Workers Compensation case study
“I’m in pain! Could I please have my surgery!” – Our client’s plea to the Workers Compensation insurer –
A man in his late thirties had a successful impairment lump sum compensation claim based on a rating of 12% Whole Person Impairment (WPI) for his lumbar spine injury on 27 April 2017 with the payout from the insurer in December 2018. However, who would have known that 3 years down the track he required an L5/S1 anterior lumbar interbody fusion and bone graft surgery for this workplace lower back injury?
The payment of medical treatment expenses must be reasonably necessary as a result of an injury as required by section 60 of the Workers Compensation Act 1987. The insurer denied his treatment on the basis that the L5/S1 anterior lumbar interbody fusion and bone graft surgery is not reasonably necessary as the surgery has not been confirmed by his treating spinal surgeon and the actual or potential effectiveness of the surgery has not been confirmed either.
In seeking a review of the insurer’s decision, our dedicated team at Alliance Compensation and Litigation Lawyers went through our client’s full medical history, every MRI scan and X-Ray, every medical report, every document. We found supporting medical evidence from the treating spinal surgeon alongside with MRI scans that indicated the problems our client had at the L5/S1 discs. Moreover, various reports from the treating spinal surgeon indicated our client’s continual lower back symptoms radiating to the lower extremities. Combining our client’s medical evidence, we successfully obtained a review of the insurer’s decision with the final outcome being that our client has received the insurer’s approval for L5/S1 anterior lumbar interbody fusion and bone graft surgery. He could finally have the surgery that he needed.
The three entitlements that injured workers are entitled to under workers compensation consist of weekly payments, payment of medical expenses for treatment that is reasonably necessary and lump sum compensation should the physical injuries attract the necessary threshold required for a lump sum compensation claim, which is at least 11% WPI. Sometimes the outcome reached may not just be monetary in value. Such as in this case, our client was satisfied that he could obtain the treatment he required to resolve his ongoing back pain. This would not have been possible without the dedication and hard work of the team at Alliance Compensation and Litigation Lawyers.
Hence, if you require assistance obtaining the insurer’s approval for your medical treatment, feel free to contact Alliance Compensation and Litigation Lawyers for your workers compensation treatment disputes. Do not leave yourself in pain when we can help you obtain the medical treatment you require.