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  1. #1
    Join Date
    Oct 2007
    Posts
    91

    Default Denied Twice

    in need of back surgery lower back fusion with plate and two shims in lower back. never had back trouble until injured lifting something herniated dsic then.filed claim denied twice .what will they do next.w/c saying unnessary surgery i'm still working but with pain pills.in which i'm sick of taking .what will they offer to do .i was told claim not denied but purposed surgery is . do i need a lawyer or be patient still?hurt in august this year now end of oct.

  2. #2
    Join Date
    Jul 2007
    Posts
    210

    Default Re: denied twice

    ANY denial for ANYTHING related to WC benefits needs the attention of a WC attorney and you would be well advised to get yourself one...HOWEVER DO NOT go for a TV lawyer, you know, the ones that have commercials during the daytime trash TV shows and late night programming. If indeed you do have a claim a lawyer will accept your case and get you the benefits you deserve. You should have done this after the first denial...Good luck to you...

  3. #3
    Join Date
    Jun 2007
    Location
    Tennessee
    Posts
    200

    Default Re: denied twice

    If your doctor says that you need the surgery, but WC is saying you don't, then I would definitely recommend that you contact an attorney to represent your interests. An attorney should be able to file the appropriate documents with the Dept of Labor to get your appropriate treatment.

    If you are in the East Tennessee area, I'd be happy to schedule a meeting to talk with you, or if you are in another part of the state, I'd be happy to refer you to one of colleagues who may be able to help you.

  4. #4
    Join Date
    Oct 2007
    Posts
    91

    Default Re: Denied twice

    i guess i'm nieve about this never had a claim in my life .i was told by my human resourse lady at work it would slow the claim up if i involved a lawyer.what the problem is my mri was read wrong by radiologist only stated small herinated disc thats it. where the nerosurgeon said they didn't see everything he saw . i then had a meylegram with dye ct scan and i believe that was done to prove what the doc had seen . i've had pyhsical thereopy and was told i was unresponsive to treatment but i was told it was only min. pain. i was taking pain pills while doing that. plus all they had to go by was mri which stated small her. of disc.plus i'm still working which i guess may doesn't look good i can't afford not to.the doc. told me to talk to my case nurse because they feel something else would be done,perhaps another opinion or mri i don't know.i work at a really good place and feel i have support with my supervisor and human resourse lady.i see alot of people on here saying not to trust the case nurse but so far she seems to be trying.the letter i got from her states she doesn't work for the state or w/c is this true? i know of a lawyer thru someone at work who used him. i just think i should give them a chance first to see what they come up with next.

  5. #5
    Join Date
    Oct 2007
    Posts
    91

    Default Re: Denied twice

    i remebered the surgery its call ALIF and for what i've read the sucess rate is really good but a pretty serious one

  6. #6
    Join Date
    Jun 2007
    Location
    Tennessee
    Posts
    200

    Default Re: Denied twice

    i was told by my human resourse lady at work it would slow the claim up if i involved a lawyer.
    And I'm totally sure that your company's human resources department just has your best interests at heart.

    As much as people may say they don't want it to be, workers' compensation cases are very very adversarial. Some companies are better than others about trying to take care of their injured workers, but most are just looking at the bottom line.

    If you have surgery that you apparently need, you'll cost your company a LOT of money. If they are self-insured, it's directly out of their pockets. If they have workers' comp insurance, it costs your company more in higher insurance premiums.

    However, the mere suggestion that you "don't need a lawyer" and that it will just "slow things down" should be enough for you to realize that they really don't want you to get a lawyer that will get you the surgery you need.

    I hate to seem overly cynical and critical, but I've been involved in too many of these cases over the years (on both sides of the fence) to not speak the truth.

    Good luck to you. If you feel like you need the surgery, but the insurance company or your company are not letting you get it, the only way you'll EVER get it is to hire a lawyer to fight for you. Your company will have a lawyer to fight for them. Would you want to take on an insurance company's lawyer by yourself or with a lawyer fighting for you?

  7. #7
    Join Date
    Aug 2007
    Posts
    374

    Default Re: Denied twice

    laura64, Take JLJ's advice. These people will tell you anything to keep you from going to a lawyer. It has taken me 20 years to figure out that they like me a lot at work as long as I keep my numbers high and it reflects on them for their bonuses, and they take credit for making those numbers happen. Not the hourly worker, or the ones under the guys getting the bonuses.

    But as soon as the injury comes, if they had someone to just send in the sewer below the building to count rats, then they would send me there, and tell me how thankful I should be to have that job.

    You have to seperate yourself from the people at work to deal with this. Don't worry about hurting their feelings. They probably play you if you are a friendly, easy going person. The people you work with are your "co-workers," They are not friends. So take care of yourself first. They are denying your treatment because they are takikng care of their pocketbook over your health. It sure looks better if they keep you off WC and it reflects on their year end bonuses. So, get help.
    I hope you get this squared away.
    Lue

  8. #8
    Join Date
    Oct 2007
    Posts
    91

    Default Re: Denied twice

    i will at least talk to one because i'm sure they'll tell me if i have a claim as its money for them.i work for the state.i also think that perhaps w/c has to be cinical too as for there is people that do rip them off.its a very rural area here everyone knows everyone.are kids go to school together as you get my picture. my coworkers are my friends and they say the same see a lawyer.i would think that just my work record should also be looked at . never leaving work calling in due to back pain prior to injury and really still haven't .well only for PT and doc's appt. etc.in fact my supervisor told me have them call me ,she is herself is returning to work from back surgery but not workmans comp.but the the bottom line is i'll go next day off atleast speak to a lawyer.i do have a question does this nurse case woman have my interest at heart as it states in her first letter contacting me?.she is the one that did resubment the surgery claim and is my claim still open ? is it just the surgery been denied? would they atleast attempt a secound opinion of this surgery from a different surgeon? if any of you could answer these question for me it would be great.also has anyone had this surgery ALIF?

  9. #9
    Join Date
    Oct 2007
    Posts
    91

    Default Re: Denied twice

    i thought i would update. yesterdays events. called my nero.for pain meds. his nurse called back saying since i was denied i'm no longer a PE of his. since last week of hereing of secound denial i have been calling w/c and case nurse trying to find out whats next with no returned calls!! my HR got hold of them immedatedly as for i was really freaking out about not controlling my pain within 15 min i was on my way to orginal doc.walkinn clinic sat there for 3 hours but did get pain meds. case nurse calls as soon as i get home says hi how ya doing all cheerie i on the other hand hurt like crazy let her have it. she tells me to calm down and that she and w/c have been working all day trying to find a secound opinion doc. closeist one she says is knoxville 2hours away!!!i said what about the other doc listed from that paper i signed she asked do you have it? what the crap that was faxed to w/c about 3 weeks ago keep in mind she just told me that w/c and herself had been working hard all day! but didn't see their own list sent to me to choose from. also, i was never told of denial from them i heard it from the doc myself and never had another doc in place. i guess i've answer some of my own questions from my last post..

  10. #10
    Join Date
    Apr 2007
    Location
    Tennessee
    Posts
    134

    Default Re: Denied twice

    Laura;Lue and JLJ are right the case manager works for the insurance company and her only interests is thiers not yours and they'll tell you anything to save a dollar and those serguries are expensive.Listen work will also tell you anything to keep thier premiums down they may seem to be on your side but be leery because they will be your best of friends as long as you have thier interests at heart and thats not good your best interests.Listen you have a spinal injury and they'll play russian rulette with you all day but they're gun isn't loaded.Listen workers comp. and the department of labor isn't the bad guys they're on your side as well as the company and the insurance company's.I also have a spinal injury that happened at work and I have an attorney and they have been trying to jerk me around since 04/04/07 but without an attorney I wouldn't have even seen the first doctor and now I go next week to see a neurosergion.Laura they will take their time and a long time unless you push them or have an attorney to push for you and time may not be on your side especially with you working while injured.Take care and consider an attorney because what I'm hearing you'll need one. HL...........

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