Will My Claim Go To a Medical Conference?
Your job was physically demanding. It required you to lift and carry heavy boxes and equipment in tight spaces and from awkward positions. Now if this was a requirement a handful of days per year, it likely would not have been a problem. But, 250 days a year? One day? Now, there’s a good possibility that something will go wrong—and it did.
Low back pain is a fairly common complaint among workers. In fact, 5% of adults have a developmental crack in their vertebrae (usually near the lower spine and tailbone). This condition is called “spondylolysis.” Many people can continue to work with this condition but over time heavy work and lifting can aggravate or accelerate this underlying condition and result in a much more severe medical condition.
Sometimes the symptoms take years to develop, and may include low back and buttocks pain, leg weakness, numbness, increased sway back, or a limp. In other words, a dramatic decrease in overall quality of life. After trying every non-surgical method available to deal with the intense pain—including physical therapy, injections, and strengthening exerices—your doctor recommends surgery to relieve the pinched nerve and a fusion surgery to prevent any further slippage of the cracked vertebrae.
The problem? Spinal fusion surgery is expensive. A ball park estimate for the procedure is 100k. Because your job duties aggravated or accelerated your back condition, you're entitled to medical benefits under the Workers’ Compensation Act.
Many times, despite this entitlement to medical benefits, the insurance company will deny surgery—many times simply because the surgery is expensive and strategically the insurer could end up paying less if the surgery is denied upfront.
One of the most common defenses the insurance company will use is that the procedure is not “necessary,” because the injury is not disablement by function (broken leg), but instead disablement by pain. Due to this difference, the insurance company’s claim reviewers will often disregard such a claim because of the alleged subjectivity. But you know the extent of the pain, and you know it’s necessary.
The next step is to find a good attorney who can guide you through the process. Do you have your doctor’s diagnosis and recommendation? Should you get another doctor? Do you have any past injuries that could pose a problem? Past treatments? A skillful attorney, knowledgeable in the area of workers’ compensation is essential to make the necessary decisions.
When a medical request is filed, the scheduling of a medical conference is automatically triggered, and should be scheduled within 60 days after receipt of request. Minn. Stat. § 176.106 details the process of administrative conferences. If no agreement is reached during the conference, a decision will be issued within 30 days, though often sooner.
A medical conference is a mediation with a neutral mediator who has extensive expertise in workers' compensation. A mediator is essentially a disinterested third party who oversees and hears both sides of a dispute. If no agreement is made between the parties, the mediator will make a decision regarding the dispute. Which will then be the final decision, if neither party requests to proceed to a formal hearing. Having a skillful attorney is crucial in deciding whether or not to proceed to a formal hearing after mediation.
With regard to attorney's fees, if your claim involves medical benefits, the employer and the workers’ compensation insurance carrier are responsible for paying your attorney for his or her time spent successfully recovering those benefits. The work compensation carrier and the employer pay your attorney Roraff or Heaton fees on an hourly rate. These fees do not come out of the benefits owed to you.
If you have unpaid medical bills related to a work injury, contact the attorneys at Meuser Law Office, P.A. today by calling 877-746-5680 for a free no-obligation consultation.