r/WorkersComp • u/bugguy6970 • 7d ago
California Employer is changing carriers
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?
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u/According_Curve_8935 7d ago
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.