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  1. #1
    Join Date
    Oct 2012
    Posts
    8

    Default Surgery Denied Due to Continued Tobacco Use

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

    I have a herniated disc at l5-s1. I have been thru physical therapy, (2)ESI, (1) facet block, Psychiatric eval (says i am a good candidate for surgery), Neurological testing reveals compressed/damaged nerves at l5-s1, (4) MRIs, (1) CT scan, (1) 3-phase bone scan, and countless X-Rays, (4) second opinions, all stating I need a spinal fusion.

    3rd request for surgery approval was denied on basis of that I use smokeless tobacco, this is from work comp. not the DR.

    So can WC do this? or is it just another stall tactic by WC? as I have jumped through all their other hoops and hurdles already.

    If they can do this, then why didnt they tell me this a year ago, instead of waiting til now?

    The WC carrier is Montana State Fund.

  2. #2
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    17,943

    Default Re: Can Work Comp Do This

    A comp carrier... or State Fund can deny anything... your recourse is to go to court to get a judge to order the Dr/surgeon recommendation for the specific treatment.

    Talk to your attorney.

  3. #3
    Join Date
    Oct 2006
    Posts
    9,078

    Default Re: Can Work Comp Do This

    Quote Quoting cornfed82 View Post
    My workers compensation claim was made in the State of: Montana

    I have a herniated disc at l5-s1. I have been thru physical therapy, (2)ESI, (1) facet block, Psychiatric eval (says i am a good candidate for surgery), Neurological testing reveals compressed/damaged nerves at l5-s1, (4) MRIs, (1) CT scan, (1) 3-phase bone scan, and countless X-Rays, (4) second opinions, all stating I need a spinal fusion.

    3rd request for surgery approval was denied on basis of that I use smokeless tobacco, this is from work comp. not the DR.

    So can WC do this? or is it just another stall tactic by WC? as I have jumped through all their other hoops and hurdles already.

    If they can do this, then why didnt they tell me this a year ago, instead of waiting til now?

    The WC carrier is Montana State Fund.
    they have to have supporting medical evidence. request a copy of their documentation.
    get an opinion from your doctor and file an appeal with the comp court.

  4. #4
    Join Date
    Feb 2007
    Location
    831 East Morehead St., Ste 355, Charlotte, NC 28202
    Posts
    3,754

    Default Re: Can Work Comp Do This

    Tobacco use hampers healing from surgery, especially fusion surgery. Some patients apparently have a higher chance of a non-union due to tobacco use. Your doctor already told you this, didn't he? If you stop using it they will probably reconsider. Many back surgeons will not even perform a fusion surgery on someone who uses tobacco regularly.
    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 and Board Certified Specialist in NC Workers' Compensation Law

  5. #5
    Join Date
    Oct 2012
    Posts
    8

    Default Re: Surgery Denied Due to Continued Tobacco Use

    DR. never said I had to quit, just recommended it. and I have quit, i can pass a nicotine test as they requested, but now denying surgery, and Dr (surgeon) said he cant do anything for me now.

    12/10/2012
    Notified by surgeons asst/nurse that on 11/13/2012 work comp denied surgery, including the ordered tobacco tests, and continued visits to surgeon.
    Noone had notified me of this at all til i found out today, 12/10 when I called to confirm my tobacco test that was scheduled for 12/14/12.

    which brings me to this:
    Montana Utilization & treatment guidelines recommends 6 weeks tobacco free, but MSF wants 3 months??? I'm tobacco free for 4 weeks now

    W/C MSF has not notified me, or my attorney that it was denied, or what their next big move will be.

    I weigh 265/275 lbs 6'5" I'm not fat, I have a 63" shoulder, and 38" waste, so I'm not fat, I have a few (10-20) lbs I could lose. But their IME DR/hitman/mercanary says I need to lose 100 lbs cause for my height I should weigh a max of 175 lbs.

    How do I dispute this? what are my options?

    Can I sue for lack of providing coverage? or operation/surgery? or sue to get them to approve?

    I am so frustrated over this whole deal, and the other great kicker to it all is I have had over 6 case workers hand my case off to another one, so the new one wants me to go thru all the same stuff the previous put me thru (PT/14th opinion/5th surgery consult) all except the 3 that WC appointed say I need the surgery, that all of the non-invasive hasnt worked. the 3 that say i dont need the surgery are their IME DR (doesnt deserve title of DR) a psychotherapist, and another surgeon, that was WC recommended DR from beginning of case. but all said to my face that there is no fault in the plan for surgery that we requested, until its on paper and in WCs hands, then its a whole different story.

    sorry for rambling, im prettty beat down and depressed over this today, tired of all their BS.

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