inquiring mind
Senior Member
Posts: 271
Joined: May 2005
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Thursday May 15, 2008 1:40 PM
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Dear All,
I have checked, may be not hard enough, about the issue on hand, but I can't seem to find any validity to the ppsitiontaken by the adjuster, who cannot even quote a statute to back up her claim.
EE received treatment from an MPN who requested back surgery while her claim is pending per LC 5402. As expected C/A wrote a letter to the PTP that no authorization sicne they have not accpeted liability and is pending the PQME per LC 4062.1. PQME issued a report opining AOE/COE and with EE needing the SX recommended by PTP. Now, the aduster is saying that a new report from the PTP is needed because the original request for SX is stale. Although I know it is w/o basis, the original report is only a month or two old when PQME issued his report.
Am I missing something here? Has there been any cases that has gone out supporting the adjuster's position? DOR/EH and Petition for Penalty has already been filed. An audit referral was made too. I am just wondering if I am missing something here.
Thanks!
IM
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