I requested epidural injections to avoid risky back disc fusion surgery. UR and IMR said I must have surgery that’s as likely to fail as to succeed..
About Me: My name is Jacinto Fonseca. I’m 60 years old and I live in San Bruno.
My Family: I am married and have four grown daughters, ages 38, 29, 28 and 23.
My Job and What Happened: I worked 34 years for UPS as a Package Car driver. Every day, I made 100 or more trips in and out of the truck, carrying packages. In the past few years, I worked overtime delivering oversized packages that the regular route driver couldn’t carry. On Nov. 3, 2011, another driver and I were trying to deliver a 145 pound oversized package. In trying to get it out of the truck, the package tumbled onto me, knocking me backwards and down. I injured my shoulder and my back.
What this has meant to my life: I used to be very active: running and playing sports. Now, I have pain in my back constantly. I’ve been waiting nearly a year while the insurer spent thousands to prevent me from getting epidural injections.
How Utilization Review (UR) Delays and Denials Affect Me: I requested epidural injections to avoid back fusion surgery. The surgeon said there was just a 50/50 chance the surgery would succeed in repairing my injured discs. The insurance company’s UR didn’t follow the medical guidelines, which show benefit from injections in cases like mine. It took IMR 6 months to uphold an invalid UR denial. The carrier claims it can’t overturn a UR denial even if it wants to provide care.
How Workers’ Comp was supposed to help me: Workers’ Compensation is supposed to provide compensation for the lost future earnings caused by my work injuries. But....Treatment is supposed to follow a “conservative” model, with the least invasive treatments tried first. The opposite is being required of me. Instead of trying epidural injections, I am being forced to have surgery that likely won’t work.
For more information, contact Steve Hopcraft, 916/457-5546; firstname.lastname@example.org; www.caaa.org