Q: Why is Workers Comp denying me back surgery?
I need to have Anterior Lumbar Interbody Fusion. Workers Comp denied it based on me not having a psychological evaluation clearing me for surgery. Every time we submit a request to see the psychologist they deny it stating they accept no responsibility for psychological injury. It seems to me they are playing games here .
A:
First, I would suggest you get an attorney to assist you with your case.
The denial of the psychological evaluation appears to be based on their denial of psyche injury as part of your claim. The surgery was denied based upon Utilization Review (UR). Is sounds like they did not UR the psychological evaluation and it is likely too late for them to do so. Your attorney can file for a hearing to force them to provide the psychological evaluation since it is needed for the surgery and a timely UR was not performed. Your are entitled to psychological treatment if it is needed for treatment of your work injury or a consequence of your work injury. The treatment protocols for the surgery specifically required the psychological evaluation.
Hope this helps and Good luck!
A: IT IS a game, but your Assemblywoman and your State Senator and Gov. Brown made it a completely legal game. Why are they denying treatment? Because your state government officials gave them Labor Code sections that permit them to deny needed treatment, all legally. So they are saving their shareholders millions and you get no treatment and lose your job, all legal. It is possible to get a hearing and show a WCAB Judge that your physician requested the psych assessment and it was denied, so it is a bad faith tactic to 'non-certify' surgery because the insurer refused the psych assessment, but whether the judge will decide you can remove it from the IMR process is not guaranteed. I'm telling every injured worker to actively campaign against the incumbent assemblywomen and state senator and let them know you are voting for their opponent and why
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