MG-2 Case Studies

Decent Essays
This is in follow up to our telephone conversation on 08/22/17 regarding the above-referenced matter. I received your email and have reviewed the file. As you know, this case is established for the left lower leg, abdomen and left hand with an average weekly wage of $532.80. You advised me that one of the claimant’s attending physicians had contacted you and wanted authorization for a left shoulder MRI. You advised him that the left shoulder was not established as part of the case. Ultimately, the doctor filed an MG-2 when you denied that on that grounds. In reviewing the file I note that the doctor should not have filed an MG-2 since the left shoulder MRI does not require prior authorization. I would recommend, in the future, that you include in your denial that the…show more content…
There is a report from Dr. Wigderson which includes an x-rays of the shoulder showing some arthritic changes. The doctor indicates the claimant had strained the muscles, tendons and rotator cuff of the left shoulder which he identifies as a new problem in Jul 2017. At no point does he indicate the shoulder problems are related to the initial accident either directly or consequentially. Ultimately, I think the MG-2 will be denied because it is on the wrong form and the treatment is considered pre-approved. If you do receive a bill for an MRI of the left shoulder, you should deny that on the grounds that the case is not yet established and that the condition is not causally related. You advised me that you gave our number to the claimant counsel and I am happy to discuss the matter with him if he chooses to call me. Otherwise, I would recommend you simply let the MG-2 be resolved and we will continue to resist any effort to amend the case to include the left shoulder. If you have any questions regarding this matter, please do not hesitate to contact me. Our statement of services will follow under separate
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