Sedgwick CMS
MRI requests from three doctors denied, 10-month wait for surgery

Sedgwick CMS denied a workers compensation case for a 3.5" L-shaped Rotator Cuff tear in left shoulder. I was working at Home Depot & suffered a torn Rotator Cuff & LAC Osteoarthritis. I am right handed, but picked up a small item with my left hand because it was closest.
I remember a bolt of pain strike my entire left side, I screamed & just kept screaming. I am not one to usually make a scene, but I had co-workers running to try & help me. The pain was intense. I could not move my
arm at all. This happened on June 26, today is August 2.
I will admit originally the injury report stated I had a "heart attack" Only the HRM knew this because he wrote it. (thought injury would look bad on the company books).
But my doctor in the morning wrote out a slip for shoulder injury to give to Home Depot. It was not until 7/15 that I found the DX error, but I notified Sedgwick with-in the hour. They said they would correct it on the computer before I hung up. Home Depot was also notified. My doctor ordered a MRI to r/o tear, request denied. My surgeon ordered MRI twice, denied, Sedgwick's IME doctor also requested, denied.
On my third court date with lawyer in February 2006 the judge ordered the MRI to be covered. Eight months for MRI, Ten months for surgery.
Two months after that I lost my job as it had been an entire year later.
The deltoid muscle needed to be split in surgery, very painful! And surgery failure May. Confirmed by MRI 6. Case closed 7.
August claim still in worker's comp review. With 10th court date coming up. No monies coming in.

Company: Sedgwick CMS
Country: USA
State: New York
City: Melville
Address: PO Box 8901

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