I injured my back on January 18th of last year. I didn't go to work for two weeks before I finally went to the doctor. No testing was done to see what could be the problem. I did some physical therapy and had frequent doctor visits. I got sent to a specialist 4 months later who ordered an MRI. I herniated two discs. They did conservative treatment to no avail and ended up having surgery last September. The surgery didnt go as well as planned and i am in virtually the same boat as before surgery. As of now my doctor is still reporting that I am "totally disabled" but my workers comp just informed me that they are now denying me treatment. Is this legal? Do I need a lawyer? I've never been denied treatment until now.
Workers' Compensation Lawyer
This may be "legal" and may not be "legal." If they are denying treatment because it has been denied by utilization review, then you may need to challenge that. If they are denying your case because now, they do not think it is work related, you may have to litigate that issue. Usually an insurance company only has 90 days to deny your claim after the receipt of a claim form; however, if there is evidence that could not have been discovered during those 90 days, or a false history was given, then they could deny it late. Something like that you would also need to litigate.
If they are simply not authorizing treatment because they are lazy or because they do not want to authorize treatment, that is something they can not do.
In your case, considering you are post a back surgery with bad results, i would highly recommend that you at least seek out a consultation with an attorney at this time. The consultation will be free and you can decide if you will need an attorney. You can find an attorney on this website, or go to CAAA.org and do an attorney search.
Disclaimers: Making a false or fraudulent workers compensation claim is a felony subject to up to 5 years in prison or a fine of up to $50,000 or double the value of the fraud, whichever is greater, or by both imprisonment and fine. Each case is pursued differently based on its own merits. As such, there is no guarantee as to the outcome of any case. No attorney/client relationship will be established by contact with this AVVO communication or any messages or emails from Silberman and Lam, LLP. An attorney/client relationship will begin only when a retainer has been signed.
6 lawyers agree
Divorce / Separation Lawyer
The denial of treatment bothers me. Contact a local workers comp attorney or use the Find A Lawyer feature here. By all means , talk to someone quickly.
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Workers' Compensation Lawyer
I agree with Mr Silberman and recommend you look for an atty in your area
If this information has been helpful, please indicate by providing feedback that the answer was either "helpful" or "best answer" as appropriate. Legal Disclaimer: Mr. Connell is a Colorado attorney licensed in only that state. The response herein is not legal advice and does not create an attorney/client relationship. The response is in the form of legal education and is intended to provide general information about the matter within the question.