Legal Question in Workers Comp in California

WC Ins Co would not approve MRI request by their Doctor.

In Feb of 2004 I was in an Automobile Accident that was work related and not my fault. I went to the Doctor that my WC Ins Co recommended and He asked for an approval for a MRI. The Ins Co said no to their own Doctor. The Doctor made three requests stressing how crucial he felt the MRI was and he was turned down.

Skipping the play by play of delays by the Ins Co, in Feb or O7 I saw a AME who certified I needed a L5-S1 fusion.

Now, the Surgeon who is actually going to do the fusion says, based on a Discogram done in late May, that I now need the L4? disc fused as well due to the deterioration of the fractured L5. I was told that this was partly because of the amount of time that passed between the injury Feb 04, and now. The Ins Co just declined the additional fusion because the AME only certified the L5-S1. My current Surgeon is sending the Discogram Record to the AME so he can certify the additional fusion.

I understand that delays are part of the business plan for Insurance Companies, but is there a point where they can be held liable for the additional injury caused by their delays? Thank you for any feedback and taking the time to read my post.

1 Answer from Attorneys

Related Questions & Answers

More Workers' Compensation Law questions and answers in California

Looking for something else?