Visitor Question

Workers’ comp not approving my future medical treatments?

Submitted By: Elizabeth (Lancaster, CA)

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.


Dear Elizabeth,

It is our position at 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.

Find a local attorney to give you a free case review here, or call 888-972-0892.

We wish you the best with your claim,


5 thoughts on “Workers’ comp not approving my future medical treatments?

  1. Kristina says:

    Wow, I am facing the same issues. I worked for an airline for 23 years and I am in constant pain with this lousy future medical. I haven’t signed the stipulation yet and I don’t want their future medical. They do not approve anything! I had back surgery, right arm surgery and neck surgery will be needed in the near future. I have such bad carpal tunnel and I am in constant pain! Isn’t there an attorney to file a class action law suit for us?!!!!!!

  2. Williams says:

    Unfortunately, it seems that future or lifetime medical doesn’t mean anything. To make a long story short the insurance company is instructing my doctor to start weaning me off of my psychotropic medication. Doesn’t anyone understand what effect that will have on me other than my Psychiatrist & my psychologist?

    They have explained it to the insurance company but “their guidelines” dictate otherwise. This is why there are so many crazy homeless on our streets. Why can’t a class action case be filed?

    Some vindictive attorney that wants to be a hero for all of us must exist somewhere in California. If not that, a news program to enlighten the victims & the future victims what they’re in for should they ever get injured at work. Where can we complain & put up a fight?

  3. Essie says:

    I am going through the same situation as you are. My treatments are denied, my medication is also denied. WC expects the doctors to provide them with so much paperwork until most of my doctors can’t fill out the papers to WC satisfaction, and therefore WC refuse to give approval.

    However, WC had me find a doctor in their system and I did. I still haven’t seen that doctor because WC can’t provide the proper paperwork that the doctor requires.

    As a result, I haven’t seen a doctor in 6 months and they won’t fill my prescriptions. I have to pay for them myself and get them from my primary doctor. One of my medications will bring on body shock if I miss taking the medicine but WC still denies me and say they are sorry.

    To get pain relief when it’s very bad, I have to go to emergency and WC have to pay a large bill. I only wished I could get some help on this.

  4. Anonymous says:

    A settlement is a settlement. I settled for permanent “lifetime” care due to physical and mental injuries sustained.

    In a bunch of mishaps my attorney passed (after settlement) which makes it hard to find a replacement and the insurance company is giving me “hell” knowing this. During settlement my employer was backed up against the wall so much, I think if it were possible they would have payed me double.

    Now I’m reeling from discrimination, insensitivity, etc., in every way possible and have practically nothing. What can do about it until I get another lawyer.

    Meanwhile, my condition, worries, fears are worsened week by week due to this “about face” by everyone involved. I’m left asking the same questions I asked when this case was awaiting settlement and I was being forced to see an army of doctors for years.

  5. Anonymous says:

    I have settled my workers comp case with future medical…what a joke. I get pain medication every 28 days and have to fight to get it approved every month. I have called my lawyer and he stated he doesn’t really care and that the defended insurance company wants to screw me.

    The attorney got paid from my final settlement and now complains he will not get any new money, meaning I get my refill whenever the insurance company gets around to approval. This is future medical!

    First off I am on a very strong and addictive pain medication…with the DEA urine testing every 3 months to make sure I have the medication in my system. Since I have no clue when my meds will be approved I will start going through drug withdrawals.

    Before I let that happen I will visit the ER for pain medication, for a charge of $1,300, or end up buying illegal opiods from the streets. This is what you get for future medical care? What a wonderful system.

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