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Workman's Comp

Workers Compensation Law Discussion

Workman's Comp

Postby Allie » Sun Nov 16, 2014 2:37 am

I am an active 61 year old woman working for a major supermarket chain 19 years. Saw my PCP for neck issues and was referred to neurosurgeon after Mri showed cervical stenosis, foraminal narrowing and herniated disk, osteophytes, etc. Neuro would not see me thinking this could be cumulative from checking 19 years. I was told by that office to file W.C. first. Did that, and was referred to spine specialist. He ordered PT and transforaminal injection. I received auth. for this with a 5 week window to have it done. I waited for auth. to be sent to Dr. who would be performing this procedure. [That office refused to set up appt. until they received auth.] Adjuster never sent them auth. and in the meantime the decision due date of 9/16/13 came and went. Also QME appt was scheduled well after decision due date through no fault of my own. Adjuster never sent me the list so had to get it from her over phone. It seems to me that this adjuster did not handle my case fairly. does this happen often? I have retained an attorney and awaiting appeal. The injection would have helped alot as I am still working full duty and am in much discomfort.
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Joined: Sun Feb 23, 2014 12:10 pm

Workman's Comp

Postby Maonaigh » Sat Nov 22, 2014 1:15 pm

Nothing in the Labor Code requires an adjuster to be fair.

The Adjuster's loyalty is to the Insurance Company and it's shareholders.

SO YOU have the responsibility of asserting your rights under the Labor Code.   YOUR ATTORNEY should have done this... you're questions here indicate you have a lazy, ineffective attorney.

Nearly every employer/insurer has A MEDICAL PROVIDER NETWORK.  IT'S THE MPN.

YOUR ATTORNEY can and should select providers from the MPN and PUT DEMANDS FOR SERVICES IN WRITING.

HAD YOUR ATTORNEY  faxed  demands for authorization to the adjuster, the adjuster would have been forced to respond. PHONE CALLS ARE A TOTAL WASTE OF TIME.   No one can prove to a judge the content of any telephone message or call.

WHEN AN OFFICE REFUSED to schedule your appointment, YOUR ATTORNEY SHOULD HAVE written the demand that either the adjuster fax the authorization within 48 hours or he will file a request to see the workers comp judge.  THAT gets authorizations done.   

Waiting and hoping and leaving phone messages being polite gets absolutely nothing accomplished.  
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