We received a call from a client who was in desperate need for a low back MRI. The injured worker had slipped and fell at work and was sent to a workers’ compensation doctor two months prior to speaking with us. He advised us that the doctor recommended an MRI as the worker may have damaged some disks in his low back. The nurse case manager was present at the doctor’s appointment and took the prescription for the MRI advising the injured worker she would set it up right away. While he waited for the scan he was returned to work in a fairly heavy duty manual labor position.
After one week passed without an appointment, the injured worker called the nurse case manager who said it was being set up and to wait. After another week went by, the injured worker again called and was told the adjuster was now investigating the need for the MRI and would get back to him. For the next two weeks he called the adjuster and nurse case manager daily, leaving messages for both and receiving no response. Getting desperate, the injured worker made an appointment to see his doctor and explained that he had not received his MRI, his back was getting worse and he was experiencing new symptoms from continuing work activities. The doctor was livid and called the nurse case manager trying to find out why the study had not been performed. He had to leave a message. Luckily for the injured worker, the doctor took him out of work until the study was performed.
That night the injured worker received a call from the nurse case manager who proceeded to berate the injured worker, saying how dare he go and make an appointment without her, that such actions were not acceptable and that behavior like that would not get his MRI authorized any sooner. The injured worker, who usually was not one to tolerate such language, kept his cool and inquired politely what would get his MRI set up, seeing as how four weeks of calls had been ignored. The nurse case manager told him he would just have to wait. And so he waited another three weeks, continuing to call without response. Finally, fed up with being ignored, he called us to hire an attorney to help him get the care he needed.
After several attempts we were finally able to contact the adjuster who had recently been assigned to the case. The new adjuster reviewed the file and begrudgingly authorized the MRI. The diagnostic study revealed multiple herniations and bulges. The doctor advised us that based on his initial complaints, had he received the MRI, the doctor would have taken him out of work, or at the least heavily restricted his work activities. But due to the delay, the continued physical exertion at work may have actually aggravated the condition to the point he now required surgery.
If you or a loved one has been hurt at work and are not getting the medical care you need, are worried about suffering further injury or need advice as to how to proceed when the insurance company won’t provide the care your doctor recommends, call one of the experienced workers’ compensation attorneys at the Law Offices of Franks & Koenig. We deal with adjusters and nurse case managers on a daily basis and understand what is involved in getting medical care authorized under Florida’s workers’ compensation system. Remember, the insurance company may provide you care, but when they are ready, not always when you need it most.