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WC denied My surgery...

AnonymousUserAAnonymousUser Posts: 49,578
edited 06/11/2012 - 7:22 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.


  • 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!
    William Garza
    Spine-Health Mod

    Welcome to Spine-Health

  • 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
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  • 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,

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  • 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?
  • 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!

  • ">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



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