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WC denied My surgery...

AnonymousUserAAnonymousUser Posts: 49,731
edited 06/11/2012 - 8:22 AM in Lower Back Pain
Got the call today that workers comp denied My surgery. So now I'm forced to get a lawyer. What does WC expect, to just deal with the pain and go back to work? That's not likely to happen, especially when My NS has Me off work still. Anything that I should aks or tell the lawyer when I go to the consultation? Any advice would help....thanks.




Just as I was about to hit submit, the phone rings. It was My NS office calling Me to say they would like Me to get some X-rays done to see if maybe that will help WC approve the surgery. My Dr already knows whats wrong with Me but She said maybe if we do this it will help. I did tell her I was getting a lawyer and she said that would be a good idea.
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Comments

  • Don t give up in the fight with w/c. they will fight you tooth and nail for things you need , document your pain and sleep depravation in a journal for the docs and w/c to see. hang tough and guird up your courage! getting legal representation is a good idea, keep track of what has been denied in the past, and keep track of symptoms
    luck to ya!
  • can't give any advice about WC but I atleast wanted to pop in and show you some support. I wish you the best and I hope that this will be resolved quickly for you. Please keep us posted....Miki
  • It seems to Me that fighting tooth and nail will just cost them more money in the long run, I dunno, i dont get it lol 8}
  • I have had 4 opinions so far, 1 from My NS, another from the Dr who gave Me the ESI and My chiropractor, plus the WC second opinion. 3 out of 4 of these specialist say I will need surgery and their Dr said He would be reluctant because of My age. (He doesn't do surgeries any more either)
    He also said He would send Me back to work on light duties. At first My NS agreed with the return to work but i asked them to make the RTW date after I had the surgery a few days later. I'm not fit to return to work yet, so what are My options about this? Just as long as My NS ok's it I'm ok?
  • Have your NS appeal. My insurance denied my surgery and after a phone call between my surgeon and the insurance company's NS (on hire for reviewing claims) they agreed. It was a few weeks of tension and I did mention (iddle threat) that I would get a lawyer. I called the claims manager daily. I was very stressed and sad..... But finally it happened.

    Sometimes they do not look at all the info or it is mis-interpreted by an idiot L) ~X( :SS

    Hang in there and try the appeal. Call and ask them for a copy of the apeal process to be sent to you immediatley.

    Good luck,

    Julie
  • I'm going to wait till Tuesday or wednesday until I contact this lawyer I was referred to by my chiropractor, there is the tropical storm heading our way and its a holiday Monday. I am glad that My NS staff is trying to get it approved and treating Me very kindly with all this. I dont know what an x-ray will do to get them to approve it the second time but We'll see. My chiropractor told Me a couple times that when You get a lawyer, the wheels start turning and there will be no squeaking lol.
  • Hi J,
    What is your diagnosis? And as to the X-rays, are they wanting just regular ones or a MRI? A regular x-ray doesn't show any of the soft tissue damage which there could be a lot of. As to the attorney, will he take this on a contngant basis or is this going to be out of pocket? Most people who have been hurt on the job like this and have to have surgery usually wind up getting a settlement. I'm really curious?
    Jewels
  • J,

    Julie is right, the folks that process this stuff are normally non medical administrative types who really don't understand unless a doc calls and says "jump dangit!"

    I'd call as soon as you can on Tuesday. Waiting just sends a message that you "aren't as bad as you claim".

    The squeaky wheel gets the grease.

    Please be careful with the storm approaching! Don't wait if it looks like you need to get up and boogie!

    "C"
  • ">image First I'd like to just say Hi to you since I haven't welcomed you yet! I hate that you are going through such a difficult time with WC. I had a bit of a deal with it too and it really stinks! Keep calling and calling until something is done. Don't give up! Follow through with everything they tell you to do and then they can't come back and screw you on it, BUT don't let them pressure you into going back to work until you are medically ready. They will put pressure on you and make you feel like you don't have a choice. They push because there are so many people that won't stand up to them and then they get away with it. Also, if they try to settle with you, check in to what all that entails because I did a settlement with them not knowing what was even going on and then it was done! I know, how would I not know... well, they sent me to a doctor to check how disabled I was and I thought that they were sending me to this doctor in order to see about surgery for me. I was soooo stupid! This is why I encourage you to check in to EVERYTHING you do. Good luck!
  • My diagnosis is I have a herniated L5-S1 disc that is also degenerated with some compression. Below are some MRI animations

    image

    image

    image
  • or is it plain to see?
  • You should also contact WC and ask for a full copy of your file so that you can review it your self.

    Your L5/S1 looks bad to me ;))

    Julie
  • I have a lot of experience spotting a herniated disk but the pix above are moving too fast for my eyes. I can't spot it. I had the exact same one as you, L-5/S-1. Are you just going to have a Laminectomy? I hope so, you will recover very quickly from that and with much less pain. Just be "careful" while you are healing! I happened to trip over something during the last week before returning to work and re-herniated the same disk. It was such a blow! My surgeon said that I had to go straight to a spine fusion because another Laminectomy wouldn't do me any good but I later found out, after it was too late that she was wrong. I am now permanently disabled because of this. Talk about needing a second opinion! But I trusted her because after the first surgery I had felt so great. Please, please, I beg of you, make sure that you have the best surgeon that you can possibly find. My life would have been so different if I had done that for my 2nd surgery. If I can prevent just one person from winding up like me, then at least what has happened to me won't be in vain. I wouldn't wish this on my worst enemy. OK, maybe I would wish it on my first surgeon, and I'm NOT kidding about this. As I mentioned on one of your threads, an attorney should be willing to be paid on a contingency basis. BTW, are you recieving WC benefits in the meantime, such as pay? And if not, why? Also does your state have disability benefits? Yes, a lot of questions, I know. Just trying to help here. Keep up the good fight and I hope you get what you deserve very soon.
    Best of luck,
    Jewels
  • You can spot the herniated disk? I'm impressed! I've tried really hard and can't see it.
  • When I had my first surgery the herniated disk was so huge and under so much pressure, the minute that the surgeon cut me open the bulge actually "popped" right out on it's own. The doc told my husband this and said it was HUGE! It had been giving me migraines on a weekly basis and they came to a halt the day after my surgery. Now I only have about 1 a month!
  • Ok, well My NS said that the disc is so badly degenerated that it would be pointless to do a discectomy or even a Laminectomy. There is compression there from the disc as well. So a fusion would be My best bet. Since its only a level 1 and it is the L5-S1 disc with limited loss of flexibility, I can deal with that.

    As far as WC paying me, yes they are. They paid for everything so far as well.

    You really cant see the herniation?
  • I also looks like you might have a touch of slippage (spondylolisthsis) and the disc is all dark.

    Julie
  • Yea, thats what My chiropractor told Me. He pretty much said I broke my back when I injured it. Gustav is heading My way so like I said, I have to wait till around Tuesday or wednesday to set up that lawyer consultaion (I hope any ways). Wish Me luck.
  • Well, as I said, I need glasses and also there is a little volume window that keeps popping up on my on my screen. It's driving me nuts! I don't know how to fix it!

    Get out of there before Gustav hits and we are all wishing you luck! Stay safe!
  • I have no idea what I'm looking at on those MRI's.But just wanted to pop in and wish you good luck.

    I hope W/C doesn't try to tell you what you need as far as medical care.Cross your t's and dot your i's and everything will work out if you hang tough.

    My brother was fighting W/C for years,and the money finally came through.750,000.00.Unfortunately,the money went to the woman he was divorcing-and the divorce was never final because he died(they were seperated).I have a biased opinion now as you can imagine.He had a lawyer.

    There is something wrong when you work for a company,get hurt working there,and have to resort to getting an attorney to help with your medical fees.

    You mentioned that you thought it would cost them more money in the long run to fight this with you,but they don't see it that way-they think that you have a valid case against them,otherwise they would see no point in 'fighting' you.Besides,they probably keep at least one attorney on the payroll,and if this is the case it won't cost them anything to fight it.They are trying to save money...IMO..lol

    I wish you the very best of luck.



  • I think My case is rock solid. I'm not sure how it works but I have 3 specialist saying My back is messed up. My neurologist, then the Dr who gave Me the ESI and My chiropractor all say the same thing. Only their Dr that they sent Me to said He would be reluctant to do surgery because of My age and He would send Me back to work on light duties. Of course He will recommend that, they are paying Him. If this goes to court, I think I could get some written statements from those 3 specialist to help with My case. Once this storm blows over and everything gets back to normal I'm going to call that lawyer and My WC case worker to get all the info that they have on Me and to tell them I'm getting a lawyer to fight for My surgery.
  • also, I'm really not worried about any settlements right now, I'm more worried about the long term damage I might have. My left foot keeps dangling when I walk and I'm starting to have a little trouble urinating, this all started after a PT session when I did the traction table about a week ago.
  • I understand,and I think they are also worried about the long term damage.I hope it all gets worked out.I doubt very much that it would end up in court,but it's good that you are thinking ahead and getting things in order.

    Too bad you have to think about that with surgery looming ahead.

    I know you didn't mention a settlement-I just threw in a personal story because your situation reminded me of my brother..but then again,this is your back-so the CO.is surely aware that there could be problems in the future.Your age would be a big factor and that might be why the Cos. Dr. is reluctant to admit that you need the operation.I saw on your MRI that you are 29.Companies think in terms of money-if you have 43 years until retirement they are thinking they might have to pay you what you 'could have' earned.Your earning potential.They have no idea that you are not thinking of a lawsuit.

    Sorry for rambling.I'm just sitting here thinking...lol
  • Its ok, I need all the help I can get. My NS want Me to get some more x-rays done and then apply again for the surgery. I can tell You how this all came about.

    Was a Monday morning truck day, where all the food and supplies come in and We are always doing these things in a rush because we loose an hour of our work putting up this truck. So Me and another employee are putting up the frozen goods and the dollies were coming in pretty fast and stacking up, slowing Us down. So I positioned Myself in a weird way, I was kneeling on My right leg and My left leg was put stretched to the left of Me and I was handed a box that I thought was light but it wasnt. It was about 40-50 pounds and when I was handed it the weight pulled My arms down and this severe sharp pains went down both legs to My feet. I couldn't put any weight on My feet at all. I didnt want anyone to help either cause of the pain. So I dragged My feet out of the cooler using boxes to lean on and none of the 2 managers their asked about going to the hospital. I didnt have insurance and didnt know anything about workers comp, So I didnt asked to go to the hospital because I couldn't afford it. But the managers didnt say anything about taking Me to the hospital or anything. So I waited for like 45 minutes standing by the door waiting for a manager to bring Me home. Finally they did and I got home and just laid down. Over the next week I was at home, I couldn't turn or twist My hip at all from severe pain, 10 scale, it was real bad. I took a week off of work and by that time I was still in pain but they asked when I was returning to work. So dumb Me who didnt know any better went back to work and worked for 4 months until I just couldn't take it any more. I complained to My older sister about it and She started setting up appointments for Me to get to the bottom of this. I went to a free clinic first and got some X-rays done and then went to a chiropractor. I told Him the whole story and He said "You aren't on workers comp" and I told him no, My job never mentioned workers comp. So after a few visits, I was in really bad pains from still working and He got Me off of work and helped Me get setup with workers comp. That is another story, getting paid but I wont get into that. So I did 3 months of Chiro visits, 3 times a week for 3 months. Finally got an MRI done and that is what it showed, clear as day. So since the chiro visits ran out and I wasnt getting any better, He gave Me a list of Good Neurologist and I picked one. Went to Her and she prescribed PT and some NSAID's both of which haven't helped with pain. Been doing that for about 2 months or so. Now My options are to keep doing what I'm doing or have the fusion surgery, I elected to have the surgery because I'm confident it will be successful. Since I've been of work and pretty much laying down for most of the day, My pain level is about 3-4. Its when I start doing things that My back aches and starts getting really weak. Plus My left legs aches when My back is hurting. I'm Just waiting to move on with My life :(
  • Yeah,I can picture it.The managers knew better too than to just send you home without having you sign an incident report.You could have gone to the hosp.right away-well I guess that's in the past now,and obviously worked out.

    Good thing you have a helpful sister helping you out.I swear,some of you guys can have a severed limb and you'll be all like 'aw it's aight,i'll just sew er up'.. =))

    My b/f sliced his knuckle a few years back.His sister is a nurse and he asked her for a suture kit and he commensed sewing.

    I'll be anxious to hear when your surgery is scheduled.
    All you take for the pain is NSAID's?I know that you said your pain level is at 3/4,but that is at rest.When/if you go on light duty,or up moving your pain level is higher on the scale I presume.I would think the Dr would know that and treat you with something better for that type of pain.

    I have cervicle DDD,and my Dr.treats mine with muscle relaxers and lortab,and a few other things.I'm just wondering if you can do anything at all with NSAID's.They just never helped me at all,and I can't take them anymore because of some other medical issues.

  • I will say YES I can see the herniation plain as day!!

    Well I can tell you a couple things about WC.
    But First, the reason why I know what I know about WC is because I was the bookkeeper and also delt with ALL employee issues, payroll, WC, taxes etc at a larger size construction company.
    OK, first your employer can get into some trouble for what they did. There are certain steps/protocall that they HAVE to follow by law, when an employee gets injured. Here are a few:
    ~Accident/incident Report
    ~Medical attention if needed. usually the ER after an injury
    ~urine test
    ~Supposed to give you a list of docs from the WC list

    They can actually get in a lot of trouble for not sending you to the ER or a doc. Most employers do not like to involve WC because then their quarterly payments go up because they have to use a higher % rate when they have injuries. So it cost's your employer more $ if there is an injury. I would bring all of this up to your doc also. Now of course it is too late to do a urine test. You are supposed to have that done right after your incident. That way if you are under the influence of drugs or alcohol they wont have to pay. Of course you can't do this now.
    Anyway, be sure to call them ASAP and ride their asses. I have had employee's who have fought tooth and nail to get their workers comp. I have always fought for the employee's also. I didn't really care about the rates going up. Put a notepad and pen next to your phone. Wrote down each date you call, who you talk to(they may give you a name and then an employee number), what time you called and what was said during the convo. Call them everyday and keep on it. If you have a log as to the above things, it will be much easier IF you do have to get a lawyer. Documentaion always is a good thing and you can never "over document".
    As far as your fusion. I had a L5-S1 fusion 4 yrs ago, with great luck. That part of my back feels so much better and doesn't bother me. I have some other issues with it now that I wont get into. My friend had his L5-S1 disk "shaved". He had this done less than a yr ago and he is having issues with his back once again. He is a 6'3" 250+lb man. He is a "tough guy" that can deal with a lot of pain. But the return of this pain has literally laid him up once again. He is going to see my NS and hopefully they can fix him up. He just doesn't want another surgery. Which I dont blame him but if they would have fused him in the first place he wouldn't be going through this again.
    Anyway keep us posted as to what is going on with you. I hope some of this info will help you a little. Any other questions you can PM me if you want.
    Stay safe during the storm!!!! :D
    MJ
  • Maybe they are gonna do flexion/extension xrays to check for instability. If you do have a Spondylolisthesis that is unstable it would definitely help your case for fusion. Does your NS know about your bladder sxs, as this can be an emergency situation? Good luck, Sue
  • I don't normally suggest this and I don't believe in frivolous lawsuits, but the business that you work for was extremely negligent in their treatment of you. That makes me angry to no end. They were incredibly irresponsible! I've always had to fill out an incident report for even the tiniest of injuries on the job, companies that I've worked for insist on it. If I were you I would get a WC attorney. You do deserve not only to have the surgery that you need, but also pain & suffering. I know people who have scammed WC and got huge settlements which I find abhorrent, but when it's a genuine case, you deserve a settlement. As I said, I don't normally suggest for people to sue, because I feel that it's done way too often and with no true cause, but for the people who have a genuine case, that is what the system has been set up for. At least think about it and good luck with your surgery, when you have it!
  • Well I finally got a WC lawyer. Told her everything that happened etc and now just waiting to see what happens. I'm guessing she is going to appeal for the surgery. She now knows everything that happened, including them not filling out the incident report the day it happened and so forth. So like I said, just waiting to see what happens now. Its funny, the denial report for the surgery states this towards the end. While this claiment may need a lumbar operation for disc excision to decompress his S1 nerve root, there was no documentation of structural instability, angular malalignment or other indications for fusion surgery. end quote...ok isnt degeneration an indication for fusion? I know it isnt always but I've read from numerous spine websites that degeneration is an indication for fusion. Seems they just screwed themselfs thier. I showed that to My lawyer as well ad she laughed.

    Another I'd like to know, what exactly is instability?
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