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Before Benefit Revue Conference Texas

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  • Before Benefit Revue Conference Texas

    I had an X-Ray on my arm the day of my injury at work. I have been told by the Ombudsmen office manager that I cannot go around requesting for an MRI to prove why my arm continues to swell.
    I would like to know why can't I go to my primary physician to order an MRI instead of a worker's comp physician? Are primary physician diagnosle admissible or not in court? I was told by my attorney that an MRI would help with my case.
    I need to get to a physician before my benefit revue conference.
    PLEASE HELP?

  • #2
    I would like to know why can't I go to my primary physician to order an MRI instead of a worker's comp physician?
    The underlying basis in WC is employER liability for injury in the workplace...as such, you/your insurance carrier are not used because you are not liable.

    When treatment/diagnostics are required to "cure or relive from the effects of injury/illness", your Dr must request prior authorization, but for emergency services, from the ER/IC.

    If you use your own health insurance, with prior authorization, in writing from the carrier, they may place a lien against your claim.

    An MRI may or may not be necessary vs X ray...nor would a request by you, vs your treating physician, even be recognized.
    You do not have to prove you are injured, no one disputes that, only to what extent benefits are due.
    Are primary physician diagnosle admissible or not in court? I was told by my attorney that an MRI would help with my case.
    I need to get to a physician before my benefit revue conference.
    You have an atty... s/he is still the best source of info regarding any issue in your claim.

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    • #3
      WC or not NO doctor worth his or her salt is going to order a MRI because the patient wants one. Your lawyer is not a doctor either so his opinion about what medical care should be rendered is irrelevant. If the doctor you are treating with for this injury does not see a medical reason to order a MRI, you aren't going to have one. Your insurance is not going to cover it even if you get your own doctor to request one because this is not their claim. It is no different than sending a bill to your homeowner's insurance for an auto accident. WC is the insurer, not your regular health carrier.
      I post with the full knowledge and support of my employer, though the opinions rendered are my own and not necessarily representative of their position. In other words, I'm a free agent.

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