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  1. #1
    top Guest

    Default Workers Comp Wants To Compel Surgery

    OK,Question for those in the know.My case was controverted(and TTD stopped,which I have no problem with generally)because I opted not to have surgery for the covered injury(hernia).The insurance carrier claims that since I opted not to have the surgery I am considered medically stable,even tho 3 Dr.'s(one belonging to the carrier)stated it is my choice not to have surgery and it can't be forced on anyone,and all 3 Dr.'s agree on light duty(my job was seasonal,and the business has since changed hands).A very reputable Dr. gave me a 12% PPI rating based on the AMA guide 5th ebition(as required in Alaska).The insurance carrier isn't aware of this yet,but had previously told me that since I am medically stable their responsibilty is over,unless I decide to have the surgery within 2 years,in which case that would be covered as well as TTD for an unspecified time.
    The Dr. who gave the rating also carries a Doctorate of law and stated that the PPI would give me the opportunity for a C&R and/or vocational rehab since NO ONE can be forced to have surgery.He stated only 5 states don't offer this,and he wasn't sure which states.I had the PPI in my home state.
    While I don't want surgery,there may come a time when I have no choice medically,but I want it covered whether it is 2 years or 30 years down the road,and a PPI and C&R seems like the best way.Like most here,I didn't ask or want to be injured and it seems I must be missing something when a carrier can just walk away when it is my right and my choice.Any answers would greatly help.I retained an attorney from the list provided by Alaska work comp,but he never even relayed the decision of the board after the pre-hearing nor has he answered my recent mail(certified).I hope some of you know more than I about handling this,Thanks a bunch

  2. #2
    anon Guest

    Default

    One of the things we as IW's must prove is a willingness to get better; that is our reponsibility. When recommended treatment is denied by the patient we are not fullfilling our part of the pact. If you are in concurrance that surgery will most likely be needed down the road why are you delaying the inevidible?

    The insurance company has the right to deal with claims as quickly as they can; to expect one to keep a file open indefinately because you don't want it "yet" is asking alot. I don't know alaska's specifics but I imagine that this may be part of what governs the limits.

    They've offered treatment and you have declined it. To wait for treatment untill the pain gets bad enough to where you decide you want it could result in complications not caused by the accident but by you choice to delay treatment.

  3. #3
    top Guest

    Default

    I am not asking to keep the case open "forever",but choose not to have surgery for a number of reasons,most importantly,because their are no assurances that this or any surgery could be performed with no problems either during or after the surgery,and the way it stands at this point is,the only problems I experience is the lack of full use of my body IE:lifting etc.,and I am in my 50's.I have never denied any treatment other than this surgery,and I am not in concurrance nor are any Dr.'s that this surgery is inevidible down the road.I could possibly live forever like this,but the fact remains that it is a work related injury and all agree on that,and my working limits have been reduced considerably.I have never been upset at the loss of TTD since controversion as I said and agree that they can't be expected to keep a case open indifinately,but all one has to do is read posting after posting and do research to see that surgery isn't always "the fix" either.Is it not an IW's choice to have or not have invasive procedures?,yet is it also not unresonable to seek a C&R if for no other reason than to cover the possibility of surgery at todays costs based on the injury and the PPI?.I am trying to see both sides here and feel I am being more than fair in my thoughts regarding this.At the same time,I can find no statute that requires an IW be forced to have surgery anywhere.Even during the PPI rating the Dr. couldn't assure me that there would be no problems after any surgery.
    I see your point and concur to an extent Anon,but also feel I am seeking to be more than fair myself regarding this injury.Thanks for your input

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