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  1. #1
    Join Date
    Feb 2008
    Posts
    1

    Default Worker's Comp Medical Claims Denied By Worker's Comp Question

    Hello, I need a little advice. My mom injured her back about 20 years ago and has not been able to work since. She has had 2 back surgeries and is in constant pain. She takes morphine to control the pain. Her doctors want to do another surgery to implant pumps that will send out the medication on a slow constant basis so that she does not have ups and downs with her pain. An independent doctor that both her doctors and workman's comp agreed for her to see said she needed the surgery. However, workman's comp still denies she needs it. They also say doesn't need a walker and she has to fight for them to pay for medications. She has a case manager at worker's comp who denies everything and won't let my mom talk to a supervisor. Any advice?? I would greatly appreciate it. By the way, we are in California.

  2. #2
    Join Date
    Feb 2008
    Posts
    578

    Default Re: Worker's Comp Medical Claims Denied By Worker's Comp Question

    They won't cover it after their own IME doctor agreed on the treatment?

    Scum insurance companies!

    She needs to request a hearing before a WC judge. It can be done without a lawyer but the insurance company will be sending theirs. Not recommended going up against a lawyer by yourself even in an administrative hearing.

    Lawyer time.

  3. #3

    Default Re: Worker's Comp Medical Claims Denied By Worker's Comp Question

    Thats their job to try and deny as much treatment as they can get away with. Often so they can obtain bonus' and job promotion/security. In Michael Moores movie 'Sicko' there is a woman featured in that movie who tells about her job(at an insurance company) denying as many treatments/procedures as she possibly could and I think even causing some patients to die as a result of these denials of treatment! It was something that she was going to have to live with for the rest of her life. Your mother needs to be represented by a competent WC attorney.

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