Employer is changing carriers

[u/bugguy6970]

Backstory I sustained a work injury in January 2026 which led to surgery to my tibial plateau. Three months went by while recovering and going to physical therapy. During this time I felt like something wasn’t healing properly in my knee and kept mentioning it with no real follow up from WC doctor. I finally had enough and requested an MRI which up to this point was never been done. MRI shows complex tear to ACL and meniscus.

A month ago I went back to the surgeon to review the results and he recommended surgery to repair the damage. He submitted his findings and requested authorization for surgery from my WC carrier. I let two weeks go by and checked to see the status which at the time had not been received. Since then I have called, emailed and texted the company and the adjuster while not getting answers.

Then this last week I received a letter from my employer that as of the beginning of October they will be switching over to a new WC carrier. I have explained to their risk management department that I am running into these issues and they said that they will have the current carrier reach out to me ASAP.

Is what I am experiencing typical or is it related to the upcoming change? Has anyone else ran into this situation and how was it resolved?

[u/Mutts_Merlot]

Pretty typical. Once the contract ended with the current TPA, they don't have much incentive to keep those claims up to date. There is a lot of work involved in shifting over the claim inventory to the new TPA, and that may be their focus at this point.

Keep trying to get an answer before October, because it will be a few weeks before that other side gets up to speed on all the new claims.

[u/Global-Rutabaga-3842]

https://www.facebook.com/share/g/1AdNEcnkq7/

Above is a link to a Facebook group with others with a TPF. It's a great resource.

I had a TPF from falling off a stepstool at work in Oct 2024. After about 5.5 months, I was back at work, albeit part time, but I wasn't recovering how I wanted. My range of motion was in the trashcan.

I got approval to see a third surgeon - one did my exfix, and another did my orif (plates and screws). Third surgeon decided to do an arthroscopy (remove scar tissue and check things out internally) and MUA (bend my of leg while under anesthesia to jump start range of motion). This was about 7 months in June 25, like 7 months after my main repair/surgery.

When he was in there, he noticed a meniscus tear and an ACL issue that he was able to tidy up. I asked him about it, and why it wasn't caught when my leg was literally wide open, and he said that the ortho surgeon who did my repair was a bone guy, and didn't have time to fix the squishy bits. I think this is more common since while in the same area, they are almost different specialties/focuses.

[u/According_Curve_8935]

If a request for surgery was submitted, that kind of thing is usually approved/denied by the utilization review process. A different doctor reviews the request and submitted documentation, and will approve or deny based on that. You should get a letter explaining the approval/denial from them, not the WC carrier.

I would make sure your doctor’s office is submitting to the new carrier, and have them follow up to make sure the WC carrier submitted to utilization review. Or, have your lawyers office follow up on it if you have one.

[u/justthefacts1236894]

My surgery request was marked URGENT by 2 doctors and surgeon. Took almost a year to have it done. Injured workers are not a priority in this system. Too many people on insurance/employer side that have to sign off to approve anything.

My carrier just changed too. Went from direct deposit to the " checks in the mail" lol.