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  1. #1
    Join Date
    Mar 2012
    Posts
    37

    Default Artificial Disc Replacement Under Worker's Comp

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

    What are the odds of having an ADR approved in the workers' comp system these days? It is something I am interested in but I don't want to get my hopes up and research if it will be shot down.

    My herniation is at L5-S1.

    Any success stories out there?

  2. #2
    Join Date
    Feb 2007
    Posts
    191

    Default Re: Artificial Disc Replacement - Allowed

    i had a friend who had microscopic sergery hes fine !

  3. #3
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,011

    Default Re: Artificial Disc Replacement - Allowed

    Prior authorization for any treatment is the responsibility of your PTP... based on your diagnosis, the ACOEM/MTUS or other evidence based medicine, and what is 'reasonably expected to cure or relieve from the effects of your injury/illness/disease". Treatment is not an option or choice...meaning while you may accept/decline any treatment recommended, your benefits will ultimately be affected by your decisions.

    There are no "odds" of any one particular procedure over another. Talk to your PTP about all of your options. How do you know ADR is recommended or appropriate for your injury?

  4. #4
    Join Date
    Mar 2012
    Posts
    37

    Default Re: Artificial Disc Replacement - Allowed

    I know my PTP has told me that I need a fusion after one failed microdiscectomy. I'm trying to do my due diligence in what will be right for me in the long run, so I research and then research some more (I can't do much of anything else right now LOL).

    So it sounds like if that is the recommendation by my PTP, it is something that may be approved by the IC? I know I'm preachin' to the choir here, but I'm in my 40's and I just can't see the rest of my life being spent in pain. I'm going to try to do all I can to get the best possible treatment.

    Thanks.

  5. #5
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,011

    Default Re: Artificial Disc Replacement - Allowed

    So it sounds like if that is the recommendation by my PTP, it is something that may be approved by the IC?
    If your PTP can provide the substantiating medical reasoning for a particular procedure, it would go through the UR process. If denied, you have the option of an AME/PQME. There are specific procedures for SOSS/Second Opinion Spine Surgery.

    Regardless of the research you do...you need to discuss your options with your PTP. That's where treatment recommendation orginiates. No sense spinning your wheels if the PTP does not see ADR in your future.

  6. #6
    Join Date
    Feb 2007
    Location
    Charlotte, NC
    Posts
    3,093

    Default Re: Artificial Disc Replacement - Allowed

    ADR is a somewhat controversial procedure that some docs have stopped doing due to the outcomes. You would want to research it extensively before consenting to it.
    The North Carolina Court of Appeals has held that "In contested Workers' Compensation cases today, access to competent legal counsel is a virtual necessity." Church v. Baxter Travenol Labs, Inc., and American Motorists Insurance Company, 104 N.C. App. 411, 416 (1991).

    Bob Bollinger, Attorney at Law

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