The company-approved surgeon recommended surgery on both shoulders for the same injuries. Before IMR, one was approved. When IMR took effect, the insurer’s UR denied surgery, and IMR upheld it. I’ve lost a year fighting to overturn denials..
About Me: My name is Art Conrad. I’m 49 years old and I live in Sacramento.
About My Family: I’m married with four grown children and five grandchildren.
My Job and What Happened: I worked more than 20 years as a Shipping Foreman for Hostess and Wonderbread. My job included putting up orders for delivery at grocery and other stores. The orders were made of up to 28 trays on racks. Each tray weighed between 5 and 20 pounds, depending on the product on them. Each rack of trays weighed from 200 up to 800 pounds. I would load trucks all day, taking pallets of bread that would just keep coming and coming down the line. The equipment was not well-maintained, and we did what we had to do to get the job done. There was never a time when I said, “We can’t finish that job.” I overworked myself and developed multiple injuries over the two decades.
The company’s approved doctor recommended surgery on both my shoulders due to the wear and tear. The right shoulder surgery was approved, but the left shoulder was denied.
What this has meant to my life: I have spent a year “on hold.” I can’t work nor do many of the things I love: fishing, going to garage sales and flea markets, or working as I used to in my yard. I have more injuries that need medical treatment, but am awaiting resolution of this disputed surgery. My back and neck, carpal tunnel syndrome, my feet and a knee injury all need attention.
How Utilization Review (UR) Delays and Denials Affect Me: Due to the delays, I have used almost all of the two year maximum Temporary Disability while fighting the UR/IMR denial of my surgery. How am I going to subsist while disabled by the remaining injuries? My Temporary Disability will be exhausted, yet I still need time to recover from back and neck injuries. I suffered an additional year of pain and disability without any justification.
How Workers’ Comp was supposed to help me: Workers’ Compensation was supposed to help me: Workers’ Compensation is supposed to provide temporary disability compensation for time off work caused by work injuries. My surgeon submitted the exact same documentation for my left shoulder as had been approved for my right shoulder. Why did UR and IMR overrule my surgeon? After denying for a year the recommended surgery, the insurance adjustor approved the surgery on the eve of my trial. They knew they’d lose, but I lost a year of my life to UR/IMR. The insurers just do what they want.
For more information, contact Steve Hopcraft, 916/457-5546; email@example.com; www.caaa.org