work, they need to pay it. You have no choice other than pay it out of pocket. I don't know many who are out on WC that can lay that kind of money down. If the judge renders that decision, then if you have a GHP, you can always have it billed to the GHP. Because it's all right there in legaleeze. Just don't try to do this unrepresented.

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