Question: The company doctor says I need a tri-level fusion surgery and retraining, but the insurance company won’t approve it, what do I do?
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Question Detail: One surgeon says that my injury doesn't warrant surgery and that I should be retrained. Another surgeon says that I need a tri-level fusion and then need to be retrained. I've been paid disability benefits but this is getting old. I have a "flare up" that lasts for months at a time. I'm a crane operator and have been for 14 years on and off. That's all I know. If I controlled the medical decisions I’d have the surgery. I'm sick and tired of being in pain and have developed a dependency on pain meds due to this injury. Pain meds don’t correct anything and I want my back fixed and my life back.
I'm a single mom that can't jump up and down when my little boy wins a wrestling match. I don't know what to do or who to trust. I need help. Please. I've had the same primary doctor since the beginning of this injury over three years ago. I get better for a while and go back to work for a few months then I'm out again for a few months. I can't ever get back on my feet before am in so much pain. I can't work and function. I'm only 43 years old and I have another 20 years of working left to do. I don't know what to do. My case manager said I have to decide if I want surgery or retraining and she said something about a cash award. My doctor said he'll support me with whatever I decide. I want to ride a snowmobile again.
Answer: Well, in Iowa the insurance company is in control of the medical decisions, but there is a way to wrestle medical decisions away from them, but it will require a written opinion from the doctor who supports the decision you wish to make. So if that’s surgery, the tri-level-fusion, then we go with that doctor.
Follow this link to read about a Tr-Level-Spine Fusion.
Does 'control of the medical decisions' really mean micromanaging the medical decisionmaking? Or does it mean you get to pick the doctor and the doctor is the one that is in control of the medical options and the decisions? If it is the doctor who holds the license to practice medicine, why would anyone think an insurance department has the right to signal thumbs up or thumbs down with any of the medical decisions?
If you decide to not have the surgery then what the surgeon is telling you is this non-operable medical condition is going to affect your employability and that translates to a larger or more important industrial disability. You'd be better be hiring a lawyer who knows workers' compensation law in Iowa and that can help you achieve a fair and reasonable settlement of your claim. I agree that at 43 you have a lot of years left to work and as a crane operator you’re paid a really decent wage and the last thing you want to do is end up in some minimum wage job trying to make ends meet after being paid a union scale crane operator’s pay.
Here is what I would suggest be done in your case: Collect the medical records, review them, order an IME and then develop the industrial disability evidence. You'll need a social, education and work history.
As for the decision to not get the operation, I’d think it through very carefully. If you are this miserable then not having the surgery and settling is the wrong one to make. These surgeries are expensive and if you delay several years this insurance company will not agree to just pay for it. You will have a huge fight on your hands about getting it covered and in the end you will not be satisfied. So will you have the back or spine surgery? While you ponder that decision, go hire a lawyer whose job it will be to worry about the legal aspects of your workers' compensation claim. Good luck and happy holidays.
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