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Insurance companies do it all the time. An injured worker's benefits were terminated because the insurance company doctor doesn't think he needs an arthroscopic surgery for his documented work related knee injury. The insurance company doctor "examined" the injured worker for about 5 minutes a couple of months ago (and was paid about $500 for that exam I suspect). That doctor later reviewed an MRI report - not the actual films - didn't re-examine the injured worker or speak with his treating physician, but just wrote another report saying the surgery wasn't necessary.
What is arthroscopic surgery? As the insurance doctor knows full well, its a procedure that is diagnostic as well as therapuetic. In other words, it will help the treating orthopaedic surgeon determine the extent and cause of the worker's knee problems - and fix those problems if necessary.
What do you think the insurance doc would say if it was his patient?
What can this worker, who was hurt on the job do now? He has to request a hearing and have a D.C. administrative law judge decide whether he needs the surgery and whether his workers compensation benefits will be reinstated. That's why we are here, we are here to help workers who go through these sort of situations. Contact our offices at (202) 393-3320, we can help clients handling workers' compensation cases.