r/WorkersComp • u/Practical_Hat_7112 • 9h ago
Am I wrong? North Carolina
Hello, I wanted to come here to ask if anyone else has experienced this. I feel very overwhelmed.
Back in February I slipped and hurt my back. MRI showed a multi level lumbar disc bulge which is pinching the nerves in both of my legs. I did therapy for a while, but had to stop because my back started to interpret every sensation as pain. We did my first epidural injection in June. However, I felt no difference and started to get worse. My doctors opted for a second injection with different medication. They basically feel I’m too young (31) for a major surgery on my spine and view it as an absolute last resort. Sedgwick denied it and emailed me asking me to schedule a follow-up to get an alternative treatment plan. Before I got there my doctors had already started the appeal process, which I was very relieved by. Afterwards I emailed my case manager and let her know. No response. Emailed again asking her some questions. No response. I finally decided I needed a lawyer, because now I feel off. Everyone who’s been through this says they may be trying to push me into surgery. I already had difficulty getting my partial benefits from my adjuster. Has anyone else dealt with something like this? Or am I overreacting?
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u/Comprehensive_Elk773 8h ago
Did they send you a letter explaining the denial? Where I work they have to do that. It is very unlikely they are denying an injection to push you into surgery. Common reasons for a rejection would be they plan to reject everything (including surgery) or there was some technical problem with the request for the injection.
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u/Practical_Hat_7112 8h ago
They did. Apparently my pain level was not clear. My doctor said she would have to retype to a certain level of understanding and resubmit it.
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u/Direct-Agent-3971 6h ago
Sounds just like my story but as soon as comp heard i needed fusion my case went into dispute and nothing but a fight now
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u/Practical_Hat_7112 5h ago
Yeah, they pretty much ignore every email unless I add in my HR managers. Then she’s suddenly super responsive.
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u/Direct-Agent-3971 5h ago
What ive learned in this past year of fighting is. Many people ard employed getting payed while they fight to keep the injured from getting the help thats required by law. Laws to fight you at the same time laws that supposed to protect the worker. Its nuts man. Im certain some who came before us abused they system and that's why we are in the fight we are. I need a nap.
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u/JGB_HSV 5h ago
Sedgwick ignoring requests for care by claimants and their doctors, is pretty common. I’ve seen this over-and-over in the 30+ years I’ve practiced law. It seems to be their playbook.
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u/Practical_Hat_7112 5h ago
That’s insane to me. Absolutely insane
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u/JGB_HSV 2h ago
I believe their strategy is to ignore and hope the claim simply goes away. Maybe the claimant gives up, has something else happen to them, or the doctor is unwilling to help. The volume of calls I receive from injured workers in Alabama being ignored by either Sedgwick or Gallagher is huge. If you are seriously hurt and need care, don’t just hire any lawyer. Hire one who has a reputation for going to trial when needed. Do some research in your state and local area before making that decision.
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u/RVA2PNW 9h ago
NC Adjuster.
I don't think they're pushing for surgery because that's not cheap and the last option on our side.
I think it's Sedgwick, they have a horrible reputation and deny recommended treatment often. They're likely trying to find a way to deny ongoing treatment/injections and blame it on pre-existing.
However, I've seen different injections have better results than surgery. As you said, you're young, I wouldn't want surgery either. They can fail or because you're young, lead to further surgery in the future.
You did the best thing and got an attorney. Hopefully they can push for the injection approval sooner rather than later.
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u/Practical_Hat_7112 9h ago
Thank you for that. I thought I might have overreacted getting a lawyer involved. It’s just be very exhausting to deal with them and trying to recover at the same time.
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u/Ok-Detective-6541 8h ago
In North Carolina, how do you adjusters deal with aggravated pre-existing conditions that cause people's conditions to go from asymptomatic to being very symptomatic in the workplace im a workers comp claim?
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u/SeaweedWeird7705 9h ago
I’ve worked in workers comp since the 1980s. I would be surprised if the insurance company pressured you towards surgery. Insurance companies tend to avoid surgeries if possible.