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  1. #1
    Join Date
    Nov 2009
    Posts
    4

    Exclamation Problem with Workers Comp Agent

    I had to have rotator cuff surgery in August 2011. All was going well until the last few weeks when it started becoming painful again and had that crunching-grinding. My doctor is wonderful and I have NO problems with him. The problem is the agent with the workers comp insurance. I of course have to have the pre op tests done but when I talked to her she actually said that I needed to wait since some of these doctors are just trying to get a 2nd surgery for the money! I explained that I went to the doctor they sent me to and that according to the new MRI the tendons (or whatever) above where he fixed it now are tearing. I called my workers comp agent to get the clearance to get to pre op test done and she said I'd have to wait.
    I have had maybe 4 conversations with her in the last 10 months so my question really is, is there anyway I can request a different agent? Others I have talked to when she's been off have been very helpful. I don't know if I have the right to ask for someone else to handle my case. It's not like I'm really looking forward to having another surgery! But as difficult as thsi all is, having her make thkngs worse is just too much. I've have to go on medication for the anxiety! Any help or experiences you can give would be greatly appreciated. Is it time to look into getting a workers comp lawyer?

    Thanks so much---Starznaz

  2. #2
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    17,938

    Default Re: Problem with Workers Comp Agent

    I called my workers comp agent to get the clearance to get to pre op test done and she said I'd have to wait.
    Wait for what?
    Your Dr is the one to get any prior authorizations...IW's can't do that.
    It's not for the CA/Claims Adjuster to determine why a Dr would request, only authorize, or go through the carries internal UR/Utilization Review process, if there is one in place. Nor is the CA to make a determination of medical necessity...that's what Dr's are for.
    If the CA wants another opinion, you can be sent to an IME.
    Talk to your Dr/surgeon... get him/her on the ball here.

    Not likely you'd be granted another CA...that's a decision made by the IC who handles your claim/benefits. Not many IW's are ever happy with their CA's. If you continue to have difficulty with this CA, talk to the unit supervisor. Express your concerns.
    Yes... talk to a few attorneys...there is no fee for consultation.

  3. #3
    Join Date
    Oct 2011
    Location
    north dakota
    Posts
    43

    Angry Re: Problem with Workers Comp Agent

    starznaz i can completely relate . my ca is very ignorant and has screamed at me on several ocassions called me a liar even when i proved my self right ,she has now cut off my td , and wont help me find a dr or even talk to them in the new state i am in , i also had to be put on anxiety depression pills just from dealing with her , she constantly lies in her dictations , witch i constanlty try to correct them cause they always twist every word you say .. i feel for you try contacting there supervisor it worked for a while for me , but now even when i leave message for supervisor
    the spawn of satan she calls back instead
    good luck

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