My workers comp case settled February 2012. It took the State Comp Insurance Fund eight months to approve my evaluation appointments with a pain management doctor, a specialist for my TMJ, and an internal medicine doctor. All three doctors recommended treatment which was never approved by workers comp but also never denied.
I was told by my attorney once a recommended treatment is not answered within a certain time frame (I don’t recall the time frame) it is considered approved due to not being answered. However, only the specialist for my TMJ went ahead and ordered my mouth guard and continued treatment on me.
I am in severe pain with my neck. I know my last MRI reflected the need for neck surgery in the very near future (this MRI is already 5 years old). Is there any way to reopen my case since my medical condition has become worse due to lack of treatment?
My case was settled under Stipulation and Award with Future Medical. I see my primary doctor from workers comp every month in order to get relief from pain medications.
I am receiving medicare but was told workers comp has to cover medical treatment for my cervical spine, bilateral shoulders, lumbar spine, right ankle, psyche, chronic pain syndrome, sleep disorder, IBS, hypertension and TMJ, which does not leave much for medicare to cover.
Every visit my primary workers comp doctor recommends treatment and they do not hear back from workers comp. It is going on two years next month, is there anything I can do??? Thank you.
Disclaimer: Our response is not formal legal advice and does not create an attorney-client relationship. It is generic legal information based on the very limited information provided. Do not rely upon the information in our response, or anywhere else on this site, when deciding the proper course of a legal matter. Always get a personalized case review from a local attorney.
It is our position at InjuryClaimCoach.com not to interfere with the attorney-client relationship. To do so would be inappropriate.
Generally speaking, once a workers’ compensation claim has been settled, especially when there exists a Stipulation and Award with Future Medical, the only issues left are the type of future medical care needed, and the amount of money the insurance company will pay for that treatment
In your case, you would be best-served by speaking with your attorney. Your attorney should be able to explain why workers’ compensation has taken so long to respond.
Learn more here: Workers Comp Denials & Appeals
The above is general information. Laws change frequently, and across jurisdictions. You should get a personalized case evaluation from a licensed attorney.
We wish you the best with your claim,
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