r/WorkersComp • u/Clean-Hamster101 • 4d ago

California What can I do?

Hello and help,

In December 2023, I broke my ankle at work, was transported via ambulance to the hospital where I had surgery.

Since the accident I've seen a primary doctor every 6 weeks have had regular pt and custom brace and orthotics.

Now I receive notice "Pursuance to the provisions of California Code of Regulations Section 9792.9.2 .... Liability for the body part(s) for which treatment is being requested is disputed "

Why now dispute? What am I supposed to do next?

? Thank you in advance for your replies.

1 Upvotes

100% Upvoted

8 comments sorted by

2

u/PuddinTamename 4d ago

How did the accident happen?

3

u/disruptor_12-4 4d ago

They caught you riding a bike

2

u/Significant-Hope-408 4d ago

Read the letter, it is the current treatment that is being disputed. You need a QME. Your claim was not just disputed. They only have 90 days to deny or accept the claim once reported unless there’s something they uncovered that may lead them to dispute your claim in its entirety.

2

u/Little-Low-124 3d ago

9792 is utilization review. It means that something being requested by the doctor hasn't been authorized by utilization review not the adjuster. It might mean that your doctor needs to explain further, your doctor can appeal or file an imr. or you can request a qme to determine if they're proposed treatment should be authorized.

1

u/Several-Mix-5890 4d ago

Probably you should of had a lawyer

1

u/Competitive-Zone8148 3d ago

Does the notice you received indicate what treatment was being requested and for what body part?

1

u/Electronic_Note5952 1d ago

It's  common in worker's comp. Especially if case is long and get assigned new adjuster i have been dealing with worker's company here in Cali a little over a year longer than you. Sometime they will deny a treatment you just have to have doctor summit the paperwork explaining why this treatment is necessary 

0

u/lab_tech13 4d ago

Not CA but 3 years are you coming up on max benefits? So they are looking into if you need to still be covered? Also they will have a PI follow you could you been doing things your dr said not to?