Orthopedic surgeon recommended surgery on both knees, after MRI results and ex rays. Other workers comp doctor agreed. What do I need to get surgery approved. The consulting doctor states on his report that the diagnosis for surgery is only good for 45 days. What does this mean? I am still trying to work with restrictions, but am really struggling. I am working with restrictions, but do not feel I can continue. I am 61 yrs old. Have always worked and never had a claim. How do I get approved to stay home till my surgeries and healing are over?
You need to contact your adjuster to request authorization. As long as your doctor keeps you on a no work status, the insurance company should continue to pay you, up to 104you weeks of benefits. It sounds like you have a lot going on in your case than you are aware of. I strongly suggest you speak with a qualified workers compensation attorney to discuss your options in detail.
TIme is your biggest enemy in W/C cases, and the adjuster is often a close second. Waiting for medical care to be authorized can often result in the patient not healing as much or as well as s/he otherwise could have. Also, the adjuster (whether innocently or not) will often not give you an accurate or complete picture of what your rights and obligations are under the W/C system. So, I strongly suggest that you seek out an experienced W/C attorney for a free consultation immediately, before you either wait too long or make a decision that was not fully informed that damages your ability to recover quickly and completely. Any experienced W/C attorney will also either personally handle auto negligence cases or will work with an experienced PI attorney, bcz many W/C cases arise out of auto accidents. In addition to learning your rights, getting to an attorney immediately will allow you to access PIP benefits under the auto case, in the event that the W/C carrier is not timely providing what you need. If you need assistance finding a qualified attorney in your area, please feel free to e-mail me at kbs_at_flalaw_dot_com.
IF there is a third party who does not work for your employer you have an independent fclaim against him or her. You should contact either a lawyer that you find on this list who handles auto claims such as our firm or another. In addition, you can see a doctor outside comp on your PIP and medpay benefits. Contact an auto lawyer in your area right away.
You should sit down with an experienced workers comp attorney who is either familiar with personal injury-auto law or get you a sit down with a personal injury attorney as well. You can use the AVVO "Find a Lawyer" tool bar to select one or both of the attorney's -Workers comp & personal injury-good luck
Your best bet in getting surgery approved is finding an attorney to help you through the process of the Florida Workers' Compensation system. Florida statute 440.13 requires the adjuster to address matters such as surgery in a timely fashion. Pushing the right buttons with the assistance of an attorney for both the worker's compensation aspect and the separate liability aspect of your claim is your best start.
I agree with Mr. Friedman. I would also add that you MUST sue the 3-party driver or assign that right to your WC insurance. You should discuss this with a Personal injury attorney ASAP. If you can identify an attorney who handles BOTH WC AND Auto Claims, that would be best.
There is no up-front cost to hire an attorney.
First and foremost, you need to obtain something in writing from the "authorized" workers' compensation doctor recommending surgery, if you don't have it already. Next, you need to provide that information to the Claims Adjuster. If the Carrier does not authorize the request for surgery within reasonable period of time you should immediately consult with a workers' compensation attorney in your area.
Based upon your question I am going to assume that the orthopedic doctor that is recommending surgery is not a workers compensation doctor. What you will need to get the surgery approved by workers' compensation is an authorized and approved orthopedic physician chosen by the workers' compensation carrier that agrees with your doctor that you need surgery. If the workers compensation doctor that the insurance company has already picked for you is not an orthopedic doctor then that doctors opinion may not be enough. Either way you will need to get the authorized doctors opinion in writing to get it approved. When this occurs, they should approve the surgery and based upon the doctors work restrictions you should get paid your compensation rate when you are totally unable to work while you recuperate. When you are on light duty, should your employer not have work available for you within your restrictions you will also receive a check while you recuperate. These benefits are maxed out at a total of 104 weeks of payments. Should you have difficulties with getting the surgery approved or your checks you should seek the advice of an attorney.
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