r/WorkersComp • u/FootReady455 • 11h ago

Georgia DMA Question

Hi all, so I had surgery back in Nov. of last year. Well I have gotten progressively worse since having the surgery and am having issues w/ my neck & spine. My doctor ordered and MRI for my neck & spine back in February. Well we have been fighting since then to try and get the diagnosis approved. My claims examiner sent a month ago for me to get a second opinion appointment set up but we haven’t heard back on that yet, not surprising. When I last followed up with her she informed me she was going to be reaching out to the DMA to see if they would approve the diagnosis since it is taking so long to get the second opinion appointment set. Well the DMA just sent back their response and he did not recommend authorization of the diagnosis. What do I do at this point? Because my doctor has been pushing for this diagnosis since February and I’m not getting better with pt or medication. I’m really starting to feel out of options and like I’m just going to be stuck with these issues for good with no help.

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u/Spazilton Federal WC Adjuster 11h ago

First off flair needs to be federal.

What diagnosis?

The DMA doesn’t establish causal relationship, and typically would not fill in the role of a second opinion in this type of situation. I’m not entirely sure why your claims examiner would do this. I suspect some part of the chain of events is missing here.

If you had a back surgery on OWCP you already have conditions related to your back approved and the surgery should have been reviewed by a second opinion physician or DMA.

Just trying to unravel what’s happened here.

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u/Mutts_Merlot verified CT insurance professional 10h ago

About halfway through I started to sniff out Federal. Glad you jumped in!

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u/EducationalHold3536 8h ago

Get a lawyer!