Q: Do I have the basis for a suit to get the doctor recommended medical surgery
I injured my back in 2007 on the job and had several operations during the years and after retirement in 2015. My Orthopedic doctor told me I needed more work done on my back and it would be a three step process, it was approved by the insurance then weeks later denied. My condition got worse and eventually the surgeries were done in Oct and Nov of 2017 the third was scheduled for 2018 after bone grew in were a disc was removed and new hardware would be installed to support and protect my spine. This last procedure was denied, my doctor has appealed this decision with no change. any opinions
Mike Patrick
A: I'm very sad to report that this capricious denial of treatment is the law. Some people are suing the Utilization Review physician for medical malpractice when a requested procedure is denied , but it's really really tough to find a medical malpractice lawyer to take that on (especially when the reviewing UR physician is out of state). The Labor Code your Governor, State Assemblywoman and State Senator all approved in SB863 let's the insurance deny treatment recommended and requested by their own physician and all you get is something called the Independent Medical Review...and 91% of IMRs deny the treatment. ELECT NEW ASSEMBLYMEN AND STATE SENATORS AND LET THE INCUMBENTS KNOW YOU ARE CAMPAIGNING AGAINST THEM for voting for SB863. IF THE DENIAL of the surgery did not match the deadline, you can take the RFA and the untimely denial to a WCAB Judge and request the judge ok the treatment, but you got it already.
Justia Ask a Lawyer is a forum for consumers to get answers to basic legal questions. Any information sent through Justia Ask a Lawyer is not secure and is done so on a non-confidential basis only.
The use of this website to ask questions or receive answers does not create an attorney–client relationship between you and Justia, or between you and any attorney who receives your information or responds to your questions, nor is it intended to create such a relationship. Additionally, no responses on this forum constitute legal advice, which must be tailored to the specific circumstances of each case. You should not act upon information provided in Justia Ask a Lawyer without seeking professional counsel from an attorney admitted or authorized to practice in your jurisdiction. Justia assumes no responsibility to any person who relies on information contained on or received through this site and disclaims all liability in respect to such information.
Justia cannot guarantee that the information on this website (including any legal information provided by an attorney through this service) is accurate, complete, or up-to-date. While we intend to make every attempt to keep the information on this site current, the owners of and contributors to this site make no claims, promises or guarantees about the accuracy, completeness or adequacy of the information contained in or linked to from this site.
