Workers' Comp and ADR, esp. in California

[KL Aguilar]

I am a Workers' Comp patient who has cervical stenosis and bone spurs from C3/4 thru C6/7. Local WC surgeon is proposing 4-level fusion, Alphaklinik is proposing 2-level ADR.

I am leaning toward ADR and have more or less resigned myself to paying out of pocket by taking out a home equity line of credit. (OUCH!) But now I have been told that if I go outside the WC network for surgery, I will not receive WC pay for any recovery time.

Someone else must have traveled this road before. If so, could you please advise?

[mmglobal]

KL, I don't know about the WC issues, but the recovery time from cervical surgery can be very short.

Mark

[dshobbies]

I too have no personal experience in this area, but from what I've read, fight. Fight like hell for your rights. Get a second opinion for an adr surgeon and fight, fight fight.

Dale

[Michelle]

My biggest advice here is call a lawyer!!!! Laws change from state to state, but my wonderful attorney got my ADR approved while the device was still in clinical trials! (Because the FDA shut down the study while considering full approval, I didn't get it until after approval though.) But IT IS POSSIBLE!! It takes some effort, but I fully believe it's worth it. Some companies are starting to believe that they're better off spending the little extra now, and hope for fewer future problems, and less time off work post-op. Even if you don't hire a lawyer, most will talk to you once for free. Ask them. I don't think WC can deny you Partial Total Disability while recovering from ADR (even if they don't pay surgical costs), so long as your recovery doesn't go beyond what would be reasonable for the fusion. But it varies state to state. Sorry, all my experience is in Colorado. But it is possible to get them to pay for the surgery. Question is can you wait long enough to fight them? Ask your WC primary doc for a referral to a surgeon who does fusion as well as ADR. Once the WC primary gives his consent for you to see that doc, it should be easier. Insist. And call a lawyer. Good luck!!

[KL Aguilar]

Thanks for all the help. I do have a WC attorney; he is the one who told me about the non-pay for recovery time if one goes outside the system. He opened a book and read the passage to me. He feels my best bet is to go to court and push to have surgery by a California ADR surgeon. However, that is time consuming and I don't have a lot of time due to severe cord compression. I was hoping that someone had already gone this route and could share their shortcuts.

Mark mentioned that the recovery time for cervical ADR is fairly short, but from reading the experiences of some cervical patients, I realize that sometimes there are complications. I have a very public job and often stand all day doing presentations in front of a hundred or more people. I can't just stop and take a break. I will not be able to do my job unless I am completely recovered.

[dshobbies]

My first thought is to get another attorney who believes in you... but I may be reading this wrong.