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View Full Version : I have 13 years w/c experience and was senior claims examiner when I became disabled




lefthanded
05-03-2008, 04:42 AM
I am reading these threads, seeing so much misinformation, sharing of information that is specific to certain claims for certain people in certain states, and hearing fear, confusion and worry . . . I would love to help! However, I can not set myself up as an expert and give legal advice, nor have I worked claims in every state and those I did have probably changed their laws somewhat since then . . .

But there are some very basics that I could offer to help you through the "system."

Is there an interest? What are your most pressing questions or issues? And what is it that you don't understand, find confusing, or find depressing about being on workers compensation?



i will begin by saying Workers Compensation Insurance is a state run program. Your employer, and most of the time you, pay premiums each month (yours comes out in payroll taxes), and those premiums are set according to the degree of hazard and the number and costs of claims your employer experiences on average in your state. They desire to keep these premiums, and their costs, low . . . and this can lead to conflicts over coverage, allowance and sometimes even the handling of your claim. This is why attorneys are sometimes needed. Because workers compensation was instituted over 100 years ago to take the burden off the injured worker, it is supposed to be a no-fault system. If your injury happened on the job -- the language usually includes the words "arising out of" and/or "in the course of" your job duties and activities, it is supposed to be covered. W/C was designed to make sure the worker got proper medical treatment, to replace the lost wages with a benefit that would keep them from economic ruin (about 2/3 of your usual wages) and keep you from losing your job for being injured.

During the industrial revolution and until about 100 years or so ago, if you were injured (cut off your arm, broke your back, etc. . . . ANY injury) you were shown the door, escorted sometimes to your company housing, where you were thrown on the street after being handed a bill for rent and your tab from the company store, and you were responsible for sewing your own arm back on or fixing your broken spine the best you could. Back then there was not even health insurance, so you really were out of luck! (I did my senior thesis on the Pullman Car Company of Calumet City, IL, where I learned these things happened all the time.)

So if your benefits and your hassles with your claims person seem too much, just appreciate what history stands behind you. Then learn about your particular state's claims process the best you can. Many injured workers went before you, blazing a painful and costly trail to this time in history.

W/C is not meant to make you rich. You will go backwards financially a little, even though you get a check each week or two. However, your medical should be paid at 100%. If you are ever billed for something that w/c should cover, turn the bill in to your claims person. If you are ever billed for a balance after w/c adjusted the bill, this is a violation of the law. . . tell your claims person!

For now let me just say a few things that are basic good claimant (that's you) etiquette:

Be polite, calm, rational and businesslike with your claims person, the doctors and anyone regarding your claim. It will move you farther than being the opposite: threatening, belligerent, angry or pushy.

Do all your paperwork promptly. There may be a reason something gets delayed, but your claims person can only act on what he or she has in the file. A common slogan among claims handlers is: If it isn't in the file it didn't happen. This is why I recommend following up every important phone call with a letter: you may need the paper trail later. Keep a file and keep copies of every letter you receive and write, every notice, note, and some even keep copies of checks (or the stub to show what it paid) . . . and a log of your phone calls, in the file.

Learn to use your word-processing program, including spell check, so your correspondence will be businesslike. If you don't have a printer, see if you can e-mail your correspondence.

Find out if you can protest any unfavorable decisions and follow the timelines. A day late and you lose! A protest is not hard to write. . . the statute will often give you the format and the words to use, or close to that.

Do not skip doctors appointments or skip treatment. Like all medical treatment, you have the right to participate in your treatment plan, to a great extent. If you are unhappy with your physician, therapist or counselor (if you are in vocational counseling) . . see if you can change. You can refuse a treatment that is against your beliefs or better judgment, and you can not be forced to have surgery or other invasive procedures against your will. However you must have a good reason, and be prepared for your claim to be a little more complicated if you refuse, say, a surgery that could return you to work with low risk, or an test that could move your healing forward.

Do not lie. Do not cheat. Do not fake. Do not try to get away with being off work if you are truly not injured. Claims people hire investigators all the time, even on "nice" people. Sometimes it is the protocol for handling claims for a particular company, or standard claims handling practice for certain types or levels of claims. (I once won a case forcing the "injured" worker to repay over $84,000 because we caught him doing heavy farming activity when he claimed he could not turn his head to drive or lift a gallon of milk. I saw it on the surveillance tapes myself!)

While you must adhere to your restrictions, you are allowed to shop, and take care of your kids . . . and, yes, you may leave the house while on total disability! You probably want to stay away from the roller rink, the softball game or even the fishing boat on a holiday weekend, depending on your injury.

It is believed you get your way by piling up phone calls and messages to your claims person. If you have to go that far to be heard, ask for their supervisor. Follow up your first call with a letter, and copy their supervisor or the manager. When their file is reviewed it will come to someone's attention you have not been answered . . . and someone should get a reprimand for ignoring you. If all 200 claimants called me every day hounding me for checks that are late, for information, or just to talk, I would never have gotten anything accomplished in a day! Remember, they are doing their job to please their boss, just like you have to when you are at work.

Keep in touch with your employer so they know a) how you are doing, b) if and when you might return to work, c) that you are still an employee (do not abandon your job mid-claim, it makes life messy later) and d) it is the correct way to keep them onboard with your claim. That way they know you are earnestly trying to get well and return, and will see you more as a returning asset than a present liability.

Stand up for your rights. If something seems amiss, ask. Protest when you feel a decision or action is wrong. Stay on top of your claim. Start a file and keep everything in it in some form of useable order.

Return to work when you are released. If it does not go well, or you flare up your injury, your doctor is the one to document the medical reason you can not continue, and might need more treatment. In fact, your doctor must provide documentation for almost all of your benefits: time loss, restrictions, treatment, and return to work, as well as when healing is complete (maximum medical improvement, end of healing period, or whatever it is called in your state) and permanent impairment.

Make sure impairment is addressed before claim closure.

Find out what the statute of limitations is for reopening, and under what conditions this claim might need to be reopened.

Understand that in many states if your injury is the same as one you have years ago with another employer, you may be asked over and over for a work history so that they can see if some of the costs should be thrown back on the previous employer's injury. Every state seems to handle pre-existing injuries or conditions differently: find out early how your state handles it. Then don't spin your wheels trying to fight it. Only cases that are hard-fought in court change laws, and unless yours seems that strong, concentrate on getting all your benefits that are due under the law. Unfortunately that can sometimes be harder than just going back and doing your job!

Of you qualify for FMLA, file for it! You have approximately 12 weeks of protection of the job you were in at the time of injury, or a substantially similar position, under FMLA. Unfortunately, if you use FMLA for your neurological condition, you may have to share that 12 weeks with your condition . . . you only get so much time under FMLA regardless of how many conditions you use it for.

Do not compare your claim to anyone else's claim. Rarely, if ever, will two injuries, severities, wages, hours, and employers be identical, let alone doctors, details, outcomes, or "settlements." . You are wasting energy wishing you would get the big "settlement" your neighbor, friend, or second cousin on your father's side did! This is a cruel trick you play on yourself if you listen to everyone else's expert advice, because they had a claim or knew someone who did. Run, don't walk, to the nearest earplugs. Tell them how interesting you find their information. Thank them. But do not ruminate on what they claim or believe you should be getting. It is almost like saying every lottery ticket is a big winner. It just ain't so. Some claims, and rightly so, close with no big jack-pot at the end.

I strongly object to the term settlement when discussing workers compensation. Being a no fault system, if you are permanently impaired or disabled by your injury, you are entitled by law in most if not all states to an award of permanent disability benefits. This money is to compensate you for future medical needs that might be consequential or might arise later (such as prescriptions, they are not generally covered after claim closure), but not be sufficient for reopening. It is also to make up for a possible drop in your future earning capacity due to your loss of function in the work place. It is not a windfall to be spent on a new 4x4 or vacation, unless you have an endless income stream guaranteed in your future. I suggest you buy a few certificate of deposits and sit on it for as long as you can. It might come in handy down the road when you get laid up with a non-work medical condition and have no or little income, or when you can no longer do your job and find you are earning less. That is what it is designed for. Honest. But I bet over 50% of the checks I cut were "blown on stuff" before the ink dried on signature on the back of the check.

Sometimes the final payment, if it is more than a year's worth of benefits would be, are paid out in monthly amounts. If this happens, be glad you have an extra check each month to put into savings after you get back to work. Don't sell out to one of those companies who will give you cash now. You will get less than you are due, because they will pay you at a discounted rate, and they will walk away counting your money as it enters their pocket. They may be legitimate, but they are immoral by preying on people in dire need in my book. If you are hard-pressed for money when it comes time for your final permanent disability payment, and it is set up as monthly payment, ask your employer or claims person if you can have a hardship lump sum of all or part of it.


Well . . I am up wa-a-a-ay past my bedtime. If there are any questions, ask away. I will discuss permanent total disability if anyone is in this situation. Sometimes it is called a W/C Pension. They are rare, hence I am no expert. But maybe I can help if you have questions I can answer or give you a direction to go for answers.

For now . . . good night. If I have any typos or misspellings. . . . it is 2:37am here right now. . . .


"Z-z-z-z-zz-z-z-z-zz-z-z . . . . . ."




Jo*mar
05-03-2008, 12:44 PM
I think most have problems with the system when they have a 'hard to prove" injury.
Something that does not show on a xray or Mri or other concrete tests.
Or if they cannot find a dr that is fully knowledgeable in whatever injury they have?

If you can share some tips on how best to deal with the wc system when you have a chronic or difficult claim?

I know my claim was kind of messed up - because I trusted the system, and I assumed the atty, the drs, etc to knew what was supposed to be done.
I didn't really have clue back then.:o

lefthanded
05-03-2008, 07:17 PM
Jo55 said:

If you can share some tips on how best to deal with the wc system when you have a chronic or difficult claim?

I know my claim was kind of messed up - because I trusted the system, and I assumed the atty, the drs, etc to knew what was supposed to be done.
I didn't really have clue back then.


I understand, because even with my experience we were unable to get my partner's COPD claim allowed as an industrial injury. She had never exhibited any signs of asthma or lung issues, including she never had bronchitis or pneumonia in her entire life. However, after working a couple years at her new employer, following her period of unemployment during my surgeries and recovery, she developed bronchitis and pneumonia which was followed by asthma. Her place of work is an extremely dusty environment, which would be like working in a chalk factory where they grind the mineral into fine powder right there before forming it into the little sticks. (This is not what she does, but a spot-on analogy . . . I don't want to reveal her employer, as her claim is ongoing. She essentially works with the same materials, and comes home dust covered almost every day.)

She now uses two types of inhaler and takes oral meds as well as prednisone when it flares up. But the independent doctor said it was only an aggravation of her preexisting asthma and not brought on solely by the dust at work. We know that is bull, but even her own doc agreed! Short of hiring our own lab to to air sampling (Labor and Industries will only do this if they think they will find a toxic substance, but copious amounts of dust don't matter!) and pulmonologists to evaluate her complete medical history, which we would have to ay for, and hire and attorney, we were sunk.

So I understand the challenge of, say, TOS which is either caused by repetitive movements at work, CTS, which is both work related and can come on in mid-life and later without work aggravation, back issues, etc. I have handled them all. The sad part is if the employer is self-insured, in many states they can be, they are usually more responsive to these kinds of claims and injuries. I know her claim had better chances of being an ongoing, work-caused claim if her employer had been self-insured. The state might have practically forced them to accept it, but the state operates here by complete different standards. I find this reprehensible, ad two people, one who works at employer A (state fund) and the other at employer B (self-insured) get completely different handling of their claims. i wish I had the power to work to stop this. . . .


The best advice I can give is that you never want to rely on anyone handling your claim. This is not about trust so much as being able to manage your claim as much as possible. This means you find a doctor who will support your claim, (or give you a good, clear explanation why it might not be covered.) However, if if it is not found caused by work, you might still be able to say the aggravation was caused by work. Then this is where you will have to direct all of your efforts, to prove that work is making your condition worse or not allowing it to get better.

I am sorry that there are health issues that are either caused, aggravated by, or arise during one's work life that are not found covered under worker's compensation. The program initially was set up to cover accidents, and over the years has evolved to cover other illnesses, like black lung, etc. Even today attorneys advertise for clients for some of the difficult lung issues, which indicates to me that workers still have an uphill battle proving work caused their illnesses.

That said, each and every person here with a difficult diagnosis, and a correspondingly difficult workers compensation issue, would need an individual evaluation of the situation. This is because, as I have said, every state's laws are different, and every employment is different, and every worker's physiology is different.


The steps I would take to approach filing a claim for TOS (I have handled several that were covered back in Iowa) or other repetitive injuries, would be:

1. File the claim with an onset date when you first noticed symptoms. If the statue has passed it is likely you may only get an aggravation claim with a more recent date date.

2. Gather all the medical history on yourself that you can to show you were never seen or treated for this condition before your work for this employer. If it began with a former employer, but continues to be aggravated by the current one, you may have to file against both.

3. Gather job descriptions from each task you perform (or performed, if a prior employer), with specific details as to the physical requirements and the amounts of the repetitive activities you do that you believe caused the condition.

4. Get medical testing that defines the nature of your conditions. I believe TOS requires some kind of Doppler exam, as well as x-rays or other means of pinpointing where the impingment is.

5. If the claim is denied, I believe it may be in your best interest to hire a good attorney who specializes in the condition you are filing for. Hiring a friend or you own personal attorney is a waste of time, and if the attorney you do hire finks out on you, fire them and look elsewhere. We have experienced this personally, with an attorney who held our file for review right u to the deadline then declined to take the case. Gr-r-r-r!

I know the above sounds like something the claims person should do. . . but they have been known to include only that which will support their position, and sometimes doctors even leave out incriminating information. Record will cost you, but it is often worth it.

The hardest thing for me to say is that it is always possible that the facts and records and symptoms simply do not compute to enough convincing evidence of an allowable claim no matter what you do. TOS, CTS, and many spinal issues carry that "normal aging" curve with them, that medical "don't know the cause" reputation, and are resisted as work related with great frequency.

The "system" was originally set up to allow filing of legitimate work injury, but over time it has been fraught with the reputation of being rife with fraud, unfairly hard on the employer (I say, what about the worker's bodies?), and an expense that must be reduced or controlled by any means possible. The ergonomics laws passed in the 90's have been so watered down or eliminated by disuse that we do not see the workplace evaluations of potential injuries that were intended to come out of the legislation.

Another factor that doesn't help is the political climate we live in. I believe beginning with the onset of big breaks to industry when they began whining about profitability, we saw a steady decline in their responsibility to the workers of America. We are back to being machines parts, expendable and replaceable. Rare is the employer who truly cares, and whose corporate structure includes safety and prevention on a large and honest scale. Most do it to front the impression that they are complying with any applicable laws. Hopefully we will see a change in this as the political climate warms under a new administration.

Imagine how universal healthcare might alleviate this. At least the treatment part. I envy workers in some European countries whose employers insist on taking care of their employees. I am afraid with our influx of workers willing to undercut everything in our system -- wages, living standard, working conditions -- we do face an uphill battle.

I will do what I can to help. W/C is not cut and dried. Being an examiner has some horrible stressors attached to the salary: we had to close claims to get paid for our work, we had a greater workload than we could handle (and we had them by client, and I had some of the tougher clients), there was constant pressure by the clients(employers) to reduce costs, and every one of our files had to be highly detailed and in perfect order (a full-time job in itself), and we were expected to sit in b.s. meeting that were no more than marketing for our service providers (nurses, vocational counselors, attorneys). In an 8 hour day were we supposed to review all diaried files, return all phone calls, monitor all medical and legal aspects, make sure all checks were issued (very important) and file an endless stream of paperwork with the state or suffer penalties. In addition, some phone calls would take much longer than average, and we were always ridden to cut them short. However it was my philosophy that if I explained claim issues to a claimant and listened to their frustrations, I could help avoid issues by increasing communication. Think so? Heck no . . , I was always under scrutiny for spending a little time with a hurt worker rather than giving quick replies and hanging up!



Enough about why claims are frustrating and why your claims person is not warm and fuzzy all the time. Enough about the reality of claims. If anyone has a question I will do my best to help you find some answers. . . . .

lefthanded
05-04-2008, 05:05 AM
thursday asked me to repost this response to her "Sweating over claim closure," so bear with me, some of it might be repetitious:



I was a Senior Claims Examiner with over 13 years of experience in worker's compensation in several states before my last employer put me on disability. Let me preface by saying every sate is different. I urge anyone on W/C to read the basic on how your state's w/c works.


A claim will stay open as long as your doctor can document that further treatment will improve your condition. Once he can no longer justify your being in treatment (even if the physical therapy, etc. keeps you from sliding backwards), you will likely be declared fixed and stable. At that point your claims examiner with do one of several options: a) prepare the claim to be closed, b) request a permanent disability evaluation from your doctor, or c) set up an independent medical evaluation for determination of permanent disability and/or restrictions.

I advise anyone nearing claim closure, that unless you feel just as healthy and fit as you did before your injury, and sometimes even if you do, request a permanent disability rating from your doctor. If he can not do one (not all doctors have the certification to do this) ask him to refer you to a doctor for a consultation for closure and determination of permanent impairment.

A permanent disability or permanent impairment rating should take into account all factors such as loss of strength, loss of range of motions, loss of sensation, residual pain, your age, and perhaps even your physical condition, and your education level. If your hand is injured, ask that your rating be to the arm, if your thumb, to the hand, etc. If you have a back, shoulder or hip injury it should automatically be rated as loss to the body as a whole. However, remember, your state may vary somewhat . . . but you can ask for a copy of the statute on disability/impairment (they are the same thing) ratings.

I urge you to not let your claim be closed without addressing permanency unless you truly feel so fully healed that you can not imagine ever having the injury site give you any grief as far as being able to work. Disability is rated with regard to ability to work, not with regard to bowling, playing golf, or climbing mountains or skiiing! (I have had every question in the book asked of me regarding sports and activities that a claimant could no longer do.. . . but unless it is a work activity, your industrial injury is most likely not going to be responsible.)

You will not get rich from your permanent impairment rating and award. It likely will seem like a mere pittance for what you have been through, unless you have suffered a severe injury like amputation or a severe head or back injury, requiring major surgery or extensive rehabilitation. if your rating seems too low, ask the doctor to explain how the figure was determined. If the state arranged your independent/rating exam and it seems unfairly low, ask for a second opinion, with your own choice of doctor.

Carpal tunnel surgery never used to carry an impairment, as it was believed surgery restored 100% function, but that was changing when last I worked. Fractures of the arms, hands, legs and feet should be rated for impairment, as should back injuries with residual pain and/or loss of flexibility, even if you did not have surgery. Hearing loss always has impairment, as does loss of sight, taste, or any of your senses. I once paid impairment for a claim for loss of the sense of taste when the treatment for the injury caused the loss, even though the injury itself did not. I also paid out a huge claim on top of the work injury when a therapist treating the work injury dropped a patient and cause paralysis! (The additional costs for the second injury went to subrogation, meaning the therapist was responsible for everything over and above the initial injury . . . but it was messy, as the patient was not nearly to the end of her treatment when the therapist dropped her!)

(Speaking of subrogation, if a third party is responsible for your injury, they will have an interest in what is paid out on your claim. However, do not let them have undue influence over the claim, or push for closure, early end of treatment, or less treatment than necessary. And do not deal with them directly . . . your employer or the claims person is responsible for dealing with this.)

The best way to deal with your claims person is to be calm, reasonable, not angry or upset, and to educate yourself as best you can, as this will get their attention. The worst thing you can do is threaten, act like you are or have an attorney (your ability to talk directly with a claims person, and sometimes even your employer, about your claim, ends when you get an attorney), or indicate that you expect to "own the company" once your claim is settled. Believe me, I have heard it all where closure, money and punishing "bad" employers and their representatives are concerned.

I used to tell my claimants who asked up front if they would need an attorney on their case: "not if I do my job correctly." And then I would tell them if at any time they feel they can no longer get what they think they need from me or the system, then that is when they might want to speak to an attorney. Fees can range from flat-rate hourly with the clock ticking on every phone call, even the ones that are not returned (number one complaint about attorneys is that they do not return client calls on w/c claims) to anywhere from 20% to 30% and more, plus expenses/costs. Some of the best reasons to get an attorney are:
1. Your claim is denied and you truly had an on the job injury. Not an accident, but an bona fide injury. An attorney will know how to best present your case before whatever review board your state provides.
2. Your claim is only allowed for part of the injury and you or your doctor feel that your injury is greater than what was allowed.
3. You are refused benefits and you have been unable to protest them out of your claims person. Remember, every order issued to you is likely able to be protested in writing. Learn to write a decent and neat (with spell check) business letter. It is beeter then righting one that culd make them laff and not take yu seeriusly.
4. Your claim is closed before you have finished treatment. Your doctor should protest this, but if he doesn't convince them, you might need an attorney.
5. If, in your state, your employer/claims person has the right to dictate which doctor treats you, and this doctor is seriously downplaying your injury, an attorney might be needed.
6. If your claim is closed without a disability rating and your claims person disregards your second opinion doctor's rating. Attorneys love ratings cases because they know approximately how much money they will make and have to spend to get it.
7. You have not received all of your time loss/loss of earning power benefits and your examiner closes your claim. After you have submitted a protest with your calculations, if you still feel they owe you for lost time or lost income benefits, you may need to get an attorney. Included here would be if your time loss rate was not calculated accurately, or does not include shift premiums, overtime or bonuses in the calculation. However, these usually must be protested within a specified period after you have received an order for payment and calculation of benefits. Do not miss this deadline . . or any deadlines, for that matter. You will be left out in the cold!
8. Your employer does something that appears to be retaliatory for your filing a claim. e.g. Your employer fires you for filing a claim and ruining their perfect no-injury record, or they treat you differently when you return to work, like forcing you to take a job that pays less even if your job position is available, or move you to another shift when there is an opening on your regular shift. This is a fuzzy area in the law, which is why you should at least ask an attorney if you feel any kind of discrimination or retaliation, and especially if it is for filing an injury claim.

This list is incomplete and may not apply to all cases in all states. I have tried to provide a summary of ideas to help you educate and protect your rights when it comes to on-the-job injuries. Learn if and how to protest any actions you feel are not timely or done improperly. Learn to speak up and stand up for yourself. It will feel like work. . . but hey, you are getting paid something in the neighborhood of 2/3 of what you had been earning before you were injured. Get to work protecting yourself!!!
__________________

diaba
05-04-2008, 10:23 PM
Hi Lefthanded, maybe you can advise me on my situation. Neck/back strain at work last Oct. Still with residual tingling symptoms that travel from back to front of my head, and intermittently in left arm.

w/c doc feels symtpoms are not related to work injury anymore(I also have MS)so they're no longer paying me or allowing me to work modified duty. MRI shows no new flares and my neuro and primary doc don't think it's the MS. MRI of neck shows minor disc changes.

So I requested a QME, the claims adjusters say I have to see a neuro QME to confirm it's not the MS. They don't want me to prove it's related to my neck injury, I need to prove it's not the MS(thought I'd done that already).

Anything else I should be doing. Thanks for your help.

Diana

lefthanded
05-04-2008, 11:13 PM
diaba . . . . have your neuros and primary physician submitted reports stating that they do not find any MS relationship to your current symptoms? Especially helpful would be records that show you have never experienced these symptoms with your MS. If your MS ever caused any symptoms like this, though, it may be pretty-darn close to futile trying to pin them on the injury.

It is to be expected in W/C cases that any residual symptoms will likely be pushed off on any pre-existing conditions. This is the game phase of your claim. I gotta be honest, sometimes you win, but more often than not you get your hopes up and they win. I can only explain this by saying -- power lies where the money is. When it comes down to it, they will hire big-bucks lawyers.

See if you can find a neuro who will read all the records. Someone with MS experience, big time. I would also ask if you could be privy to a copy of the questions asked the QME doctor, and what records he uses to make his determination. This may not be all that simple. I wish I could give you a magic formula. I would say it may also be time to see if there is an attorney good in both comp and ADA. An attorney can often make sure the records are not an abridged set, skewed to get the result they want. However, you do want this to be a clearly independent exam, too, or if it ever makes it into a court room, it will lose water for being biased.

Was your employer making any ADA accommodations before the injury? If so, and you do lose the residual symptoms case, then perhaps they will still have to look at reasonable accommodations for your "new" MS symptoms of tingling of the LUE and head and neck. I would push for accommodations if you do not prevail on this issue in your W/C case.

This case really reminds me of my partner's case, where they agree she needs a respirator, but deny that the dust at work was the proximate cause of her asthma. They allowed your neck strain, but "NO!" the neck, arm and head symptoms you never experienced before are your MS. I totally understand the frustration.

I don't know a great deal about MS, nor what kind of work you do. But the fact that you are(were?) working and doing work sufficient to cause a neck and back strain speak well of your intent to be a productive employee. And you didn't say whether any of the doctors feel that these symptoms may dissipate with time or not. If they do, then it would not seem you are at medical stability or maximum medical improvement. It this is the case, it seems their decision to withdraw offers of light duty work and pay are premature. However, I am aware that in some states MMI and healing period are not as strong concepts as in other states. Each state also seems to have a different take on how to handle pre-existing conditions. Some factor them into the injury equation, making allowances when they slow healing, return to work, etc. Others just discount the disability by the corresponding disability of the pre-existing condition.

In many claims I have handled in the past (way past) I recall IME wars. . . .files that were enlarged almost weekly by the battle of the doctors opinions. This is just sick, and a waste of money. So is fighting an employee who wants to work. But I am afraid often times the employers are not that enlightened.

I hope that your doctors can garner the data and medical evidence to refute that your residuals are due to MS. It sounds to me like you understand the nature of the battle you are in. I am sorry I couldn't offer something very new here . . .

diaba
05-05-2008, 04:15 PM
Hi lefthanded, thanks for your input. I'm a PT who works doing a fair amount of patient lifting. I didn't have any accomodations prior to this, they didn't even know I had MS, and my symptoms are new. So I'll wait and see what happens next. It's been an education, that's for sure. Thanks again!

Take care, Diana

sandi_k
05-23-2008, 08:34 PM
Lefthanded:

Thanks for your expertise; it's very useful to read! I have two questions for you (I just had my second QME yesterday).

1) I hired a lawyer a year ago, when I first got the MRI results showing spinal cord impingement by a LARGE osteophyte, and my employer's orthopedic surgeon said it was 90% work-related. The spur is at C5-6, so in a very BAD place. I want a neurosurgeon to at least be a surgery partner, in substitution for or in tandem with, their orthopedic surgeon. In CA, to your knowledge, do I ahve the right to demand a neurosurgeon?

2) I now have 3 out of 3 drs. (who have seen the MRI) agree that I need surgery. If I NEED it imminently (before the legalities are ironed out), is it possible for me to have the surgery regardless, and then have either myself or my regular health insurer SUE the WC organization to recoup costs? I'm afraid I may have to delay care due to concerns over who pays for it...and that would not be in my best interests.

Thanks.

Sandi

mrxtramean
05-25-2008, 09:21 PM
I'm from Oregon and I'm an injuried worker. I'm fighting our so called "trailblazer" workers' comp system. Oregon is said to have one of the best workers' comp. laws in the nation. But, in my opinion, best for the insurance/employer and not the injuried workers.

I will soon be putting up a website to help Oregon injuried workers' at oregonworkerscompensation. net. I have lots of information, but at the moment, dealing with my own case.

I had a lifting injury in 2002. Extruded, free fragment, herniated nucleus pulposus at L5-S1 with lumbar strain. I filed for aggravation in 2007 and was denied.

For all injuried workers.
1) Get an attorney asap. It does not matter how bad your injury is, get one.
2) Ask multiple physicians, a physical therapist, a chiropractor, your primary care physician and your specialist (if you had one), "What can I expect my condition to develope into in 2-5, 5-10 years? Is my condition degenerative now or will it be? What should I do to protect me from future 'worsening' of the injury?"
3) If you have a herniated disc, your disc motion unit ( www .chiro.org/Vertebral_Subluxation/Anatomy_101.shtml) will degrenerate faster than normal. In my opinion, this is what the claims examiner/insurance co. hope for because then they can deny your claim for aggravation based on injury not being the "major contributing pain factor", it becomes a "pre-existing injury" and a "combined injury". You should get the attorney, if possible, to get claim to except "degenerative disc disease". It's not really a disease and the classification needs to be changed. I'll much to say about DDD on my website. DDD is a "catch-all" phrase and the pain from which the IME (independent medical examiner) says you have may not be from DDD but from a multitude of conditions.
4) Read your states law on workers' comp. and it's statute changes.
5) Have your doctor log everything! If it's not in the medical records, then it's harder to prove.
6) Claims examiners work for the insurance company, from which your employer has bought a policy from to deal with their injuried workers. The claims examiner, in my opinion, is not the "good guy/girl". They do not work for you, but against you. With that said, my claims examiner is nice, but she still works against me.
7) Doctors suck. Many do not want to deal with workers comp claims, many do not want to take the time to deal with direct issue's because they're too busy following "medical guidelines/protocol". A private doctor might be your best choice, as they will be able to focus more in details. A clinic doctor gives your 15 mins, is too busy with patients. And for hearings, a specialist will provide greater "persuasive" weight against the insurance companies IME.
8) IME's are supposed to be "un-biased", but when they are paid, like mine were, $13,000 between the 2 IME's and the office visits for both were under 90 mins, you know you will not get an "un-biased" examination.

I applaud you lefthanded for trying to help. Injuried workers are blindsided and left to think all will be well when their claim closes, but that's not the case. In many cases, like mine, depression, stress and on-going painful conditions will limit your range of motion, life qualities and your ability to function like you did prior to your injury. Just be aware of this and ready for it.

Lefthanded, tell injuried workers what they really need to know to get the help they need with their present pain/injuy and their future aggravation conditions.

Thank you, MrXtramean. No struggle, No progress.

lefthanded
05-29-2008, 05:27 PM
mrxtramean, I agree that Oregon has an incredibly regulated and tight w/c system. . . .I once looked into working as a claims person in their system, and decided my own mental health would not permit me to do so! I don't recall now just what all the rules and regs were, but that the amount of oversight by the state is incredibly oppressive.

Please, do not believe that just because you have experienced a claim as an injured worker that you can just "hang out a shingle" on the internet and start advising other workers. It takes a good deal of education to understand the ins and outs of the laws, the history, the whole arena of risk management, and lastly, claims. I have been through numerous and highly specific claims training classes, both in comp and liability, even a little malpractice, and have a year of law school as well. All that makes me is "dangerous." I never hold myself out as an expert. . . just someone with experience that many do not have, information that most do not have, and some good stories that may net me a free drink at a cocktail party now and then!

I understand your fears, frustrations and anger at the system. However, the belief that an injury should mean that the employer should be on the hook for every ache, pain, twinge or problem in the future is based more on wishful thinking than it is on REALITY. Workers compensation is designed to make sure you have an income while you can not work, that you get adequate care (this is often the language of the law, meaning no, you don't get to travel across the country to a specific doctor for your injury), and your claim will not remain open for years and years and years until you are sure you will never have any additional issues.

Insurance is sold by a rating system, and employers would be out of business if claims were open indefinitely. An employer often has a level of self-insurance (aka deductible) for each injury, and they must set aside reserves of money that correspond to a guesstimate of what their total claim costs will be. If an employer were never allowed to close a claim, those reserves would grow each year as new claims occur, and eventually there would be nothing left for overhead, salaries, benefits or capital improvements. In effect, w/c would bankrupt the employer, and the workers, injured or not, would be unemployed.

However, I do agree on these points:
1. If you are injured, by all means, learn how your comp system works in your state!
2. Make sure your doctor documents everything correctly. Also have your doctor explain your injury thoroughly.
3. IME's are so badly abused that in some states they have limited their use and scope. However, I have seen IME's nail an employer for an injury they tried to resist --- they are not all BAD doctors or BAD exams.
4. An injury can be complicated by a degenerative condition. But most states do not allow for the entire package (injury + degenerative changes) to become your employer's responsibility, even if you never had severe issues with the degenerative condition.
5. Many doctors seem to have forgotten how to take care of patients, because they have so much else to deal with, including regulations about documentation, continuing education, and malpractice premiums among them. Their time with patients seems to have been compromised by the requirements insurance companies put on them to get paid.
6. While it is true claims people are employed by the company, the state laws usually regulate what they can and cannot do. Some companies push for denial, while others push for compliance with the laws, and others for reducing costs within the law.



However, I suggest you put yourself in the shoes of an employer for just a second. Imagine your own money on the line, and the hundreds of employees you have working for you as income and expense columns on your books. At the end of the year you want a balance between making a product and having a little profit from which to take your own salary or means of living, and paying your workers, their health insurance and other benefits (sometimes over $1000 a month for each, when you add up medical, dental, vision, vacations, etc.) AND paying not only w/c premiums but also claims costs. Before damning the entire system as evil, do remember that w/c really is a system meant to relieve the burden on the injured worker, but not designed to alleviate all issues.

And count your blessings that you do not have to sleep on the ground in a campground right out of a back surgery because you are homeless, like one of my claimants did. Or that other medical issues, totally unrelated to your work injury, caused horrible delays in your treatment that meant you would not recover as well as if you had been healthy otherwise, like another of my claimants. True, you should not have to fight your employer for an injury that is clearly work related. Unfortunately, there are those employees out there who have faked and frauded their employers to the point of making them suspicious of everyone who files a claim.

I had a guy who actually asked me how much more he could get if more of his fingers were amputated. A quick check of his claims history revealed a pattern of suspicious claims that were essentially whittling away at his dominant hand. Before each claim we found either a bad review at work or other evidence he was after all he could get from his employer. Too bad for him that it was only money to them. . . he was the one left with deformed hands!

lefthanded
05-29-2008, 06:15 PM
Lefthanded:

Thanks for your expertise; it's very useful to read! I have two questions for you (I just had my second QME yesterday).

1) I hired a lawyer a year ago, when I first got the MRI results showing spinal cord impingement by a LARGE osteophyte, and my employer's orthopedic surgeon said it was 90% work-related. The spur is at C5-6, so in a very BAD place. I want a neurosurgeon to at least be a surgery partner, in substitution for or in tandem with, their orthopedic surgeon. In CA, to your knowledge, do I ahve the right to demand a neurosurgeon?

2) I now have 3 out of 3 drs. (who have seen the MRI) agree that I need surgery. If I NEED it imminently (before the legalities are ironed out), is it possible for me to have the surgery regardless, and then have either myself or my regular health insurer SUE the WC organization to recoup costs? I'm afraid I may have to delay care due to concerns over who pays for it...and that would not be in my best interests.

Thanks.

Sandi


First, I have never handled California w/c, and from what I recall it is a very complex system in its own right.

So, my questions:

Have you filed a claim for an injury? How did you injure your C5-6 at work? Has it been allowed as a claim? (Osteophytes, or bone spurs, are a common occurrence in the general population, and a result of normal arthritic development. I have C5-6 athritis.)

What does your lawyer say? If you have a lawyer, these are the kind sof questions for a lawyer.

It depends on what California law says whether you have a choice in treating doctors. If the law gives the worker the right to choose, then you have more of a chance of putting together the team you want. If the law limits that, you can pay for any additional medical benefits you like, but don't expect your health insurance company to voluntarily pay. If your claim is not allowed, insurance will likely step in and pay, but not usually on the contingency that they will recover from comp. This prevents hindsight claims . . . w/c getting claims for which they can no longer investigate because the condition has been treated or has resolved. You wouldn't expect your homeowner's insurance to pay for a new roof you just put on without having you submit a claim and have their adjuster inspect it for covered damages would you?

mrxtramean
05-30-2008, 06:43 PM
Only reply I will give. Thank you for your comments.


Please, do not believe that just because you have experienced a claim as an injured worker that you can just "hang out a shingle" on the internet and start advising other workers. It takes a good deal of education to understand the ins and outs of the laws, the history, the whole arena of risk management, and lastly, claims. I have been through numerous and highly specific claims training classes, both in comp and liability, even a little malpractice, and have a year of law school as well. All that makes me is "dangerous." I never hold myself out as an expert. . . just someone with experience that many do not have, information that most do not have...

Advice. If someone had given me "advice" in 2002, I'd be much better off today health wise. Everyone should take in all advice and then research it, weigh it's worth and of course, always ask a "professional" for help/opinions.



I understand your fears, frustrations and anger at the system. However, the belief that an injury should mean that the employer should be on the hook for every ache, pain, twinge or problem in the future is based more on wishful thinking than it is on REALITY. Workers compensation is designed to make sure you have an income while you can not work, that you get adequate care (this is often the language of the law, meaning no, you don't get to travel across the country to a specific doctor for your injury), and your claim will not remain open for years and years and years until you are sure you will never have any additional issues.

Some injuries will never heal and pain and depression will be a part of that person for the rest of their life. In my case, I have lifetime palliative care. When I was injured, no one, not the doctors, not the insurance company or my employer explained what these benefits were or how to apply for medical compensation. If your hurt on the job and the employer lets you go back to the same job you did before, who's at fault or negligent? Most employer's have job analysis and every injuried employee should have one done after an injury. This is why LBP is "2nd only to the common cold as a cause of lost work time; it is 5th most frequent cause for hospitalization & the 3rd most common reason to undergo a surgical procedure. emedicine.com/neuro/topics516.htm". If the employer ignores the warning signs, then expensive future medical cost will come. There just needs to be a better relationship between employer & employee.


Insurance is sold by a rating system, and employers would be out of business if claims were open indefinitely. An employer often has a level of self-insurance (aka deductible) for each injury, and they must set aside reserves of money that correspond to a guesstimate of what their total claim costs will be. If an employer were never allowed to close a claim, those reserves would grow each year as new claims occur, and eventually there would be nothing left for overhead, salaries, benefits or capital improvements. In effect, w/c would bankrupt the employer, and the workers, injured or not, would be unemployed.



3. IME's are so badly abused that in some states they have limited their use and scope. However, I have seen IME's nail an employer for an injury they tried to resist --- they are not all BAD doctors or BAD exams.

True, not "all" are bad. But, I had two different doctors in two different fields and they weren't professional, in my opinion. One took notes for 35 mins then handed my a test and left me alone in office for over 2 hours. Told me to turn off lights and lock door when I was done. The other IME doctor took notes for 30 mins and a physical examine for 7 mins. He did "some" but not all the AMA Lumbar test, he didn't have a clipboard to log anything on and when I got his report back with ROM (range of motion) readings on it, I know he didn't have an inclinometer, like he said in his report. Again, in my opinion, the IME system needs to change. The IME's need to be paid by someone other than the insurance company.


4. An injury can be complicated by a degenerative condition. But most states do not allow for the entire package (injury + degenerative changes) to become your employer's responsibility, even if you never had severe issues with the degenerative condition.

Many people develope "degenerative" issue's from the main injury, but the insurance company will, most always, deny this. I ask myself this question, "What would my life be like, would I still be able to play golf & more, and would my disc be degenerative to the point it is today?" This question always makes me wonder. hmmm



However, I suggest you put yourself in the shoes of an employer for just a second. Imagine your own money on the line, and the hundreds of employees you have working for you as income and expense columns on your books. At the end of the year you want a balance between making a product and having a little profit from which to take your own salary or means of living, and paying your workers, their health insurance and other benefits (sometimes over $1000 a month for each, when you add up medical, dental, vision, vacations, etc.) AND paying not only w/c premiums but also claims costs. Before damning the entire system as evil, do remember that w/c really is a system meant to relieve the burden on the injured worker, but not designed to alleviate all issues.

I don't want money. Like you said, just medical coverage and time lost wages coverage. The insurance companies bill for my case is going to be outrages, and all I wanted was just a "little" relief help from my employer that I've worked for 22 years! Again, insurance companies might nice, but they really got in my way and again, health care cost go up and someone has to pay.



And count your blessings that you do not have to sleep on the ground in a campground right out of a back surgery because you are homeless, like one of my claimants did.

Sorry, but I'm speaking now for everyone that's hurting. We all have our own pains and problems. Our problems are the same as your friends, I don't think I would ever compare my problems to someone's elses. We simpy hurt in one or more ways. My depression was so bad, that I almost lost my marriage of 22 years. But I'm not the only one dealing with it. I feel everyone's fraustration in dealing with workers compensation and trying to get disability. I've been there and it's not fun. And no one makes it easy when you're hurting.


Unfortunately, there are those employees out there who have faked and frauded their employers to the point of making them suspicious of everyone who files a claim.

I think many people, like me, just want treatment and time to heal. Not a ton of time, but enough to allow us dignity to get back to work and feel helpful. Yes, there are scammers, but doctors, if in doubt, should refer patients to specialist, etc. to find the truth. I laugh at this, because I'm one of those "hard to define" patients. And I say this only because I know a little more about the physiology of my injury. And a doctor simply saying, "DDD", just isn't enough in my mind to say, "Ok, I guess your right." I'm a fraud? I've seen 7 different doctors and still waiting for a doctor with some biochemical and biomechanical knowledge in lumbosacral injuries to step up to the plate. I still have unexplained pain. I'm a fraud? If I were, I'd feel a lot better.


Lefthanded, I really hope that you can help people. That's all I want to do now, is help. I'm just on the other side of the fence trying to deal with the "system". Keep up the good work. And remember, "No struggle, No progress!"

lefthanded
05-30-2008, 09:14 PM
mrxtramean . . . welcome to the fold of sufferers of pain "of unknown etiology." What I have learned in the 18 years since I first learned the terminology and language of medical claims is that there is very little the medical sciences can tell us for sure. If you find a doctor who believes he has the "right" answer, I say "RUN!" Injuries, healing, and pain levels are as individual as individuals are.

What I might have said -- in many fewer words -- was NO TWO CLAIMS ARE ALIKE. Giving advice, even sharing experiences and insights, is not as simple as recounting the details of any other single or category of specific claims from the past. In the past two decades not only has the workplace changed, but so has the business/corporate climate, the medical responses to injury, and what we know about the human body. Add to that the internet, where what used to be a small circle of acquaintances has morphed into an unnumbered global cyber-community, bringing with it more experts and expertise, more information, and unfortunately, more useless and worthless garbage!

I see that you listed in your history that you had not had surgery, and that you experienced resorption of your hnp, but still experience pain. I am curious where you have heard/read that you would be pain free after a disc herniation. No doctor worth his salt will claim to make you pain free after a spinal injury. Often we hear "improved pain" as pain free. I have been known to be guilty of this. And in my experience I think even some attorneys propagate this cruel myth when they imply that they will be able to get their client the treatment, the resolution, the final result, that he ultimately desires.

I wholeheartedly agree that the medical rolls are littered with doctors who may have license, but fail daily to even approach practicing medicine anymore. All too often these are the ones whose "practice" consists, more likely than not, of performing exams and rendering opinions for flat fees that should make the entire insurance industry cringe. I will say that a good doctor can gather dozens of bits of functional data during a 10-15 minute exam, which to you or I seems rushed and hardly thorough. I have seen it done many times. The measurements you speak of can be more accurately assessed by an excellent and experienced practitioner without tools than an inexperienced one with all the right devices and tools. That is not to say that an objective and independently done exam should not have exact measurements taken in standard ways, that can be reproduced again and again by other physicians. To me it is simply a matter of measure twice, cut once. I might be good at estimating materials for a project, but before I buy them, I measure, measure, measure. However, you have to agree with me here, no matter how carefully we measure, once in a great while we come up short. We face either an inaccuracy, or a change that we did not expect . . . or our own error interpreting the hash-marks of whatever rudimentary rule-stick we may have used. Doctors are human, and every now and then even the good ones err. Imagine, I do, that this means that not-so-good doctors mess up more frequently, or more easily, or because they just have less "professionalism."

Unfortunately, almost all have license and the ability to fill up a website with impressive credentials and promises. I guess the burden then falls back on we, the medical consumer, to decide of we like casual, business casual, business or black tie credentials and promises . . . and to decipher the true benefits from the b.s.

And I agree, again, without reserve, that the ideal of worker's compensation would be better served if it allowed for more than adequate, but rather medically indicated and beneficial treatment, occurring promptly and applied at least somewhat liberally, accompanied by a healthy respect for the need to rest an injured body, at least initially, to aid in healing. I propose that every time an injured worker senses he is being pushed to return to work prematurely, that he find his "Welcome of Acme Co." employee handout and present to his impatient employer the page on which it is stated "ACME Co. cares about its employees." That, coupled with the ingrained and rather correct assertion that one should follow through to completion those treatments recommended by his doctor in order to get well, would go a long, long way toward making worker's compensation fill a need in wellness-inspired places of employment.

I can not just fault employers and insurance companies for the failure of our worker's compensation system to deliver on its centuries-old promises. The economic mind-set in this country has shifted back into "the survival of the fittest" paradigm. Our brief foray into sensitivity in the workplace and valuation of the employee as a person during the 50's-70's is long departed. We tried it and it worked, in that the generation that experienced living by good principals and standards of practice still expect it to this day, some two-and-a-half decades after its dismantling. This, I believe is the seat of your dissatisfaction with your comp experience. Yes?

Then, our next step is to discover if there are any clever (or not) steps we can take to both navigate the current flawed and ineffective system of industrial accident insurance, and incorporate it into a more comprehensive way of looking at the value we place on human life, not just the birth of it, but the maintenance . . . the care and feeding. . . . and the repair and support of it as it wanes through injury, illness, or just aging. One would think that the minds of 2008 could meet up with some sort of model-city design for the healthy community of tomorrow.

We can talk further of the navigation of the murky waters of present day workers compensation in search of a more satisfactory injury claim experience. I am afraid, in the end, it might all boil down to the injured worker's willingness to become a full-time claims expert on his own specific claim.

You may pick up your manual at the door . . . . ;)

finz
06-05-2008, 12:11 AM
.

The measurements you speak of can be more accurately assessed by an excellent and experienced practitioner without tools than an inexperienced one with all the right devices and tools. That is not to say that an objective and independently done exam should not have exact measurements taken in standard ways, that can be reproduced again and again by other physicians. ;)

I understand your poiunt, Lefthanded, but I think you misunderstood MrXtra's . Of course, a skilled practitioner can often approximate ROM, but they cannot lie and say that they measured with a specific device if they did not use that device. I took MrXtra's comments to mean the IME doc's report says that he measured with the device when he did not use one.

As a nurse, I know that I could lose my license if I document that I did something which I did not do. In my early days as a visiting nurse, we still used mercury thermometers. Frequently, in the summer, they would explode. I could feel their forehead and document that they were afebrile, but I can't write that their temp was 98.6 unless I really used the thermometer.

I had a similar experience to MrXtra's with fraudulent documentation by the IME. He claimed that there was a female attendant in the room for the exam. I have seen him 5 times over the years and there was never an attendant in the room. On that particular occassion, I can prove it as I had a witness. I actually agree with his physical findings...........it's his conclusions that I have a problem with ;), but it still begs the question.......why do they find the need to lie at all ? I confronted him about it on my next visit with him and his response was....."If I documented she was there, she was there." Ummmm..........sure

I absolutely understand and agree with you that not all IME docs are bad and not all WC reviewers are evil........but damnit, somedays it sure does feel that way ! :p


I

sandi_k
06-05-2008, 01:07 AM
First, I have never handled California w/c, and from what I recall it is a very complex system in its own right.

So, my questions:

Have you filed a claim for an injury?

Yes, I filed in July 2000, was treated for "bilateral upper extremeity strain", and received PT. No diagnostic work such as an Xray or MRI was ever ordered.

How did you injure your C5-6 at work? Has it been allowed as a claim? (Osteophytes, or bone spurs, are a common occurrence in the general population, and a result of normal arthritic development. I have C5-6 athritis.)

I was doing 7-9 hours a day of keyboarding. the belief is that the keyboarding resulted in a "chin forward" posture that tilted the vertebrae against one another, with the disc pushed to the back. Once the vertebrae were in contact, they abraded, and caused the spurs.

Yes, it has been allowed. They offered to pay me off to close the claim in 2006, and I returned to medical care (after an unbelievably anger-inducing P&S report from 2001). the new WC doc sent me to PT again, prescribed elavil for the chronic pain, and with a lot of work (and a QME report that reamed them for lack of diagnostic work), they agreed to conduct an xray, which did NOT show TOS (the then-current diagnosis). With the QME report, I persuaded them to do the MRI to get a "baseline" snapshot.

Then all h*ll broke loose. DDD C2-C7, with one disc "worse than moderate" and two moderately degenerated. Spinal stenosis. bone spurs, mainly anterior. The WC doc stopped dealing with me, and referred me to a new ortho surgeon for care and a new P&S report. The new doc has certified that this is 90% work-related.

However, one bone spur is BIG. I've been told I could "end up paralyzed" if I "slip in the shower", due to the spur severing the spinal cord. And that it's the cause of the numbness and tingling in my middle, ring and pinky fingers since 2000 and before.

So, no, I don't expect the insurance co. to "pay for a new roof." But I DO expect adequate medical care. If I end up disabled permanently due to delay in surgery and treatment, my insurance company will be stuck with me forever as a medically separated employee. It seems like it'd be in their best interest to agree to pay for surgery now, and bill the WC company for the bill, since the WC company has delayed treatment, diagnostic work, tests and care for 8+ years.

What does your lawyer say? If you have a lawyer, these are the kinds of questions for a lawyer.

Yes, I have a lawyer. He thinks the latest QME (mutually agreed to by us and the WC claims people) will write a scathing report on my behalf, indicating immediate surgery. (He said "wow, look at that" and "I strongly suggest surgery" after looking at the MRI). If that is appealed by WC, we file for a court date. This can take months. In the meantime, what if I'm rear-ended on the freeway? What if I do slip in the shower? At what point do they have a responsibility to TREAT ME?

It depends on what California law says whether you have a choice in treating doctors. If the law gives the worker the right to choose, then you have more of a chance of putting together the team you want. If the law limits that, you can pay for any additional medical benefits you like, but don't expect your health insurance company to voluntarily pay. If your claim is not allowed, insurance will likely step in and pay, but not usually on the contingency that they will recover from comp. This prevents hindsight claims . . . w/c getting claims for which they can no longer investigate because the condition has been treated or has resolved. You wouldn't expect your homeowner's insurance to pay for a new roof you just put on without having you submit a claim and have their adjuster inspect it for covered damages would you?

See above.

Thanks for your time.

Sandi

lefthanded
06-05-2008, 04:00 AM
finz . . .

Remember I said
That is not to say that an objective and independently done exam should not have exact measurements taken in standard ways, that can be reproduced again and again by other physicians.

I would never say that the doctor should eye-ball measurements for an exam, let alone fabricate them! I agree that IME docs shouldn't, but often do, put things in the final report that never occurred, or happened much differently, than they report. I have experienced it with my own partner, who was misquoted several times throughout her IME for COPD.

And the chaperone or bring-a-friend-to-be-a-witness is something that I have been surprised to read here in this forum is ignored by many IME providers. It is an absolute patient right, as far as I am concerned, no matter who ordered or is paying for an exam! I would ask the doctor to document that he is refusing me a witness, have him sign it, and walk out! I handled too many claims where actual abuse of power or just plain abuse took place in an exam. . . . even improper touching for the exam ordered! And not just women are entitled to a witness; I believe men have just as much at stake in an exam.


sandi_k . . . .

It sounds like you actually have a worthwhile attorney who is pretty much staying on top of your claim. I am glad for you for that, as complaints about attorneys are near the top of the complaint list when it comes to w/c claims.

I would never suggest that anyone injured on the job should not get all the treatment necessary for the injuries that they have incurred on the job. It seems that you have also found doctors who support, for the most part, that your symptoms are the result of work-related conditions. And I agree with you that 7-9 hours a day of keyboarding is not good for anyone's health. I have seen everything from TOS to my own fun new diagnosis of carpal tunnel syndrome, (most likely brought about by my last job of claims work, which included keyboarding and grasping and moving files by hand repetitively all day!) to back strains, from desk jobs!

As for intervening accidents. . . if you are rear-ended on the highway, other insurance companies would definitely become involved, and unfortunately, litigation would go on for a long time. (The issues can be very complex, and who-is-on-the-hook-for-what depends on state laws and precedents.) The slip in the shower would depend on how your state handles intervening injuries and how it might seek to separate the causes of every aspect of the now seriously complicated injury.

Delays in treatment happen in private insurance cases, just as they do in worker's compensation cases. My mother's lumbar fusion was delayed by a doctor who objected to my sister, Mom's advocate, asking so many questions. They actually documented that my sister's questions and "attitude" delayed her surgery, not anything the doctors did. And all my sister was doing was what every article on getting good care tell you to do: ask questions, bring an advocate if you are not in your best mental form, and question everything that was being recommended. Sis, by the way, has background in nursing home and hospice management. I trust her judgment. . . .

Remember, I said I came here and started this thread to shed some light on what I knew of worker's compensation. I am not the enemy, but it seems if and when-ever I speak from the heart and the little knowledge and experience I bring, about how what we all may think the worker should get may not be matched with the reality of how the claim is handled, I raise some reality-generated anger. While I agree that worker's compensation rarely delivers on the basic promises the system was founded upon, I also find that injured worker's often come to the table with expectations that are not reality-of-the-real-world based. An example is the idea that "I want to be put back exactly how I was before I was hurt." Rarely happens, if ever. Another is the "I never felt that pain before the accident," when the new pain has no relationship -- short of coincidence -- to the allowed injury. Some things just happen when they happen. Rarely are we returned to 100% after ANY kind of injury, let alone work injury, which has a much slower return-to-work rate, injury by injury, than those accidental injuries that happen off-the-job. I recall dealing with a lot of claimants who didn't understand that just because their "employer caused their pain," they themselves were not still going to have to do all the work to get well! It is the "you broke it you fix it" belief that I believe is nestled in the unrealistic expectations that many injured workers harbor that I think leads to much of their dissatisfaction with the system.

And as far as back injuries. . . .I still maintain that a minute fraction of the population could have an x-ray @ age 30 that wouldn't show some spurring, maybe a little stenosis, and some other changes in the joints of the spine. So I am always a little cautious with doctors who are ready to attribute each and every spinal diagnosis to the workplace . . . if for no other reason than that their opinions might appear to be slanted toward the injured worker. I am not saying that is bad, but it does draw additional scrutiny when a complex claim is being evaluated.

I understand your frustration and obvious reason for tension over a spur that hovers above your spinal cord, seemingly waiting for an opportunity to wreak havoc with your life. I live with medical facts, that if tweaked just right, would leave me without many options for any kind of life. I guess we have to learn to live with that knowledge and try to operate around it as best we can . . .

You know, you have the option of having the surgery just as soon as you can schedule it. You may have to bargain with your insurance company to cover what they can until a decision comes through. . . .after all, if comp denies coverage, your health insurance company is on the hook. That way you can get some of your life control back while the courts deal with that over which you have little or no control.

I hope that things begin to move along toward the resolution you seek, and that the delays are fewer and farther apart in your future. Remember, I am not the enemy . . . just the bearer of experience-based realities of the claims world. I know this whole ordeal can hijack your life . . . and it feels personal. Claims and insurance people, as you should know by now, are trained to not engage in personal feelings when it comes to the subjects of their work. It isn't always easy. I treasured my thank you letters and compliments from injured workers far more than I did compliments for saving a company money on its claims. I always tried to deal in a fair but realistic manner, both with injured workers and their employers and insurance companies. . . . but was not always appreciated for that approach by both sides -- imagine that!

And I always felt that injury claims money is better spend on treatment than endless diagnostics and litigation.

thursday
06-05-2008, 03:28 PM
I would never suggest that anyone injured on the job should not get all the treatment necessary for the injuries that they have incurred on the job. It seems that you have also found doctors who support, for the most part, that your symptoms are the result of work-related conditions. And I agree with you that 7-9 hours a day of keyboarding is not good for anyone's health. I have seen everything from TOS to my own fun new diagnosis of carpal tunnel syndrome, (most likely brought about by my last job of claims work, which included keyboarding and grasping and moving files by hand repetitively all day!) to back strains, from desk jobs!
........

Remember, I said I came here and started this thread to shed some light on what I knew of worker's compensation. I am not the enemy, but it seems if and when-ever I speak from the heart and the little knowledge and experience I bring, about how what we all may think the worker should get may not be matched with the reality of how the claim is handled, I raise some reality-generated anger. While I agree that worker's compensation rarely delivers on the basic promises the system was founded upon, I also find that injured worker's often come to the table with expectations that are not reality-of-the-real-world based. An example is the idea that "I want to be put back exactly how I was before I was hurt." Rarely happens, if ever. Another is the "I never felt that pain before the accident," when the new pain has no relationship -- short of coincidence -- to the allowed injury. Some things just happen when they happen. Rarely are we returned to 100% after ANY kind of injury, let alone work injury, which has a much slower return-to-work rate, injury by injury, than those accidental injuries that happen off-the-job. I recall dealing with a lot of claimants who didn't understand that just because their "employer caused their pain," they themselves were not still going to have to do all the work to get well! It is the "you broke it you fix it" belief that I believe is nestled in the unrealistic expectations that many injured workers harbor that I think leads to much of their dissatisfaction with the system.
......

I hope that things begin to move along toward the resolution you seek, and that the delays are fewer and farther apart in your future. Remember, I am not the enemy . . . just the bearer of experience-based realities of the claims world. I know this whole ordeal can hijack your life . . . and it feels personal. Claims and insurance people, as you should know by now, are trained to not engage in personal feelings when it comes to the subjects of their work. It isn't always easy. I treasured my thank you letters and compliments from injured workers far more than I did compliments for saving a company money on its claims. I always tried to deal in a fair but realistic manner, both with injured workers and their employers and insurance companies. . . . but was not always appreciated for that approach by both sides -- imagine that!


Thank you so much lefthanded!! Your experience is a great peek into the WC system. And I understand that we shouldn't kill the messenger :hug: Your input is valued because it's practical.

MYACHINGNECK1
09-08-2008, 12:44 PM
Hurt on job by patient last nov07 had cervical fusion march08 and still in lots of pain. At present time have no problems with w/c. I am asking what can i expect now that dr. Says there is nothing else he can do for me

English
02-03-2009, 04:42 PM
I am reading these threads, seeing so much misinformation, sharing of information that is specific to certain claims for certain people in certain states, and hearing fear, confusion and worry . . . I would love to help! However, I can not set myself up as an expert and give legal advice, nor have I worked claims in every state and those I did have probably changed their laws somewhat since then . . .

But there are some very basics that I could offer to help you through the "system."

Is there an interest? What are your most pressing questions or issues? And what is it that you don't understand, find confusing, or find depressing about being on workers compensation?



i will begin by saying Workers Compensation Insurance is a state run program. Your employer, and most of the time you, pay premiums each month (yours comes out in payroll taxes), and those premiums are set according to the degree of hazard and the number and costs of claims your employer experiences on average in your state. They desire to keep these premiums, and their costs, low . . . and this can lead to conflicts over coverage, allowance and sometimes even the handling of your claim. This is why attorneys are sometimes needed. Because workers compensation was instituted over 100 years ago to take the burden off the injured worker, it is supposed to be a no-fault system. If your injury happened on the job -- the language usually includes the words "arising out of" and/or "in the course of" your job duties and activities, it is supposed to be covered. W/C was designed to make sure the worker got proper medical treatment, to replace the lost wages with a benefit that would keep them from economic ruin (about 2/3 of your usual wages) and keep you from losing your job for being injured.

During the industrial revolution and until about 100 years or so ago, if you were injured (cut off your arm, broke your back, etc. . . . ANY injury) you were shown the door, escorted sometimes to your company housing, where you were thrown on the street after being handed a bill for rent and your tab from the company store, and you were responsible for sewing your own arm back on or fixing your broken spine the best you could. Back then there was not even health insurance, so you really were out of luck! (I did my senior thesis on the Pullman Car Company of Calumet City, IL, where I learned these things happened all the time.)

So if your benefits and your hassles with your claims person seem too much, just appreciate what history stands behind you. Then learn about your particular state's claims process the best you can. Many injured workers went before you, blazing a painful and costly trail to this time in history.

W/C is not meant to make you rich. You will go backwards financially a little, even though you get a check each week or two. However, your medical should be paid at 100%. If you are ever billed for something that w/c should cover, turn the bill in to your claims person. If you are ever billed for a balance after w/c adjusted the bill, this is a violation of the law. . . tell your claims person!

For now let me just say a few things that are basic good claimant (that's you) etiquette:

Be polite, calm, rational and businesslike with your claims person, the doctors and anyone regarding your claim. It will move you farther than being the opposite: threatening, belligerent, angry or pushy.

Do all your paperwork promptly. There may be a reason something gets delayed, but your claims person can only act on what he or she has in the file. A common slogan among claims handlers is: If it isn't in the file it didn't happen. This is why I recommend following up every important phone call with a letter: you may need the paper trail later. Keep a file and keep copies of every letter you receive and write, every notice, note, and some even keep copies of checks (or the stub to show what it paid) . . . and a log of your phone calls, in the file.

Learn to use your word-processing program, including spell check, so your correspondence will be businesslike. If you don't have a printer, see if you can e-mail your correspondence.

Find out if you can protest any unfavorable decisions and follow the timelines. A day late and you lose! A protest is not hard to write. . . the statute will often give you the format and the words to use, or close to that.

Do not skip doctors appointments or skip treatment. Like all medical treatment, you have the right to participate in your treatment plan, to a great extent. If you are unhappy with your physician, therapist or counselor (if you are in vocational counseling) . . see if you can change. You can refuse a treatment that is against your beliefs or better judgment, and you can not be forced to have surgery or other invasive procedures against your will. However you must have a good reason, and be prepared for your claim to be a little more complicated if you refuse, say, a surgery that could return you to work with low risk, or an test that could move your healing forward.

Do not lie. Do not cheat. Do not fake. Do not try to get away with being off work if you are truly not injured. Claims people hire investigators all the time, even on "nice" people. Sometimes it is the protocol for handling claims for a particular company, or standard claims handling practice for certain types or levels of claims. (I once won a case forcing the "injured" worker to repay over $84,000 because we caught him doing heavy farming activity when he claimed he could not turn his head to drive or lift a gallon of milk. I saw it on the surveillance tapes myself!)

While you must adhere to your restrictions, you are allowed to shop, and take care of your kids . . . and, yes, you may leave the house while on total disability! You probably want to stay away from the roller rink, the softball game or even the fishing boat on a holiday weekend, depending on your injury.

It is believed you get your way by piling up phone calls and messages to your claims person. If you have to go that far to be heard, ask for their supervisor. Follow up your first call with a letter, and copy their supervisor or the manager. When their file is reviewed it will come to someone's attention you have not been answered . . . and someone should get a reprimand for ignoring you. If all 200 claimants called me every day hounding me for checks that are late, for information, or just to talk, I would never have gotten anything accomplished in a day! Remember, they are doing their job to please their boss, just like you have to when you are at work.

Keep in touch with your employer so they know a) how you are doing, b) if and when you might return to work, c) that you are still an employee (do not abandon your job mid-claim, it makes life messy later) and d) it is the correct way to keep them onboard with your claim. That way they know you are earnestly trying to get well and return, and will see you more as a returning asset than a present liability.

Stand up for your rights. If something seems amiss, ask. Protest when you feel a decision or action is wrong. Stay on top of your claim. Start a file and keep everything in it in some form of useable order.

Return to work when you are released. If it does not go well, or you flare up your injury, your doctor is the one to document the medical reason you can not continue, and might need more treatment. In fact, your doctor must provide documentation for almost all of your benefits: time loss, restrictions, treatment, and return to work, as well as when healing is complete (maximum medical improvement, end of healing period, or whatever it is called in your state) and permanent impairment.

Make sure impairment is addressed before claim closure.

Find out what the statute of limitations is for reopening, and under what conditions this claim might need to be reopened.

Understand that in many states if your injury is the same as one you have years ago with another employer, you may be asked over and over for a work history so that they can see if some of the costs should be thrown back on the previous employer's injury. Every state seems to handle pre-existing injuries or conditions differently: find out early how your state handles it. Then don't spin your wheels trying to fight it. Only cases that are hard-fought in court change laws, and unless yours seems that strong, concentrate on getting all your benefits that are due under the law. Unfortunately that can sometimes be harder than just going back and doing your job!

Of you qualify for FMLA, file for it! You have approximately 12 weeks of protection of the job you were in at the time of injury, or a substantially similar position, under FMLA. Unfortunately, if you use FMLA for your neurological condition, you may have to share that 12 weeks with your condition . . . you only get so much time under FMLA regardless of how many conditions you use it for.

Do not compare your claim to anyone else's claim. Rarely, if ever, will two injuries, severities, wages, hours, and employers be identical, let alone doctors, details, outcomes, or "settlements." . You are wasting energy wishing you would get the big "settlement" your neighbor, friend, or second cousin on your father's side did! This is a cruel trick you play on yourself if you listen to everyone else's expert advice, because they had a claim or knew someone who did. Run, don't walk, to the nearest earplugs. Tell them how interesting you find their information. Thank them. But do not ruminate on what they claim or believe you should be getting. It is almost like saying every lottery ticket is a big winner. It just ain't so. Some claims, and rightly so, close with no big jack-pot at the end.

I strongly object to the term settlement when discussing workers compensation. Being a no fault system, if you are permanently impaired or disabled by your injury, you are entitled by law in most if not all states to an award of permanent disability benefits. This money is to compensate you for future medical needs that might be consequential or might arise later (such as prescriptions, they are not generally covered after claim closure), but not be sufficient for reopening. It is also to make up for a possible drop in your future earning capacity due to your loss of function in the work place. It is not a windfall to be spent on a new 4x4 or vacation, unless you have an endless income stream guaranteed in your future. I suggest you buy a few certificate of deposits and sit on it for as long as you can. It might come in handy down the road when you get laid up with a non-work medical condition and have no or little income, or when you can no longer do your job and find you are earning less. That is what it is designed for. Honest. But I bet over 50% of the checks I cut were "blown on stuff" before the ink dried on signature on the back of the check.

Sometimes the final payment, if it is more than a year's worth of benefits would be, are paid out in monthly amounts. If this happens, be glad you have an extra check each month to put into savings after you get back to work. Don't sell out to one of those companies who will give you cash now. You will get less than you are due, because they will pay you at a discounted rate, and they will walk away counting your money as it enters their pocket. They may be legitimate, but they are immoral by preying on people in dire need in my book. If you are hard-pressed for money when it comes time for your final permanent disability payment, and it is set up as monthly payment, ask your employer or claims person if you can have a hardship lump sum of all or part of it.


Well . . I am up wa-a-a-ay past my bedtime. If there are any questions, ask away. I will discuss permanent total disability if anyone is in this situation. Sometimes it is called a W/C Pension. They are rare, hence I am no expert. But maybe I can help if you have questions I can answer or give you a direction to go for answers.

For now . . . good night. If I have any typos or misspellings. . . . it is 2:37am here right now. . . .


"Z-z-z-z-zz-z-z-z-zz-z-z . . . . . ."

Hello,
I hope this note finds you happy, healthier, and coping with the day for the gift we've been given. You changed my day, thank you. I have two questions in hopes you can guide me to where I need to search for the answers.
First, if several injured workers uncovered a few internal acts of financial merit gain to specific claims managers that have been gladly receiving this $$ monthly merit pay = to and in exchange for denying valid, timely, entitled under RCW with 1,2,3 + opinions, and so these injured workers exposed this activity. Instead of the right thing working to make the system work within its scope, it has backfired and no one will investigate it. What are the remedy options?
If I was to be pensioned 3 years ago, but my CM refuses and now is deleting my health diagnoses that have remained within the record since my first year injured, what can I do about it?

Again, thank you,
English:)

Jo*mar
02-03-2009, 10:42 PM
hello English,

I'm not an expert on this sort of thing..
does your state or county have a website that you can contact with questions of how to proceed with something like this?

do you have any papers, emails or witnesses to offer as proof?
Keep any originals and only give out copies..

In general you need to go up the chain of command
If the supervision level does not investigate then you would need to go to the next level of management and up , then if internal doesn't act , you go on to state or local government with your complaints.

and if still no action contact your senator or representative with your concerns.
but these things can get stressful.. blowing the whistle on wrong doers can have some repercussions , so keep your name out of it if you can.

There's is always the news media that many go to when things are wrong and the company won't fix it until they get bad press. :(

flyaway
02-17-2009, 10:51 PM
finz . . .

Remember I said


I would never say that the doctor should eye-ball measurements for an exam, let alone fabricate them! I agree that IME docs shouldn't, but often do, put things in the final report that never occurred, or happened much differently, than they report. I have experienced it with my own partner, who was misquoted several times throughout her IME for COPD.

And the chaperone or bring-a-friend-to-be-a-witness is something that I have been surprised to read here in this forum is ignored by many IME providers. It is an absolute patient right, as far as I am concerned, no matter who ordered or is paying for an exam! I would ask the doctor to document that he is refusing me a witness, have him sign it, and walk out! I handled too many claims where actual abuse of power or just plain abuse took place in an exam. . . . even improper touching for the exam ordered! And not just women are entitled to a witness; I believe men have just as much at stake in an exam.


sandi_k . . . .

It sounds like you actually have a worthwhile attorney who is pretty much staying on top of your claim. I am glad for you for that, as complaints about attorneys are near the top of the complaint list when it comes to w/c claims.

I would never suggest that anyone injured on the job should not get all the treatment necessary for the injuries that they have incurred on the job. It seems that you have also found doctors who support, for the most part, that your symptoms are the result of work-related conditions. And I agree with you that 7-9 hours a day of keyboarding is not good for anyone's health. I have seen everything from TOS to my own fun new diagnosis of carpal tunnel syndrome, (most likely brought about by my last job of claims work, which included keyboarding and grasping and moving files by hand repetitively all day!) to back strains, from desk jobs!

As for intervening accidents. . . if you are rear-ended on the highway, other insurance companies would definitely become involved, and unfortunately, litigation would go on for a long time. (The issues can be very complex, and who-is-on-the-hook-for-what depends on state laws and precedents.) The slip in the shower would depend on how your state handles intervening injuries and how it might seek to separate the causes of every aspect of the now seriously complicated injury.

Delays in treatment happen in private insurance cases, just as they do in worker's compensation cases. My mother's lumbar fusion was delayed by a doctor who objected to my sister, Mom's advocate, asking so many questions. They actually documented that my sister's questions and "attitude" delayed her surgery, not anything the doctors did. And all my sister was doing was what every article on getting good care tell you to do: ask questions, bring an advocate if you are not in your best mental form, and question everything that was being recommended. Sis, by the way, has background in nursing home and hospice management. I trust her judgment. . . .

Remember, I said I came here and started this thread to shed some light on what I knew of worker's compensation. I am not the enemy, but it seems if and when-ever I speak from the heart and the little knowledge and experience I bring, about how what we all may think the worker should get may not be matched with the reality of how the claim is handled, I raise some reality-generated anger. While I agree that worker's compensation rarely delivers on the basic promises the system was founded upon, I also find that injured worker's often come to the table with expectations that are not reality-of-the-real-world based. An example is the idea that "I want to be put back exactly how I was before I was hurt." Rarely happens, if ever. Another is the "I never felt that pain before the accident," when the new pain has no relationship -- short of coincidence -- to the allowed injury. Some things just happen when they happen. Rarely are we returned to 100% after ANY kind of injury, let alone work injury, which has a much slower return-to-work rate, injury by injury, than those accidental injuries that happen off-the-job. I recall dealing with a lot of claimants who didn't understand that just because their "employer caused their pain," they themselves were not still going to have to do all the work to get well! It is the "you broke it you fix it" belief that I believe is nestled in the unrealistic expectations that many injured workers harbor that I think leads to much of their dissatisfaction with the system.

And as far as back injuries. . . .I still maintain that a minute fraction of the population could have an x-ray @ age 30 that wouldn't show some spurring, maybe a little stenosis, and some other changes in the joints of the spine. So I am always a little cautious with doctors who are ready to attribute each and every spinal diagnosis to the workplace . . . if for no other reason than that their opinions might appear to be slanted toward the injured worker. I am not saying that is bad, but it does draw additional scrutiny when a complex claim is being evaluated.

I understand your frustration and obvious reason for tension over a spur that hovers above your spinal cord, seemingly waiting for an opportunity to wreak havoc with your life. I live with medical facts, that if tweaked just right, would leave me without many options for any kind of life. I guess we have to learn to live with that knowledge and try to operate around it as best we can . . .

You know, you have the option of having the surgery just as soon as you can schedule it. You may have to bargain with your insurance company to cover what they can until a decision comes through. . . .after all, if comp denies coverage, your health insurance company is on the hook. That way you can get some of your life control back while the courts deal with that over which you have little or no control.

I hope that things begin to move along toward the resolution you seek, and that the delays are fewer and farther apart in your future. Remember, I am not the enemy . . . just the bearer of experience-based realities of the claims world. I know this whole ordeal can hijack your life . . . and it feels personal. Claims and insurance people, as you should know by now, are trained to not engage in personal feelings when it comes to the subjects of their work. It isn't always easy. I treasured my thank you letters and compliments from injured workers far more than I did compliments for saving a company money on its claims. I always tried to deal in a fair but realistic manner, both with injured workers and their employers and insurance companies. . . . but was not always appreciated for that approach by both sides -- imagine that!

And I always felt that injury claims money is better spend on treatment than endless diagnostics and litigation.


Lefthanded,

your words are wise to those who come of search---

I have a question regarding ime's their reports and the adjuster or attorney who reads them.

first of all do they have on hand certain ime's they can call on when they want to make sure the report goes in their favor

do they really believe all that these ime's write

how can they rely on an ime's report when all corresponding doctor's treatments and diagnosis are the same

knowing that these ime's are paid (during mine's deposistion is was brought out) a half a milliion dollars a year to write such reports--how can the workmans comp system justify acknowledgeing any such report as it was generated for a rather large amount of money---more so than any doctor that they injured or common public sees that charges a miniaml fee for such services

how do the workmans compensation boards look at the letters of the ime's compared to the injured's doctor's reports treatments and diagnosis.

unfortuanately, yes i was hurt at work and even more so had gone through such experiences years ago and from that experience learned alot on ime's.

i do take my husband with me to all appts. i would never attend an appt without him

i take pictures of what my condintion is like minutes before i see him (all the physical aspects of it)

i know that most all ime's appt are videotaped and recorded. many times you are video tapped leaving your house and going to appts. (fyi for all on workmans comp-usually you can see the hole in the conor of the room where the video camera is placed. and believe it or not my last one was not only videotapped but being observed by another individual from another room who was calling the doctor having him ask me certain questions)
I have found that they only time they actually will admit that these tapes exist is if they feel they show you really can do something. if the tape shows the true extent of the injury the tape is never mentioned--is this because that once it is mentioned it could be obtained by your attorney and used as evidence for yourself??

how does the (my case) husband witness testimony against the ime's report and what actually happened effect the commission when it comes to ruling on the legitimentze of the report

Do you believe that the commissions are able to determine a false report when referenced to multiple of reports
and if so do they ever turn such doctors over for review?

as you can see i am not fond of ime's ive have had 1 write an accurate report--early on in the injury--seems the further you go the worse they get

instead of hiring the md's that list themselves on the interent as offering these kind of services--why don't insurance companies use respectful doctors. It cerainly would cost them and the employer a lot less amount of money.

I guess i don't get it why all the games why not just let the injured worker be treated by his physicans--i think it would cause alot less of stress which actually hampers alot of people's recovery and it would allow the injured to return to work at an earlier amount of time. this stopping and starting treatments caused by the ime's is devasting and quite honestly they should be held liable for it.

thanks in advance for any answers and letting me vent

you really are a service to many

cheers!!!!!!!!!!!

flyaway!!!!!!!!!

lefthanded
02-21-2009, 05:18 AM
First I want to say to anyone with a question that has not been addressed, sorry I have been away so long. I had my own health issues, another surgery, but before that a much needed vacation.


Flyaway,

I am sorry I don't have answers to many of your good questions. The frustrations with IME's run across all aspects of W/C, from claims managers to treating physicians to claimants. The system, in my opinion, is on the verge of being fraudulent in many instances.

Simply yes to "are there certain MD's that lawyers use, etc." There are doctors whose reputations precede them as either worker-friendly or employer-friendly. And to you question as to why IME's can't be done by good practicing physicians . . . aside from the few that actually do have open practices, most MD's are simply not interested in budgeting time away from patients that they can actually treat.

AS I think I said, or at least intimated, IME's have become a game, a part of the standard operating procedure of most insurance companies, claims teams, etc. I think it stinks, and I used to say so regularly. That may be one reason my performance reviews were never stellar . . . instead of kowtowing to employer's desires I actually used to try to make sure my claimants had the chance to get well. But this took time away from other aspects of my job, and I was highly criticized for spending too much time educating claimants about their claims. Our bosses just wanted them closed, of course! I don't miss that one bit, I have to tell you.

flyaway
02-22-2009, 11:16 PM
First I want to say to anyone with a question that has not been addressed, sorry I have been away so long. I had my own health issues, another surgery, but before that a much needed vacation.


Flyaway,

I am sorry I don't have answers to many of your good questions. The frustrations with IME's run across all aspects of W/C, from claims managers to treating physicians to claimants. The system, in my opinion, is on the verge of being fraudulent in many instances.

Simply yes to "are there certain MD's that lawyers use, etc." There are doctors whose reputations precede them as either worker-friendly or employer-friendly. And to you question as to why IME's can't be done by good practicing physicians . . . aside from the few that actually do have open practices, most MD's are simply not interested in budgeting time away from patients that they can actually treat.

AS I think I said, or at least intimated, IME's have become a game, a part of the standard operating procedure of most insurance companies, claims teams, etc. I think it stinks, and I used to say so regularly. That may be one reason my performance reviews were never stellar . . . instead of kowtowing to employer's desires I actually used to try to make sure my claimants had the chance to get well. But this took time away from other aspects of my job, and I was highly criticized for spending too much time educating claimants about their claims. Our bosses just wanted them closed, of course! I don't miss that one bit, I have to tell you.

Lefthanded, thanks--for the info. I really wanted the reassurance that they are evil and it is just not in my head. i was reading through other post of yours and i came across one on pre-existing conditions. so that brings me to more of any imput you have
my case is in il. I was initial injured on a different job in 1994 that resulted in rsd i was off from both of my current and that job for 5 years. i returned only to the job that i did not recieve the injury on. they had the choice to allow me back or not and even made sure through their medical board that i was fit to return.
over the years i have had some injuries at this job that along with the injury the rsd also presented itself and the w/c paid me and all medical(never off for any long period of time)
in 2006 i was injured again and when i tried to clear the medical department they would not allow me too. come to find out my supervisor wrote medical a letter telling them that i have cost the company so much money becuase of my rsd and should therefore be medicaly disqualified. in all acuatelity she was referring to all my fmla's that i had taken for gyno reason--she just assumed everything was all rsd related. the medical doctor called me at home after i constantly kept calling him trying to figure out why i could not clear medical. he told me he had recieved this letter and that i had even had a plane land because of the rsd costing the company 10,000 dollars---I told him he was way off and he should of checked my records before calling and accusing me of this as the plane landed after i was given 2 iv's and on board doctors requested landing--i had severe food poisiong--and my blood pressure had gone to 190/115. basicaly sounds like they were doing anything to get me out of this company. The doctor called me the next day and kept apologizing(im sure he was worried what would happen to him after listening to a supervisor instead of reading my chart). as this accident resulted in rsd he said he had to take it to the medical review board(the two prior accidents resulting in rsd i did not have to be taken to the mrb) botttom line i did not care as the rsd had gone into remmission and all my doctors said i was fit to fly
i returned to flying the next day(so really he did not take me to the mrb)
so now comes this accident(which i will tell you all accidents were caused by their passengers causing direct injury to me) march 2007
once again a passenger caused direct injury to my foot and knee which resulted in the rsd presenting itself again
w/comp paid my bills and ttd up until december of 2007 when they would no longer pay for any medical treatments but continued to pay my ttd and perscriptions.
in feb 2008 i contacted cellulitus(i had ulcers all over my legs from the rsd and it is believed that is where the bacteria entered as the right leg was where the major swelling and heat was located)and went into septic shock--admitted into icu in a coma where i spent the rest of feb. in and out of the hospital.
w/comp continued to pay my ttd all through this
as soon as i was able to travel they wanted me to go to an ime--i went in may--keep in mind i was cleared of cellulitus in april
the ime's report stated i could not work my legs were swollen and purple with ulcers but he believed this was all due to cellulitus(he did not have the report that cleared me however i was on a drug used to treat it but i was on it to treat the ulcers so i think he assumed i still had it)
he then stated that yes there was rsd but it was minimum and not related to the injury and the test my doctors wanted to do blocks and a scs would be of benefit but my private insurance could pay for it.
w/comp stopped my ttd but continued paying for my perscriptions as you can imagine the rsd continued to worsen with no treatment and w/comp refused to give me a letter stating they would not pay for future payments so social security could pay(any insurance co had to have this letter or they would not pay)
in nov. i finally recieved the letter and social security agreed to take over for my medical treatments. i started on blocks still not getting ttd but during this time they got the reports from my infectious disease doc stating that in april i was cleared of cellulitus. so now they want me to go see the same ime again on dec. 23.
I felt that i should not have to go as they were not paying for anything but the sooner i went the quicker everything would go and hopefully i could get my back pay-continued pay-and continue pay from w/comp
I also had a scs trial implanted before i saw this ime(like i said same ime as before)
we drove again 2 and 1/2 hours to see him. tough on me but trust me i had plenty of pain meds in me--one being oral morphine swallowed right before he entered.
i told him the scs worked that i was going to get it permantely implanted (this is one medical procedure that does confirm the pain of rsd ) during the vocal part of exam we were discussing what meds i was on and his phone rang. now he wants all the info on the oral morphine how often i take it how quick it works
he wants to do an exam and asks me to totaly disrobe i will never do this again - i felt violated and never in 14yrs have i ever been asked to do so. well he press's on my neck and shoulder wants to know if i feel pain - no---now his phone rings again(i can hear) they want to know when i last took the oral morphine i told him right before he came in he continued with the rest of his exam which included sticking me with a pin which i finally told him to cut it out. after he tried to raise my legs up from a laying position and i would not allow it(i was still recoveing from the scs trial that was in my back) he grabs his folder and walks out. nothign phases me with these ime's as you know. and i have every reason to be mad because if w/comp would of continued to pay for my treatments (including the rsd that they were paying for) i would of probably been back to work last year and not to the point i am at now that the rsd is worse than i had it back in 1994
the w/comp is sticking by the ime's report that the rsd is not related to this injury(if i had rsd then i would not of been working in the first place nor the two schedules i worked which enabled me to collect just about the most allowed under il. comp)
the deps are done all 4 of my docs say it is related and yes i have been injured before and yes it does present itself when injured---however i was not being treated for it when i was injured) all they have is this one ime who now states that he doesnt think the scs would be of use(because we requested they pay for it) that because i was not in severe pain when he touched me with a pin(he neglects to tell them about the oral morphine and how it takes away skin layer pain) and his determination that my pain etc. from the rsd no way is as bad as it looks with me in a wheel chair
so finally, where are they coming from i have a hearing this week where the deps will be recorded and i will be questioned by my atty and theres. that is if they do not stall they were waiting on mayo clinic records from 1994 which i think they will be surprised as like i said this rsd is in no way mimicks this rsd ie ulcers amount of swelling the high doeses and use of morphine and not to mention the need to use a wheel chair for any walking or sitting distance.
your post i believe said it is hard to prove a case when there is a pre existing condition. after reading this do you believe i will have such a fight quite honestly yes i want my back pay and i want my ttd until i return to work but most of all i want to be able to recieve the medical treatments i need to return to work. i for one love my job and like i said worked a double schedule it was and is my dream job i can not fanthom not returning my life has been turned upside down by this injury not to mention the lack of treatment inabling it to get worse. i have no life right now life is not sitting at home all day in a chair hooked up to a machine that takes away the swelling not being able to drive go to the store etc. i am 46 and in no way should be on social security for that fact just being home at all. i have always worked and it is depressing not to.
if you have any ideas how i can get this work comp to see i need the medical treatment i wuld appreciate it- this is not a joke why do they refuse to pay for treatments and ttd. won't it just cost them more in the future. yes i do have an attorney--a very good one who understands rsd i just thought with your knowledge you could help me understand what is going on. my rsd always goes into remission - force impacts reactivate it they have always paid in the past to get me back to work(i really think they know i do like my job as the minute i am released from my mds i am back at work the next day unfortunately there is no modified work i can do its all or nothing or if possible(ive done it in the past)work at some other company until i can return.
i think just 1 more question this has happened in the past my doctors clear me to return to work my company has not cleared me through their medical department there for i am no longer recieving work comp or a salary from my company is this right? my company says it is that once my doctor clears me iam taken off work comp and have to go on an unpaid status until medical dept. clears me. i would really like to know the answer as the past injuries on duty- i filed and recieved work comp , except for the time that it took their medical departmet to clear me(weeks without pay) i have not closed any of these cases as i really did not care before i was just happy to return to work. now with all the crap i am taking i plan on putting them all together and closing them at one time. I was happy working overtime loving my job now im home unable to do anything any sort of work im scared what the future holds not just being able to return to my dream job but to any job i am sooo mad they allowed the rsd to get to where it is at
sorry this is so long just thought a little background would help and to be honest for once i feel like i can ask someone a question and get a real answer or somewhat of a comparison to

thanks in advance for any answers I hope your health is getting better i like you have been away due to medical reasons if just for the nite it feels good just to be able to type

cheers!!!!!!!!

flyaway!!!!!!!!!!!!!!!!!

lefthanded
02-26-2009, 06:31 PM
Flyaway. . .

I have to admit is struggled through your story. . . and I am sorry that my levels of concentration and lack of insight on much of your dx and tx made it hard to understand. . . .but the bottom line is

This is common, unfortunately, for all types of injury claims. The w/c system, like our healthcare system, has been corrupted by management of medical care with the aim of reducing costs instead of increasing outcome success!

The continuation of Rx without medical coverage is unconscionable, as you should never be on meds without supervision. The discontinuation of medical care prematurely under w/c is rampant. I am sorry I don't have an answer. Hopefully your lawyer is well versed in both the legal and medical aspects of difficult cases.

Pre-existing conditions are handled on a state-by-state basis and are one of the most challenging of aspects in w/c. I came from a state in which pre-existing conditions were allowed for treatment only if it interfered with healing of the exact injury (i.e. diabetes or heart issues, etc.) Any pre-existing disability for a re-injury of a body part (i.e. back injuries) would not be covered by the claim, and were actually deducted, particularly if noted prior to the injury in the medical records. however, in the last state I worked there was a doctrine that allowed even untreated but ongoing issues if they were "lit up" or aggravated by an allowed injury/accident.

The lines between occupational injury and occupational disease are blurring more and more each year . . . and employers hate claims with gradual or "questionable" onset. As much as they hate time and place accidents with witnesses and definable injuries, they despise the repetitive and collateral damage injuries more. Until insurance companies, insurance claims, and employers cease to see EMPLOYEES as the enemy . . . I believe this will not be resolved. And what are the chances of that happening?

I can not state emphatically enough how I personally feel about IME's. When I was working claims I did everything I could do to find doctors whose opinions I might be able to trust if I were the claimant. My philosophy was that if the injury is treated promptly, all win. If the IME is truly independent and unbiased, all benefit. But the world, and my workplace, are hardly examples of the ideal. I am sure if I went back to work as a w/c claims examiner today I would have a shock in store . . . and especially now with the financial mess we are all facing. Why do you think so many services are farmed out to contractors? Employers have always wanted to be able to resist responsibility for injuries their workers endure as a result of their working there. Always. Rare is the employer with the more enlightened, somewhat European attitude that the worker is to be valued and cared for as a human being.

Throughout history the human story has been one of constantly needing to assert one's humanity and worthiness of respect as a human being. No where do I see that more than in the US today, and in the workplace, and especially in the instances where a worker is injured. What is not profitable has, in recent history, become illegitimate in the eyes of big business.

I am sorry I can not address the specifics in your post. I simply do not have the background or tools to do so. I spent 13 years searching for the "magic wand" that I believed I could bring to the problems of workers and employers and doctors when an injury occurs at work. It does not exist. I struggled to be a good examiner, putting the law before the employer's desire to contain costs, the worker's needs before the nit-picking, and the employer's bottom line as a function of a healthy workplace. This approach did not bring the kudos and rewards I had anticipated. I still cling to the the few letter documenting those times when I did get this to work on a few specific claims. I need to know that in those isolated instances I was on the right track, and that this was valued. The rest is the "crap" our systems have devolved into . . .

rsdwife
03-08-2009, 12:52 AM
Does having a third party claim along with the workmans comp claim change the way workmans comp handles a claim? My husband drives mixer and a log truck pulled out in front of him which resulted in quite a collision. Workmans comp gave us 3 choices, 1- to deal with the 3rd party on our own and they have a right to be refunded $$$ 2-they will deal with 3rd part, but won't represent us any way or 3- hire a lawyer. For us the no-duh answer was 3. My husband has been diagnosed with crps by his pain managemnt dr and now are waiting for wc to accept this condition so he can seek a spinal cord stimulator trial. If he has to remain on pain meds for this condition, he will not be able to keep his commerical drivers license and will no longer be able to drive for a living. They have him scheduled for 3 different ime's within a 48 hour period, which legally in Oregon only counts as 1 of the 3 times they can send him to imes. So frustrating.... thanks for any insight!

lefthanded
03-09-2009, 12:03 PM
Does having a third party claim along with the workmans comp claim change the way workmans comp handles a claim? My husband drives mixer and a log truck pulled out in front of him which resulted in quite a collision. Workmans comp gave us 3 choices, 1- to deal with the 3rd party on our own and they have a right to be refunded $$$ 2-they will deal with 3rd part, but won't represent us any way or 3- hire a lawyer. For us the no-duh answer was 3. My husband has been diagnosed with crps by his pain managemnt dr and now are waiting for wc to accept this condition so he can seek a spinal cord stimulator trial. If he has to remain on pain meds for this condition, he will not be able to keep his commerical drivers license and will no longer be able to drive for a living. They have him scheduled for 3 different ime's within a 48 hour period, which legally in Oregon only counts as 1 of the 3 times they can send him to imes. So frustrating.... thanks for any insight!

I am not familiar with Oregon w/c. However, in my experience, w/c should cover any injury that occurs on the job, and any third-party claims I have ever handled were subrogated by the w/c carrier (I have ONLY handled self-insured w/c claims) once the claim has closed, or when the statute required. Now, if you have a direct claim against the third-party for damages NOT covered by w/c., it is true that using an attorney to assert those rights is likely the best way to go, unless you have sued without one before and had success. Most folks are not able to do this on their own.

The IME's are just a nuisance fact-of-life when it comes to w/c. Again, I am not familiar with Oregon's statutes, but if you have an attorney for the third party claim, he or she will likely have chosen a good doctor for an evaluation for your husband.

Sorry I can't be of more help. I find it frustrating that w/c has devolved into a battle for benefits in many states, since it was originally created to reduce the loss to the worker. These days it can seem to make life more difficult, often delaying the treatment that one would seek on their own much more quickly. Just remember that a little over a century ago your husband would have received nothing more than a termination notice after his accident in many cases . . . medical treatment and job retention were NOT part of workplace protections before w/c laws were developed. I have heard Oregon has very "progressive" w/c laws . . . which of course means "progressive" for the employer's side. I once had a choice to take a job in Oregon and declined for that reason . . . I heard it was oppressive working under this law for claims examiners (because of the heavy oversight) and hard on the workers. I can't shut off my empathy and desire to help injured workers enough to work under those conditions! However, that said, I am a realist, and have always told my claimants (injured workers) what the law could and couldn't do for them.

So, I guess getting a very good attorney with lots of third-party experience would be in your best interest. Then hang in there with all the patience you can muster. . . . as the process is never as fast as it should be. My best advice to those seeking attorney representation is to establish the timeline for all filings the attorney will have to make on your behalf, and then check in with them BEFORE each filing deadline to make sure they are on-task. Most failed claims are a result of untimely filings and missed opportunities. . . . so regardless of the attorney's "cut" of any settlement, you still have to do a lot of the legwork to make sure it all happens.

The best attitude is to understand the law is to provide treatment, wage replacement, etc., but that you often have to push to get those benefits.

I wish you the best in this situation.

Dew58
03-19-2009, 08:30 PM
I was injured at work on 3/24/07. I have been through every treatment known to man, have endured 2 right knee surgeries, and finally sent to a Pain Management Specialist to be diagnosed with Sympathetically Mediated Pain Syndrome/Chronic Pain. I understand it is a water-downed version of CRPS I. In earlier diagnosis with other docs(15 in all), I was told it is RSD/CRPS.

My employer let me go 6/28/08. At that time, my TTD was cut off, my personal insurance cut-off, and a promise for a PM doc,immediately,was in my near future.

I had to go to my family doc for pain relief as the ortho surgeon would not prescribe anything other then darvacet and motrin. In 8/08, I went to WC PM appt., to be told I have RSD. There was no treatment given, only an evaluation. I was devastated because I need pain relief. WC didn't like that diagnosis, and sent me to a 2nd PM appt. with another doc. That doc agreed with 1st doc diagnosis;however, he called it sympathetically mediated pain syndrome/chronic pain.Again, I was told that this was only an evaluation!! 8 weeks later I was given the OK to be treated with this PM doc.

Currently, I take 20 meds per day; have physical therapy twice per week, see a psychologist every 2 weeks( started in 4/08 due to depression, panic/anxiety attacks). Yesterday, my husband took me to see the PM doc; he told us that I would never be cured; this was for Life and I need to come to terms with this fact. This syndrome would get progressively worse. He told me to file for SSDI.

I feel so helpless and angry, at the delays in treatment that started 03/24/07. The PM doc told me that if he had seen me in a timely fashion of my injury,(within 6 months), he could have reversed it.

The 2nd right knee surgery was 1/16/08. I did not work again until 10/20/08-1/5/09; I had to quit the job as the sedentary job was not allowing me to take my daily meds, which stressed me out, and was in constant pain flare. The PM doc sent a script to the WC stating I am TTD as of 1/5/09. WC told my atty. that it was not stated in the PM report, so TTD would not be awarded. PM was not pleased that WC wanted the TTD in the report and said that it would be in this report: TTD to start 1/5/09, in the present time, and in the future!

My meds keep me in a "sleepy" state, and only when pressured by my atty.for WC to start paying for them, because of the job I started in 10/08, did WC start to pay for them. My meds cost $2500.00 per month, I use a Ten's Unit, Flexor Patches; and a compound pain cream that are not figured into that $ amount. Currently, WC owes me for 1500 miles of travel and $30.00 worth of tolls. They know that they owe the $$, but ignor the payment requests. My atty. filed a Form 9 on WC, and we are waiting for a court date. WC agreed in 2007 that my injury is a work related injury.

My question is:
How does WC get away with such criminal behavior by dragging out immediate treatment, paying for meds, and reimbursement of mileage and tolls?

Thanks,
Dew

lefthanded
03-19-2009, 10:23 PM
Wow, one look at Oklahoma's w/c site and I can see why you are angry! It offers no links to the actual laws, and it does not explain anything. Have they got something to hide? Right there on their own website I found links to workers stories of how OK w/c is not working for them! Amazing!

I am sorry you have suffered the frustration that w/c was originally create to alleviate. However, remember that delay in authorizing treatment is a malady common to the American health care experience. It seems if there is an insurance company involved there will be some delays in many cases. I am not making excuses. . . just stating an obvious fact.

Sorry it is pain that brings you here. . . but welcome to the pain forum. You have lots of company. We all live with pain, and some have some incredible stories of surviving their pain. . . and even making peace with it. If you might spend a little time looking around you will find forums that may help you address the pain issues you experience.

I am sorry I have no solid insight on why your OK claim has been handled so poorly. I know it adds to the pain you feel, even if the increase is more emotional than physical.

Dew58
03-20-2009, 09:01 AM
I appreciate your reply to my question. My atty. told me that the judge will not be pleased with the withholding of TTD and reimbursement of mileage and tolls. That offers little peace in my mind for the anxiety and stress/pain flares that come with each delay.

I can't help but wonder that if pain and suffereing were able to be granted in WC cases, WC would be a totally different animal:cool:

Again, Thank you,

Dew:)

:grouphug:

lefthanded
03-23-2009, 02:21 PM
Sometimes, Dew, I agree that P&S might be the fire under their feet that could get claims moving . . . but on the other hand, they might fight even harder!

Dew58
03-24-2009, 03:15 PM
....well, the WC/doc/PT paper trail that is left would be proof that WC is not doing their part in caring for the worker. RSD/CRPS is a syndrome that is on a timer when it comes to reversal. My WC case is filled with paperwork where they pretty much ignored my concern of the burning pain as constant..as well as discolorization..temp. changes..all of the symptoms. The docs I have seen don't want to admit that it is RSD/CRPS, until one of the docs said that is what I have..then several others jumped on board.... 2 yrs. later :mad:

MY current PM stated to me,"You do understand that you will not get better, this syndrome is forever..and you will get progressively worse." I have never had a doc be so negative about this issue. However, maybe he is just telling me the truth. My shrink told me that I should stay positive..they don't know my will :winky:.

I have filed for SSDI, and have an appt. for a mental exam in 5/09. My shrink was surprised about this exam, as he wrote a letter in my behalf.

Thanks,
Dew

Jo*mar
03-24-2009, 11:06 PM
Hello dew,
Have you visited our RSD forum yet?
http://neurotalk.psychcentral.com/forum21.html

You might find a few more ideas there , a few have WC cases too, but many also have the problems of long time to diagnosis, finding good doctors, pain management etc...

Dew58
03-26-2009, 02:35 AM
Thank you for your comment. I appreciate this site, and all the people that share their stories and experience. We can all learn from each other.

My atty. called me today and told me that the WC court date is 4/08/09, at 9:00 AM, in OKC. This is to settle the dispute of the TTD ordered by my treating PM doctor, 2 months ago. On my last follow up visit to my PM doc, I shared that the TTD script he wrote was not recognized by the WC ins. co. or their atty. PM doc said that he had never had this happen before, and was not pleased. He told me that he would write in this report that I was TTD as of 01/05/09, TTD at the present time, and TTD in the future.

I am having a hard day. Sympathetically mediated pain syndrome/chronic pain(CRPS I), the monster that has changed my life forever, is difficult to control. My emotions are just a mess. I cry when I talk about it, or cry at anything, no matter how small, that may bother me. It is embarrassing. The thought of going to court scares me. How will the syndrome effect my emotions when I take the stand. Can I hold it together???:Melting 2:

I have seen a psychologist every 2 weeks because of this syndrome, since 4/08. I take 20 pills per day;also,Tens Unit pain creams and pain patches, heat pad. I don't sleep much. I have water PT twice per week.I have an atty. that tells me to "hang in there",while WC ignores me. I have a PM doc that tells me straight out that I will never be my active self again.

I think how much work I placed in my dream of finishing my college degree.I had dropped out in 1979. I did it, took me 18yrs. to put that goal back into action. I then went directly to grad school, in Studio of Fine Arts and Psychology/Behavioral Science. I achieved the dual Masters degree in 2001; I was 42 yrs old.

Currently, I am married (27 years), with a son(21 years old). It was hard on all of us; the sacrifices each of us made for this dream. It was for all of us.

Amazing how it doesn't seem so long ago. I am now 50 yrs. old now, and cry from the burning pain and all the symptoms of the syndrome, the loss of my active self. I cry from not being able to be touched without first bracing myself. On 3/24/07, my life and my body was not mine to control,anymore.

I had no idea what hell I was about to endure as I entered the WC arena.

I am angry. I am tired. The WC system is cruel and unusual punishment for anyone that has dared to challenge the insurance company.

"I am a warrior; I will be triumphant." :Viking:That is my meditation chant.

I must not forget this part of myself.:Sob:

:Talkative: Thank you for being here for me.

hugs,
Dew:grouphug:

finz
03-27-2009, 12:58 AM
I'm sorry that you are dealing with this too, Dew.

The system is really screwed up. My story might make you laugh. I am waiting over a year for the court case to get into the pain clinic at the hospital where I worked. My neuro wants me seen there. The pain specialists there want to see me. The hospitals WC denies the visit.......doh ! :rolleyes: Yet they continue to pay me for 5 years.......wouldn't it be cheaper to take care of the pain ????

Jo*mar
03-27-2009, 01:14 AM
When the wc stuff is finally settled and it does take a very long time.
{don't be surprised it they stall or reschedule you hearing date....}
mine was rescheduled 2 times and right before the hearing - it became a settlement negotiation...
but my claim was for rsi and shoulder neck strains at the time- which was accepted for awhile and then denied so i appealed.

Anyway when it is all done with, your life will settle down and the roller coaster ride of wc will be over.
Believe me it is a great weight that will be lifted off of you.
the you will have time to deal with the feelings caused by rsd and life changes.

lonnibdd
03-27-2009, 01:44 AM
hello to all My name is Bill and I have rsd/ CRPS as well and am on workers comp have been since july 06'. I have it in my right ankle and leg i know what you are talkin about when it comes to the indep. docs and w/c not wanting to allow "certain" cond. I had to fight mine all the way to the industrial commision board. I see one of the leading docs on this cond. and I am still in unbearable pain 98% of the time. I am really glad I found this site I hope to meet some other people out their as I feel so alone w/this my family is awesome but as you all know u hear the I wish there was something I could do or the opp. sure its not in ur head, I hate that. so hello to all and god bless.

Brachial6
03-30-2009, 01:31 PM
I was very impressed for all you had to share with us. I had a work injury in CA on 4/27/1990 leaving me a chronic pain patient worse than ever after getting a staph infection from the operating room during surgery to try to remove scar tissue. I was replaced at my job before I even got out of the hospital in 2000! I haven't been able to work since then! I have a very long workers compensation case with my work comp attorney for almost 19 years. Tomorrow I go to an agreed medical exam for the final report. This is at Dr. Ahn's office in L.A. he wanted to do an invasive test and I will not agree to anymore surgeries or invasive tests. I had 5 surgeries at my left clavicle and 1 at my right clavicle by Dr. Filler to remove scar tissue but getting the Staph infection only made the pain worse than ever! I have TOS. Thanks for what you add to this site. Jackie;)

rsdwife
04-01-2009, 11:31 AM
My husband and I too are in the midst of a w/c battle. He was injured in may of last year and diagnosed rsd/crps aprox 3 months after. We are now awaiting the results from 3 of w/c IME Dr's. Our lawyer has told us to be prepared for them to deny our request of accepting rsd/crps condition, even though our PM dr said my husbands case is on of the most obvious of his rsd patients.

The hurry up and wait part is difficult. Having the attorney deal with w/c has at least taken some of the stress of of our family. We try and only take one day at a time, otherwise this dx could consume us 24/7.

Please let us know what your outcome is with your hearing. My husbands job has him sitting in a chair 8 hours a day doing nothing (aka light duty) and pays part of his wages and w/c pays the rest. He gets to sit all day and watch all his co works drive by in their trucks, and wonder if he will ever be able to drive his again.... its great for his mental health :)

take care.. you and everyone else here are in our thoughts!

jeffirish1
04-11-2009, 02:45 PM
Lefthanded. I have been waiting months to talk to someone like you. I got hurt in oct 06 started out major elbow and 4arm pain. Went to a ortho Dr who said my pain was in my neck. Got MRI it showed hurnaited disc c6-c7 had acdf one level in aug 07. Pain and numbness stayed in left elbow and 4 arm also in my fingers. Had 3 EMG that showed major problem with the ulner nerve it was entraped. Had the ulner nerve moved also muscle debridement done on 4arm was told tendon pulled off of bone. They did CT on left had a t same time that was done in dec 07. Was rushed back to work in feb 08 my job finaly had light duty. Through all of the time from oct06 to Dec 07 I had two IME's they were both in my favor. I also had a great claim manager she was the best. In Aug of 08 had pain between shoulder blades went to neuro who did acdf surgery he did CT scan and said everything was perfect. Still worked until Nov 08 pain finlly got the best of me I am a plumber. From Nov to Dec I had 3 claim manegers. Went to back ortho with the Ct Scan from neuro from Aug and new Dr in Jan in 2 seconds he looked at the Aug CT scan and said your fusiion has failed andthe bone holding the plate is fractured. HE got the report from the CT scan it said the cageing and fusion was healed perfect. I had a plate not a cage. We think the neuro Dr was just looking at the report and not the scan itself. Now my main probllem the insurance company has not paid me any money since I left work in Nov. Company said thay dont have any light duty now and sent me home. The Dr took me out of work complety in Jan. The insurance compay sent me to my third IME who finanly said that none of the surgerys were needed and the only one he would have recomended was the debridment. He even had my new CT mylogram showing the fusion not there. I have had an atty since this accident happened. We go to court at the end of the week just wanted to see what you thught the insurance company was thinking. Thanks for your time

lefthanded
04-16-2009, 08:21 PM
Lefthanded. I have been waiting months to talk to someone like you. I got hurt in oct 06 started out major elbow and 4arm pain. Went to a ortho Dr who said my pain was in my neck. Got MRI it showed hurnaited disc c6-c7 had acdf one level in aug 07. Pain and numbness stayed in left elbow and 4 arm also in my fingers. Had 3 EMG that showed major problem with the ulner nerve it was entraped. Had the ulner nerve moved also muscle debridement done on 4arm was told tendon pulled off of bone. They did CT on left had a t same time that was done in dec 07. Was rushed back to work in feb 08 my job finaly had light duty. Through all of the time from oct06 to Dec 07 I had two IME's they were both in my favor. I also had a great claim manager she was the best. In Aug of 08 had pain between shoulder blades went to neuro who did acdf surgery he did CT scan and said everything was perfect. Still worked until Nov 08 pain finlly got the best of me I am a plumber. From Nov to Dec I had 3 claim manegers. Went to back ortho with the Ct Scan from neuro from Aug and new Dr in Jan in 2 seconds he looked at the Aug CT scan and said your fusiion has failed andthe bone holding the plate is fractured. HE got the report from the CT scan it said the cageing and fusion was healed perfect. I had a plate not a cage. We think the neuro Dr was just looking at the report and not the scan itself. Now my main probllem the insurance company has not paid me any money since I left work in Nov. Company said thay dont have any light duty now and sent me home. The Dr took me out of work complety in Jan. The insurance compay sent me to my third IME who finanly said that none of the surgerys were needed and the only one he would have recomended was the debridment. He even had my new CT mylogram showing the fusion not there. I have had an atty since this accident happened. We go to court at the end of the week just wanted to see what you thught the insurance company was thinking. Thanks for your time

Your time loss is dependent on your doctor documenting that you are unable to work. This is something as a claims examiner I was pretty strict about, as without this requirement, employers would have increased time loss and potentially injured workers who are not treating to get well. An injured worker can not take him/herself off work without documentation from a physician. Time loss documentation . . . resubmit it if your doctor took you off work in November . . . this would be my recommendation. However, if you have a decent attorney I think he/she should have suggested or done this by now. Maybe you should ask your attorney to follow up on this with repeat documentation. If you state allows for penalties for delayed payment you should file for these as well . . . however, often there is a time deadline for filing.

Dew58
04-16-2009, 09:43 PM
....well, the WC/doc/PT paper trail that is left would be proof that WC is not doing their part in caring for the worker. RSD/CRPS is a syndrome that is on a timer when it comes to reversal. My WC case is filled with paperwork where they pretty much ignored my concern of the burning pain as constant..as well as discolorization..temp. changes..all of the symptoms. The docs I have seen don't want to admit that it is RSD/CRPS, until one of the docs said that is what I have..then several others jumped on board.... 2 yrs. later :mad:

MY current PM stated to me,"You do understand that you will not get better, this syndrome is forever..and you will get progressively worse." I have never had a doc be so negative about this issue. However, maybe he is just telling me the truth. My shrink told me that I should stay positive..they don't know my will :winky:.

I have filed for SSDI, and have an appt. for a mental exam in 5/09. My shrink was surprised about this exam, as he wrote a letter in my behalf.

Thanks,
Dew
My SSDI was approved in 10 weeks from me filing on my own. My atty. was shocked..as he told me that I would prob. not get it as in OK one almost has to be in a coma to get SSDI.
I wanted to share the good news..soft hugs, Dew

screwballpookie
07-01-2009, 12:46 PM
Hi lefthanded,
I just have a couple of questions for you.I had a work related injury back in 2002 and worked under docs care for a year and a half and they let me go on October 3, 2003 because I brought back permanent restrictions and they said they did not have anything i could do with those permanent restrictions so it was odios to me. Also while being under docs care wc decided we weren't getting anywhere so they dropped my case as well. By the way I live in Iowa. Can wc do that legally and can my place of employment do what they did to me? I have been fighting them for 6 yrs now. We did settle out of court 2 yrs ago with them making up the agreement. All I wanted at that time was an open file since I can't get health insurance due to my rsd. That is one thing I got. It was also processed through the state and all signed sealed and whatever else it goes through. Wc decided they are not going to oblige by what they agreed on. They are not paying docs visits or for my meds. I do still have my atty and we are still fighting them due to what they did. Is what they did as far as not doing as they agreed to legal and why do we have to fight them again? If we already settled why don't they have to do what the agreement was? Also I can tell the rsd is not getting any better if anything in my opinion I feel it is spreading but i can't get any doc to diagnose the right hand arm, and shoulder as well as my lower legs and feet. The weakness and pain and swelling i deal with on a constant basis has to be obvious.I think the docs just don't want any part of the lawsuit so they won't diagnose it. Am I thinking right or am I way off base here? My left hand was injured and it moved into my whole left arm, shoulder and neck and that is what the first settlement was based on but now that I am getting worse in my opinion and can't get a doc to diagnose it but goes as far as to tell me verbally that i need a cane or walker to help me walk now but not put it in his records. What can i do? And The next case can it be based on all my new injuries I guess you would call them or how does something like this work? I am still paying for all my meds and my hubby is the only one bringing in the income because I hurt so much more. My attorney said this time we can go after them for punitive damages this time. Is this true and if so what all am i looking at for this second case? I am scared and don't know what to expect. Please help me!!!!!

Sincerely,
Tracy

lefthanded
07-04-2009, 09:22 PM
Tracy,
I am afriad I do not know the ins and outs of the "settlement." When I handled Iowa claims (up until 1995) a full and final settlement was just that -- the last word. So a settlement that provides any kind of agreement beyond "done" is something I do not know anything about. This is why you have an attorney.

As far as your case being dropped . . I am not sure what you mean by this, given you mention having some kind of a past settlement. W/c claims are rarely, if ever, left open for extended periods of time, or for medical follow-up. Even total disability pensions usually only paid a monthly wage-replacement benefit, and did not medical care. I know a few years back that the value of medical insurance was included in the evaluation of wages of determining your weekly benefit in many states, but I am not sure about Iowa. I am aware of only a few cases that were left "open," and those usually were because the condition was one that was expected to deteriorate a good deal, such as a closed head injury that caused a stroke, leaving a claimant unable to care for himself.

RSD is relentless, and still not fully understood. And unfortunately our society still does not deem it necessary to integrate individuals into the workplace that have lost functioning due to inexplicable and often debilitating pain. I know . . . because my employer was one of "those" that thought it wasn't worth the effort. So almost 15 years of training and experience get wasted, and I disappear. I don't have RSD, but I do have neuropathy in my feet, carpal tunnel in both hands, arthritis in my right wrist that needs a joint replacment, and Crohn's. I know how you feel . . .


Hi lefthanded,
I just have a couple of questions for you.I had a work related injury back in 2002 and worked under docs care for a year and a half and they let me go on October 3, 2003 because I brought back permanent restrictions and they said they did not have anything i could do with those permanent restrictions so it was odios to me. Also while being under docs care wc decided we weren't getting anywhere so they dropped my case as well. By the way I live in Iowa. Can wc do that legally and can my place of employment do what they did to me? I have been fighting them for 6 yrs now. We did settle out of court 2 yrs ago with them making up the agreement. All I wanted at that time was an open file since I can't get health insurance due to my rsd. That is one thing I got. It was also processed through the state and all signed sealed and whatever else it goes through. Wc decided they are not going to oblige by what they agreed on. They are not paying docs visits or for my meds. I do still have my atty and we are still fighting them due to what they did. Is what they did as far as not doing as they agreed to legal and why do we have to fight them again? If we already settled why don't they have to do what the agreement was? Also I can tell the rsd is not getting any better if anything in my opinion I feel it is spreading but i can't get any doc to diagnose the right hand arm, and shoulder as well as my lower legs and feet. The weakness and pain and swelling i deal with on a constant basis has to be obvious.I think the docs just don't want any part of the lawsuit so they won't diagnose it. Am I thinking right or am I way off base here? My left hand was injured and it moved into my whole left arm, shoulder and neck and that is what the first settlement was based on but now that I am getting worse in my opinion and can't get a doc to diagnose it but goes as far as to tell me verbally that i need a cane or walker to help me walk now but not put it in his records. What can i do? And The next case can it be based on all my new injuries I guess you would call them or how does something like this work? I am still paying for all my meds and my hubby is the only one bringing in the income because I hurt so much more. My attorney said this time we can go after them for punitive damages this time. Is this true and if so what all am i looking at for this second case? I am scared and don't know what to expect. Please help me!!!!!

Sincerely,
Tracy

Abbie
07-04-2009, 11:55 PM
I don't know if this will help you or not...but here is the link to Division of Worker's Compensation --- Iowa.

http://www.iowaworkforce.org/wc/

Lot's of information there... you may have to do a little reading to find the answers for which you are looking...

I wish you the best...
:hug:
Abbie

screwballpookie
07-06-2009, 07:13 PM
Dear lefthanded,
i want to thank you for taking the time to answer my questions. As far as wc dropping me it was while I was still working but under doctors care and they said that I was at MMI even though i was not fully diagnosed and just dropped the case. I am so glad you were here to answer my questions. it really helped me out. Thank you again.

Sincerely,
Tracy

redrose51
11-11-2009, 01:01 AM
I have been reading some of the advise that you have passed on to others, and it seems that I came to the right source for my situation. I was injured at work in nov.07, and have since had back surgery, physical therapy, and all that goes with that kind of injury. My question is that after being back at work for just one week I slipped on wet floors and landed on my back, just had an MRI done on my injured back and the doctor told me that the L5 on my back shows a protusion. Can workmans comp force me to close my case and why would workmans comp add this second injury to the first injury? The doctor I am now seeing suggested I hire an attorney after I told him that w/c was treating this as one accident. What do you suggest? Nov.16, is my two year closure. HELP!!!!!!!!!:confused:

lefthanded
11-13-2009, 06:13 PM
I have been reading some of the advise that you have passed on to others, and it seems that I came to the right source for my situation. I was injured at work in nov.07, and have since had back surgery, physical therapy, and all that goes with that kind of injury. My question is that after being back at work for just one week I slipped on wet floors and landed on my back, just had an MRI done on my injured back and the doctor told me that the L5 on my back shows a protusion. Can workmans comp force me to close my case and why would workmans comp add this second injury to the first injury? The doctor I am now seeing suggested I hire an attorney after I told him that w/c was treating this as one accident. What do you suggest? Nov.16, is my two year closure. HELP!!!!!!!!!:confused:

Not knowing what state you are in, or the particulars of your injuries, I really can not comment with competence on your particular issues. In most jurisdictions where I worked your recent slip and fall would have been considered a new injury, as it had a definite time and place incident causing the injury. If you are unable to find out how the laws of your state work in this regard, then I recommend you contact your industrial insurance division and ask, and short of getting a satisfactory answer, it might be advisable to get an attorney's opinion. I would not allow closure of this claim if indeed, you are stuck with the new injuries being rolled into it. I would seek to file a new claim. But then it is up to the statutes of the state where you work how this will be handled.

I have not been in claims in over 7 years, and even the laws here in WA state have changed significantly since then. I am not a lawyer, nor have I any specialized training in w/c law apart from the study necessary to get certified in this state years ago. I am in this sub-forum only to offer insight and any advice I feel I can. Most often I find what I am doing is dispelling myths about w/c and how it works. . . or doesn't work! You have a definite deadline to meet. I would contact your states industrial insurance division immediately and ask them to help you in defining new injury versus aggravation or exacerbation, and I would ask if I could file a new injury claim for the most recent incident.

And, by the way, if you have not had an examination for the evaluation of residual permanent impairment (range of motion, strength, and pain), you also need to ask what must be done to get one scheduled. In most states you will be assigned a disability percentage or category based on the injury, the requirement for surgery to correct it, and how complete your recovery has been. This would then entitle you to payment of permanent partial disability benefits . . . which sometimes are referred to as "settlement." It is not really a "settlement" as much as it is paying what is owed you by law at that point, as "settlement" implies a dispute over the exact amount. These payments are most often made over time . . . and I personally recommend that they be put into a savings fund for use on future medical costs that my arise because of your injury. I have seen far too many claimants run out and buy a boat or a new 4x4 truck with their "settlement," only to call me in a few months complaining that they don't have any money to use to pay for the occasional pain pill or massage visit that they may need because of their injury! This benefit is to compensate your for future expenses, including but not limited to medical expenses and loss of earnings if your condition deteriorates and you can no longer work at the same level of pay.

In most (if not all) jurisdictions before a claim can be legally closed you must have reached maximum medical improvement or stability, your doctor must say no more treatment will further your improvement, you must know if you have any permanent restrictions you should observe, and you should know if you have suffered any permanent impairment. In addition there should be no outstanding bills for your treatment, you should have received reimbursement for mileage to and from treatment and exams (if applicable), and you should know your status at work.

All that said, never solely rely on online forums for information which carries a legal consequence. This forum is a support forum for folks who live with chronic pain . . . and is not designed to be a resource for insurance questions. While I worked in w/c insurance for over a dozen years, my illness was not work-related, I never suffered a work injury, and my loss of income, my disability, and my medical care have been borne 100% by myself. This is why I am a strong advocate for individuals purchasing their own long-term disability coverage . . . because the state does not take care of illness the way it does injury on the job!

Big Sky
03-14-2010, 10:27 PM
:winky:I am reading these threads, seeing so much misinformation, sharing of information that is specific to certain claims for certain people in certain states, and hearing fear, confusion and worry . . . I would love to help! However, I can not set myself up as an expert and give legal advice, nor have I worked claims in every state and those I did have probably changed their laws somewhat since then . . .

But there are some very basics that I could offer to help you through the "system."

Is there an interest? What are your most pressing questions or issues? And what is it that you don't understand, find confusing, or find depressing about being on workers compensation?


:wink:
i will begin by saying Workers Compensation Insurance is a state run program. Your employer, and most of the time you, pay premiums each month (yours comes out in payroll taxes), and those premiums are set according to the degree of hazard and the number and costs of claims your employer experiences on average in your state. They desire to keep these premiums, and their costs, low . . . and this can lead to conflicts over coverage, allowance and sometimes even the handling of your claim. This is why attorneys are sometimes needed. Because workers compensation was instituted over 100 years ago to take the burden off the injured worker, it is supposed to be a no-fault system. If your injury happened on the job -- the language usually includes the words "arising out of" and/or "in the course of" your job duties and activities, it is supposed to be covered. W/C was designed to make sure the worker got proper medical treatment, to replace the lost wages with a benefit that would keep them from economic ruin (about 2/3 of your usual wages) and keep you from losing your job for being injured.

During the industrial revolution and until about 100 years or so ago, if you were injured (cut off your arm, broke your back, etc. . . . ANY injury) you were shown the door, escorted sometimes to your company housing, where you were thrown on the street after being handed a bill for rent and your tab from the company store, and you were responsible for sewing your own arm back on or fixing your broken spine the best you could. Back then there was not even health insurance, so you really were out of luck! (I did my senior thesis on the Pullman Car Company of Calumet City, IL, where I learned these things happened all the time.)

So if your benefits and your hassles with your claims person seem too much, just appreciate what history stands behind you. Then learn about your particular state's claims process the best you can. Many injured workers went before you, blazing a painful and costly trail to this time in history.

W/C is not meant to make you rich. You will go backwards financially a little, even though you get a check each week or two. However, your medical should be paid at 100%. If you are ever billed for something that w/c should cover, turn the bill in to your claims person. If you are ever billed for a balance after w/c adjusted the bill, this is a violation of the law. . . tell your claims person!

For now let me just say a few things that are basic good claimant (that's you) etiquette:

Be polite, calm, rational and businesslike with your claims person, the doctors and anyone regarding your claim. It will move you farther than being the opposite: threatening, belligerent, angry or pushy.

Do all your paperwork promptly. There may be a reason something gets delayed, but your claims person can only act on what he or she has in the file. A common slogan among claims handlers is: If it isn't in the file it didn't happen. This is why I recommend following up every important phone call with a letter: you may need the paper trail later. Keep a file and keep copies of every letter you receive and write, every notice, note, and some even keep copies of checks (or the stub to show what it paid) . . . and a log of your phone calls, in the file.

Learn to use your word-processing program, including spell check, so your correspondence will be businesslike. If you don't have a printer, see if you can e-mail your correspondence.

Find out if you can protest any unfavorable decisions and follow the timelines. A day late and you lose! A protest is not hard to write. . . the statute will often give you the format and the words to use, or close to that.

Do not skip doctors appointments or skip treatment. Like all medical treatment, you have the right to participate in your treatment plan, to a great extent. If you are unhappy with your physician, therapist or counselor (if you are in vocational counseling) . . see if you can change. You can refuse a treatment that is against your beliefs or better judgment, and you can not be forced to have surgery or other invasive procedures against your will. However you must have a good reason, and be prepared for your claim to be a little more complicated if you refuse, say, a surgery that could return you to work with low risk, or an test that could move your healing forward.

Do not lie. Do not cheat. Do not fake. Do not try to get away with being off work if you are truly not injured. Claims people hire investigators all the time, even on "nice" people. Sometimes it is the protocol for handling claims for a particular company, or standard claims handling practice for certain types or levels of claims. (I once won a case forcing the "injured" worker to repay over $84,000 because we caught him doing heavy farming activity when he claimed he could not turn his head to drive or lift a gallon of milk. I saw it on the surveillance tapes myself!)

While you must adhere to your restrictions, you are allowed to shop, and take care of your kids . . . and, yes, you may leave the house while on total disability! You probably want to stay away from the roller rink, the softball game or even the fishing boat on a holiday weekend, depending on your injury.

It is believed you get your way by piling up phone calls and messages to your claims person. If you have to go that far to be heard, ask for their supervisor. Follow up your first call with a letter, and copy their supervisor or the manager. When their file is reviewed it will come to someone's attention you have not been answered . . . and someone should get a reprimand for ignoring you. If all 200 claimants called me every day hounding me for checks that are late, for information, or just to talk, I would never have gotten anything accomplished in a day! Remember, they are doing their job to please their boss, just like you have to when you are at work.

Keep in touch with your employer so they know a) how you are doing, b) if and when you might return to work, c) that you are still an employee (do not abandon your job mid-claim, it makes life messy later) and d) it is the correct way to keep them onboard with your claim. That way they know you are earnestly trying to get well and return, and will see you more as a returning asset than a present liability.

Stand up for your rights. If something seems amiss, ask. Protest when you feel a decision or action is wrong. Stay on top of your claim. Start a file and keep everything in it in some form of useable order.

Return to work when you are released. If it does not go well, or you flare up your injury, your doctor is the one to document the medical reason you can not continue, and might need more treatment. In fact, your doctor must provide documentation for almost all of your benefits: time loss, restrictions, treatment, and return to work, as well as when healing is complete (maximum medical improvement, end of healing period, or whatever it is called in your state) and permanent impairment.

Make sure impairment is addressed before claim closure.

Find out what the statute of limitations is for reopening, and under what conditions this claim might need to be reopened.

Understand that in many states if your injury is the same as one you have years ago with another employer, you may be asked over and over for a work history so that they can see if some of the costs should be thrown back on the previous employer's injury. Every state seems to handle pre-existing injuries or conditions differently: find out early how your state handles it. Then don't spin your wheels trying to fight it. Only cases that are hard-fought in court change laws, and unless yours seems that strong, concentrate on getting all your benefits that are due under the law. Unfortunately that can sometimes be harder than just going back and doing your job!

Of you qualify for FMLA, file for it! You have approximately 12 weeks of protection of the job you were in at the time of injury, or a substantially similar position, under FMLA. Unfortunately, if you use FMLA for your neurological condition, you may have to share that 12 weeks with your condition . . . you only get so much time under FMLA regardless of how many conditions you use it for.

Do not compare your claim to anyone else's claim. Rarely, if ever, will two injuries, severities, wages, hours, and employers be identical, let alone doctors, details, outcomes, or "settlements." . You are wasting energy wishing you would get the big "settlement" your neighbor, friend, or second cousin on your father's side did! This is a cruel trick you play on yourself if you listen to everyone else's expert advice, because they had a claim or knew someone who did. Run, don't walk, to the nearest earplugs. Tell them how interesting you find their information. Thank them. But do not ruminate on what they claim or believe you should be getting. It is almost like saying every lottery ticket is a big winner. It just ain't so. Some claims, and rightly so, close with no big jack-pot at the end.

I strongly object to the term settlement when discussing workers compensation. Being a no fault system, if you are permanently impaired or disabled by your injury, you are entitled by law in most if not all states to an award of permanent disability benefits. This money is to compensate you for future medical needs that might be consequential or might arise later (such as prescriptions, they are not generally covered after claim closure), but not be sufficient for reopening. It is also to make up for a possible drop in your future earning capacity due to your loss of function in the work place. It is not a windfall to be spent on a new 4x4 or vacation, unless you have an endless income stream guaranteed in your future. I suggest you buy a few certificate of deposits and sit on it for as long as you can. It might come in handy down the road when you get laid up with a non-work medical condition and have no or little income, or when you can no longer do your job and find you are earning less. That is what it is designed for. Honest. But I bet over 50% of the checks I cut were "blown on stuff" before the ink dried on signature on the back of the check.

Sometimes the final payment, if it is more than a year's worth of benefits would be, are paid out in monthly amounts. If this happens, be glad you have an extra check each month to put into savings after you get back to work. Don't sell out to one of those companies who will give you cash now. You will get less than you are due, because they will pay you at a discounted rate, and they will walk away counting your money as it enters their pocket. They may be legitimate, but they are immoral by preying on people in dire need in my book. If you are hard-pressed for money when it comes time for your final permanent disability payment, and it is set up as monthly payment, ask your employer or claims person if you can have a hardship lump sum of all or part of it.


Well . . I am up wa-a-a-ay past my bedtime. If there are any questions, ask away. I will discuss permanent total disability if anyone is in this situation. Sometimes it is called a W/C Pension. They are rare, hence I am no expert. But maybe I can help if you have questions I can answer or give you a direction to go for answers.

For now . . . good night. If I have any typos or misspellings. . . . it is 2:37am here right now. . . .


"Z-z-z-z-zz-z-z-z-zz-z-z . . . . . ."

Would you have any helpful tips for the situation involving my son. He has been diagnosed with RSD/CRPS the result of an accident at work while peeling logs. You may be aware there is no cure for this crippling disorder. The disease has progressed from his right shoulder, arm and hand migrating into his lower right leg and foot making it difficult for him to walk; he's in constant pain. Unless something drastically changes I don't see him returning to work. There is a IME panel scheduled early next month and I'm certain a push for MMI (from the panel) shortly after that despite his primary physican pushing back MMI for at least twelve and possibly eighteen months (Aug 09). Any help you can provide would be welcomed, thanks.

Al

lefthanded
03-16-2010, 03:25 PM
:winky:

Would you have any helpful tips for the situation involving my son. He has been diagnosed with RSD/CRPS the result of an accident at work while peeling logs. You may be aware there is no cure for this crippling disorder. The disease has progressed from his right shoulder, arm and hand migrating into his lower right leg and foot making it difficult for him to walk; he's in constant pain. Unless something drastically changes I don't see him returning to work. There is a IME panel scheduled early next month and I'm certain a push for MMI (from the panel) shortly after that despite his primary physican pushing back MMI for at least twelve and possibly eighteen months (Aug 09). Any help you can provide would be welcomed, thanks.

Al

Al, it would depend on the state you are in and the industrial insurance laws of that state. RSD was a difficult diagnosis back when I was working in the field, and CRPS has not been assigned as the new diagnostic term yet. The best advice I can give is to know what the basic law says, to establish to the best of your ability a strong relationship between the injury and the condition, and then to understand that even in the best cases worker's compensation is not a perfect patch to a bad situation.

You did not say what the original injury was, if surgery was involved, or whether you had already sought the opinions of several related specialists. A good pain program may help him cope, and for some it even allows them to return to some kind of employment. I know it sucks, because right now I feel every step I take forward is followed by two steps backward. The clue is to not turn around and accept that as the direction of your life, even when it feels like it.

RNcrps2
09-15-2010, 06:19 PM
Lefthanded, Thanks ahead for you time. At work i lift, push and pull heavy things. I went to the Dr with a sore upper arm/elbow-told i might be starting with tennis elbow. Got a cortisone shot(my request). Went back for f/u 2 weeks later and arm felt fine.
Couple months later working and pulled a heavy weight and my forarm swelled. An acute injury. 2weeks later MRI showed small tendon tear & needed therapy. At a month the therapist called my brace a tennis elbow brace. I completely forgot about my elbow because it wasnt at the same site. And never mentioned it to w/c(along with forgetting 2 broken toes, and breast cyst).I called my Dr. when i got home and he said that is a large surface area and it sounds like an acute injury. So i never told w/c figuring i would be going back to work anyway. After a therapy session my arm was painful and swollen. MRI#2 showed new effusion at elbow. EMG showed pinched nerve. Finally went to my own Dr. Ortho looked at both MRI's and said needed surgery on elbow and nerve. Entire arm painful and burning. After surgery, at 7months not progressing having flare ups. Finally sent to pain Dr. diagnosed with RSD.(believed i had it before surg) Ortho disagreed and sent for ulnar EMG. Negative and that Dr. said it was RSD! Since Rsd wasnt caught early on it spread and now i have full body RSD. w/c asked for settlement but when they saw what we asked they said no way we only pay small claims. What does that mean? How long do they have to pay(PA). Will me failing to tell that had tennis elbow effect my claim? The only reason i didnt is i truely felt like an idiot forgetting about it and was embarrassed to tell them. They also are trying to get out of including RSD since it didnt occur the day of the injury.
I loved my job and now i am out no way i can do it.
The hardest thing is with RSD stress makes the RSD flare so i want things over so i dont get worse.
Any thoughts? momof4

lefthanded
09-16-2010, 01:11 PM
Lefthanded, Thanks ahead for you time. At work i lift, push and pull heavy things. I went to the Dr with a sore upper arm/elbow-told i might be starting with tennis elbow. Got a cortisone shot(my request). Went back for f/u 2 weeks later and arm felt fine.
Couple months later working and pulled a heavy weight and my forarm swelled. An acute injury. 2weeks later MRI showed small tendon tear & needed therapy. At a month the therapist called my brace a tennis elbow brace. I completely forgot about my elbow because it wasnt at the same site. And never mentioned it to w/c(along with forgetting 2 broken toes, and breast cyst).I called my Dr. when i got home and he said that is a large surface area and it sounds like an acute injury. So i never told w/c figuring i would be going back to work anyway. After a therapy session my arm was painful and swollen. MRI#2 showed new effusion at elbow. EMG showed pinched nerve. Finally went to my own Dr. Ortho looked at both MRI's and said needed surgery on elbow and nerve. Entire arm painful and burning. After surgery, at 7months not progressing having flare ups. Finally sent to pain Dr. diagnosed with RSD.(believed i had it before surg) Ortho disagreed and sent for ulnar EMG. Negative and that Dr. said it was RSD! Since Rsd wasnt caught early on it spread and now i have full body RSD. w/c asked for settlement but when they saw what we asked they said no way we only pay small claims. What does that mean? How long do they have to pay(PA). Will me failing to tell that had tennis elbow effect my claim? The only reason i didnt is i truely felt like an idiot forgetting about it and was embarrassed to tell them. They also are trying to get out of including RSD since it didnt occur the day of the injury.
I loved my job and now i am out no way i can do it.
The hardest thing is with RSD stress makes the RSD flare so i want things over so i dont get worse.
Any thoughts? momof4

I must first tell you I am not at all familiar with Pennsylvania worker's comp law, so I can not answer your specific questions about pay, reporting requirements, etc. However, most states have a time limit for reporting injuries, sometimes up to a year or more. Your case is more complex with your multiple serial aggravations or injuries to the arm.

This is a link to PA L&I where some of your questions may be addressed: http://www.portal.state.pa.us/portal/server.pt?open=514&objID=552715&mode=2 It appears you have a pretty stringent timeline for reporting injuries in PA, 120 days (3 months) or you forfeit your right to file. Occupational diseases have longer. However, like I said, in a case where the same part is reinjured, aggravated or there are ongoing or recurring issues, it becomes more difficult to predict what your comp outcome will be.

If you haven't already spoken to your claims examiner, I would start there with your questions. Many will tell you to rush out and get an attorney, but I have always felt it is best to know a little about the status of your claim before doing so, as they take real money out of your pocket for their representation. If you determine that there is a good chance you have not been allowed benefits you feel are due you, then it is time to contact an attorney.

RNcrps2
10-29-2010, 06:37 AM
Lefthanded, I recently went for a consult with a Dr. I gave him my history which was complex and even gave him a written time line of when things occurred. He told me and my husband his impression which we agreed, but when i received his written consult he wrote wrong history of events. What can i do? This can impact my w/c case. Do I call or write Dr. and tell him his report on his history is incorrect? But does this change anything? because once it is written in chart isnt it a permanent record? please help. momof4

Jo*mar
10-29-2010, 11:56 AM
it probably was an typo/mistake - I think getting it clarified is important.

maybe send it back to Dr with the part that needs correction highlighted and a note below containing the corrected portion.??

most likely he had it typed by staff, and they missed it or didn't proofread.

lefthanded
10-30-2010, 02:49 PM
I always suggest returning a copy of the report to the doc with the incorrect parts highlighted and the corrections attached. I'd type a cover letter explaining that you believe the history was recorded incorrectly and give the correct history for the record. I also suggest copying this information to everyone who would receive this incorrect report so they all know you are making corrections. This is more common than you think. It is also a good idea once in a while to make sure your primary physician's records are also correct, as well as your personnel file at work, as a general practice.

foreman94
01-11-2011, 02:35 AM
Lefthanded I am currently under Dr.s care and receiving Workmans Compensation for a work injury which resulted in surgery , would it be wrong/harmful to me if I wanted to send out Resumes for future employment at other Employers other than the one I am at currently at ? I am in Illinois and I see some jobs currently available in my previous field that I would like to send my resume to but I don't want to have any issues with my current situation with Workmans Comp and current Employer, I would state on my cover letter that I am currently recovering from a specific surgery, like if they found out some how that I was sending out Resumes, could they stop my benefit just because I'm sending out resume's to other potential employers? Thanks

lefthanded
01-11-2011, 03:23 PM
Lefthanded I am currently under Dr.s care and receiving Workmans Compensation for a work injury which resulted in surgery , would it be wrong/harmful to me if I wanted to send out Resumes for future employment at other Employers other than the one I am at currently at ? I am in Illinois and I see some jobs currently available in my previous field that I would like to send my resume to but I don't want to have any issues with my current situation with Workmans Comp and current Employer, I would state on my cover letter that I am currently recovering from a specific surgery, like if they found out some how that I was sending out Resumes, could they stop my benefit just because I'm sending out resume's to other potential employers? Thanks

An employee always has the right to look for other work. You should continue to receive benefits as long as your physician can support with objective findings that you are disabled from performing your job of injury. I can't speak to the specifics of your case, or Illinois law, as it has been over 15 years since I handled Illinois claims. If I were you I might contact the Illinois Industrial Commission with your question, or a local comp attorney who will give you a free phone consult.

I wish I could give you a more definitive answer. Of course, I am sure you know your benefits end if you do physically return to work, job of injury or new job. But just sending out resumes should have no bearing on your benefits until your doctor releases you to work. Good luck landing a new job!

Lisa in Ohio
01-19-2011, 10:26 PM
Hi Lefty (from another lefty), I am going to write a paper for college regarding WC and was wondering if it would be OK to use some of the great information that you have provided? Of course I would cite properly. Thanks, Lisa

legalmania
01-20-2011, 07:17 PM
Hi Lefty (from another lefty), I am going to write a paper for college regarding WC and was wondering if it would be OK to use some of the great information that you have provided? Of course I would cite properly. Thanks, Lisa

I know this is a little o/t but believe it or not when I went to elementary school I use to get hit on the knuckles with a ruler for writing with my left hand. I am now ambidextrous because of that. I still write with my left hand but favor my right hand.

lefthanded
01-21-2011, 01:45 AM
Hi Lefty (from another lefty), I am going to write a paper for college regarding WC and was wondering if it would be OK to use some of the great information that you have provided? Of course I would cite properly. Thanks, Lisa

Lisa, this community has some rules and guidlines you should check out before attempting to use anything you have read here. At the bottom of the screen is a link to Community Guidelines, where this is stated pretty prominently:
Forums are Research-Free

These forums strictly prohibit any research being conducted on them by any third-party (e.g., you cannot conduct research on the messages found in our community). You are welcomed to post announcements of clinical trials or other research topics you believe are of interest to other members in the community. You are welcomed to help other members research topics and provide research that is potentially helpful to others.

Even if research were permitted, it would not be advisable to base a research paper at the college level on a web forum. I did several research papers in college on topics similar to or related to labor, work, and industrial accidents and their consequences throughout history (I was a history major). I had neither a computer nor internet access, doing all of my research the old fashioned way . . . at the library! I am sure research takes 1/10 the time with internet resources available these days.

Now, that said, if there are any members whom you would like to quote or interview, you could contact them and see if they would be willing, outside of the forum. However, gleaning members for research might still bump into the intent of the above quoted guideline . . .

I am very flattered, and I encourage you to contact me if you would like help narrowing your topic, outlining a potentially dynamic "A" paper, etc. I have even helped others with editing and proofreading. But the research and work must be yours if you are to benefit from your education.

RNcrps2
02-15-2011, 08:58 AM
Lefthanded, Thanks for being here. I have been on w/c for 4 years now and they have never given me a problem paying for what i need. Besides the original injuries i also developed RSD r/t injury. I am so confused. I am going to court to have RSD included but recently when was accepted on SSD found out that if w/c picks up RSD it will be more complicated later when on medicare. With RSD stress makes me worse so i want everything overwith. My attorney said their attorney said they never settle. How long can this drag on? They can have me go to 2 different Dr(which will burn in hell for how they out right lie) every 6months-just more stress. I do not want a lump sum i want it worked out over years to assure i am covered -what is your input? I only get a set amount by SSD which is offset by any settlement so i wont even come close to what i had been living on. It is very depressing. Is it better to have them pay for medications or have a larger settlement? How do i determine that? If they ever settle in a lump sum when my kids go to college wont that money be my income and have to be used for college-than i wont have anything to cover my care. Please help me understand. thanks. momof4

lefthanded
02-15-2011, 11:36 PM
Lefthanded, Thanks for being here. I have been on w/c for 4 years now and they have never given me a problem paying for what i need. Besides the original injuries i also developed RSD r/t injury. I am so confused. I am going to court to have RSD included but recently when was accepted on SSD found out that if w/c picks up RSD it will be more complicated later when on medicare. With RSD stress makes me worse so i want everything overwith. My attorney said their attorney said they never settle. How long can this drag on? They can have me go to 2 different Dr(which will burn in hell for how they out right lie) every 6months-just more stress. I do not want a lump sum i want it worked out over years to assure i am covered -what is your input? I only get a set amount by SSD which is offset by any settlement so i wont even come close to what i had been living on. It is very depressing. Is it better to have them pay for medications or have a larger settlement? How do i determine that? If they ever settle in a lump sum when my kids go to college wont that money be my income and have to be used for college-than i wont have anything to cover my care. Please help me understand. thanks. momof4
I am afraid your question is very state-specific and way out of my range of experience. I would ask your attorney for an analysis of your questions. A good attorney should be willing to explain your options, potential outcomes, and how they may work.

Good luck.

Jo*mar
02-21-2011, 05:06 PM
Patti
I'll move your posts to a thread of your own on this same forum - it will be easier to keep track of.
and we can pick up on the discussion there.
http://neurotalk.psychcentral.com/thread145376.html

guru1
01-04-2012, 04:09 PM
A friend is currently involved in a work comp claim for a herniated disc in low back.13 years ago he had a low back strain at home and went to the doctor once and was fine a few days later. He hasn't mentioned this to anyone yet cuz no one asked and he actually just recalled it. He has an IME coming up and I think he should disclose it if asked. He is worried they will blame his current condition on that old injury. What do you think?

Jo*mar
01-12-2012, 12:39 AM
If he only went to a dr 1 time 13 yrs ago and had no ongoing problems I think it is safe to not mention it.
If he has his own atty for wc then it would be good to check w/ his atty to verify, but still 13 yrs is a long time.

But- if he mentioned anything about back pain or soreness to coworkers or boss, before this new injury , then that might make for complications if the mention was fairly recent before this injury.

IME Dr is NOT a friend or a care provider, so only answer the questions , no more no less, and don't expect any warm fuzzy feelings from them.

Ask for a copy of the IME report to be sent to so he can see what IME dr says.
Usually there are many 'mistakes" or falsehoods... that your atty & you need to correct.

see the sticky threads above the list of threads for more info.

Or just Google IME exam

janjan
01-24-2012, 12:43 AM
I was injured over a year ago at work. I was hit in my head by a pressurized object that flew out of wall. I have been diagnosed with post concussive syndrome almost 7 mos. later.

The work doctors stated i could go back to work 3 weeks post my injury. They told me after asking about my symptoms and looking at the tests that i could go back to work. I would have a headache for a while but i should return to work.

Every doctor they send me to has said i could go back to work. My own nurse practitioner and my neuro said i can not work until i feel better. I continue to have a headache, that is not helped by meds. I have shooting pains in my head. I have visual disturbances and intermittent vertigo. Mri's and ct scans show nothing. I had one abnormal eeg, which showed slowing and spiking. The eegs i had afterwards showed nothing. The neuro said I should watch myself for any seizure like activity.

The neuropsychologist that my job sent me to said I am just pretending. I became dizzy and had to sit down during our testing. I also suffer with fatigue and had to take a short nap while there. I have had sleep paralysis where i was awake but could not move my body. Since then i have been unable to sleep without tv on, too scary.

my head pains have improved to the point where i feel i can go back to work but i exhausted my fmla and no longer have a job. I have applied for unemployment benefits. I have only received 2 weeks workmens comp to date. Today i had a headache with visual disturbance. I was in bed for hours. I am depressed about this situation. My attorney is really not very helpful or informative. I don't know what else to do regarding these headaches and shooting pains in my head.

Brachial6
02-15-2012, 08:25 PM
After 21 years since my work injury I did receive settlement money! I was awarded lifetime medical and lifetime support at a very small weekly amount! I keep leaving messages at my attorney's office to no avail! I have never received the weekly amount to date when I received the final award in 11/11! I am left a chronic pain patient with bilateral brachial plexopathy, I am very limited as to what I can do without aggravating the pain! I was replaced at my job in 2000 when I was inpatient in the hospital recovering from a Staph infection I got from the operating room while the neurosurgeon was trying to remove scar tissue. In the end the surgery left me worse off than I started because of additional scar tissue! There really is no justice in Work Comp especially in CA.

Hybernating
04-01-2012, 10:18 AM
Hello Lefthand...

This is my first time posting on this site, I'm hopeing you get this. I need some advise, don't know what to do or who to trust. I had an accident at work 18 months ago, fell and hit my head. I was taken to the hospital where I spent 2 days, then was released. The horrible symptoms started. Noiwse in my head, ringing, sensitivity to light,sound, headaches. Just felt like I was going crazy. I had to "beg" , "treaten", worker's comp to get me a doctor that there was something seriously wrong. That took 3 months. The neurologist they sent me to looked at me and said "she's just depressed", gave me Elavil and I went home and slept 15 hours a day for three months. When I went back to the WC Neurologist she took me off the medicfine and said there is nothing wrong with me, sent me back to work. I was stiull having "serious" symptoms, but living my life as an athlete, I went back to work. I have not had ONE day symptom free. Eight months later...I* couldn't take it any longer and went out of FMLA. I was fired two weeks prior to the three months ending. Yesterday I had a deposition, next week a mediation. I have had the Neuro Pyche testing done by two PHD's.One of them say I am suffering from a CLOSED HEAD INJURY, the other one says I'm exxagerating. I feel like I can't even trust my own attorney, believing that they only want to settle to collect their money. This is my life!! I'm not sure I'll ever be able to work again or be normal. Any advise would truley help???






thursday asked me to repost this response to her "Sweating over claim closure," so bear with me, some of it might be repetitious:



I was a Senior Claims Examiner with over 13 years of experience in worker's compensation in several states before my last employer put me on disability. Let me preface by saying every sate is different. I urge anyone on W/C to read the basic on how your state's w/c works.


A claim will stay open as long as your doctor can document that further treatment will improve your condition. Once he can no longer justify your being in treatment (even if the physical therapy, etc. keeps you from sliding backwards), you will likely be declared fixed and stable. At that point your claims examiner with do one of several options: a) prepare the claim to be closed, b) request a permanent disability evaluation from your doctor, or c) set up an independent medical evaluation for determination of permanent disability and/or restrictions.

I advise anyone nearing claim closure, that unless you feel just as healthy and fit as you did before your injury, and sometimes even if you do, request a permanent disability rating from your doctor. If he can not do one (not all doctors have the certification to do this) ask him to refer you to a doctor for a consultation for closure and determination of permanent impairment.

A permanent disability or permanent impairment rating should take into account all factors such as loss of strength, loss of range of motions, loss of sensation, residual pain, your age, and perhaps even your physical condition, and your education level. If your hand is injured, ask that your rating be to the arm, if your thumb, to the hand, etc. If you have a back, shoulder or hip injury it should automatically be rated as loss to the body as a whole. However, remember, your state may vary somewhat . . . but you can ask for a copy of the statute on disability/impairment (they are the same thing) ratings.

I urge you to not let your claim be closed without addressing permanency unless you truly feel so fully healed that you can not imagine ever having the injury site give you any grief as far as being able to work. Disability is rated with regard to ability to work, not with regard to bowling, playing golf, or climbing mountains or skiiing! (I have had every question in the book asked of me regarding sports and activities that a claimant could no longer do.. . . but unless it is a work activity, your industrial injury is most likely not going to be responsible.)

You will not get rich from your permanent impairment rating and award. It likely will seem like a mere pittance for what you have been through, unless you have suffered a severe injury like amputation or a severe head or back injury, requiring major surgery or extensive rehabilitation. if your rating seems too low, ask the doctor to explain how the figure was determined. If the state arranged your independent/rating exam and it seems unfairly low, ask for a second opinion, with your own choice of doctor.

Carpal tunnel surgery never used to carry an impairment, as it was believed surgery restored 100% function, but that was changing when last I worked. Fractures of the arms, hands, legs and feet should be rated for impairment, as should back injuries with residual pain and/or loss of flexibility, even if you did not have surgery. Hearing loss always has impairment, as does loss of sight, taste, or any of your senses. I once paid impairment for a claim for loss of the sense of taste when the treatment for the injury caused the loss, even though the injury itself did not. I also paid out a huge claim on top of the work injury when a therapist treating the work injury dropped a patient and cause paralysis! (The additional costs for the second injury went to subrogation, meaning the therapist was responsible for everything over and above the initial injury . . . but it was messy, as the patient was not nearly to the end of her treatment when the therapist dropped her!)

(Speaking of subrogation, if a third party is responsible for your injury, they will have an interest in what is paid out on your claim. However, do not let them have undue influence over the claim, or push for closure, early end of treatment, or less treatment than necessary. And do not deal with them directly . . . your employer or the claims person is responsible for dealing with this.)

The best way to deal with your claims person is to be calm, reasonable, not angry or upset, and to educate yourself as best you can, as this will get their attention. The worst thing you can do is threaten, act like you are or have an attorney (your ability to talk directly with a claims person, and sometimes even your employer, about your claim, ends when you get an attorney), or indicate that you expect to "own the company" once your claim is settled. Believe me, I have heard it all where closure, money and punishing "bad" employers and their representatives are concerned.

I used to tell my claimants who asked up front if they would need an attorney on their case: "not if I do my job correctly." And then I would tell them if at any time they feel they can no longer get what they think they need from me or the system, then that is when they might want to speak to an attorney. Fees can range from flat-rate hourly with the clock ticking on every phone call, even the ones that are not returned (number one complaint about attorneys is that they do not return client calls on w/c claims) to anywhere from 20% to 30% and more, plus expenses/costs. Some of the best reasons to get an attorney are:
1. Your claim is denied and you truly had an on the job injury. Not an accident, but an bona fide injury. An attorney will know how to best present your case before whatever review board your state provides.
2. Your claim is only allowed for part of the injury and you or your doctor feel that your injury is greater than what was allowed.
3. You are refused benefits and you have been unable to protest them out of your claims person. Remember, every order issued to you is likely able to be protested in writing. Learn to write a decent and neat (with spell check) business letter. It is beeter then righting one that culd make them laff and not take yu seeriusly.
4. Your claim is closed before you have finished treatment. Your doctor should protest this, but if he doesn't convince them, you might need an attorney.
5. If, in your state, your employer/claims person has the right to dictate which doctor treats you, and this doctor is seriously downplaying your injury, an attorney might be needed.
6. If your claim is closed without a disability rating and your claims person disregards your second opinion doctor's rating. Attorneys love ratings cases because they know approximately how much money they will make and have to spend to get it.
7. You have not received all of your time loss/loss of earning power benefits and your examiner closes your claim. After you have submitted a protest with your calculations, if you still feel they owe you for lost time or lost income benefits, you may need to get an attorney. Included here would be if your time loss rate was not calculated accurately, or does not include shift premiums, overtime or bonuses in the calculation. However, these usually must be protested within a specified period after you have received an order for payment and calculation of benefits. Do not miss this deadline . . or any deadlines, for that matter. You will be left out in the cold!
8. Your employer does something that appears to be retaliatory for your filing a claim. e.g. Your employer fires you for filing a claim and ruining their perfect no-injury record, or they treat you differently when you return to work, like forcing you to take a job that pays less even if your job position is available, or move you to another shift when there is an opening on your regular shift. This is a fuzzy area in the law, which is why you should at least ask an attorney if you feel any kind of discrimination or retaliation, and especially if it is for filing an injury claim.

This list is incomplete and may not apply to all cases in all states. I have tried to provide a summary of ideas to help you educate and protect your rights when it comes to on-the-job injuries. Learn if and how to protest any actions you feel are not timely or done improperly. Learn to speak up and stand up for yourself. It will feel like work. . . but hey, you are getting paid something in the neighborhood of 2/3 of what you had been earning before you were injured. Get to work protecting yourself!!!
__________________

lefthanded
04-07-2012, 02:01 AM
Hello Lefthand...

This is my first time posting on this site, I'm hopeing you get this. I need some advise, don't know what to do or who to trust. I had an accident at work 18 months ago, fell and hit my head. I was taken to the hospital where I spent 2 days, then was released. The horrible symptoms started. Noiwse in my head, ringing, sensitivity to light,sound, headaches. Just felt like I was going crazy. I had to "beg" , "treaten", worker's comp to get me a doctor that there was something seriously wrong. That took 3 months. The neurologist they sent me to looked at me and said "she's just depressed", gave me Elavil and I went home and slept 15 hours a day for three months. When I went back to the WC Neurologist she took me off the medicfine and said there is nothing wrong with me, sent me back to work. I was stiull having "serious" symptoms, but living my life as an athlete, I went back to work. I have not had ONE day symptom free. Eight months later...I* couldn't take it any longer and went out of FMLA. I was fired two weeks prior to the three months ending. Yesterday I had a deposition, next week a mediation. I have had the Neuro Pyche testing done by two PHD's.One of them say I am suffering from a CLOSED HEAD INJURY, the other one says I'm exxagerating. I feel like I can't even trust my own attorney, believing that they only want to settle to collect their money. This is my life!! I'm not sure I'll ever be able to work again or be normal. Any advise would truley help???

I am not at all familiar with Florida's worker's compensation system. And I am very sorry I did not get back to you before your mediation. All I can do now is ask how it went.

Hybernating
04-07-2012, 09:04 AM
Lefthanded...I'm curious, were you disabled because of a head injury? I have a problem and am beginning to see it being a fight. Yesterday, I had my mediation. The employer never even made it into our room, I told my attorney "NO" to a settlement that would have been in the $7500.00 range. Accident was in 2010, fell, hitting my head. When I attended my first WC Neurologist appointent, the case manager went into the room with me.(I know now, not to let them in the room). Well, both the case manager and my self got thrown out of the doctors office that day, while I stand there begging for help. Evidently the doctor and case manager had issues from past patients, so then I get another appointment with the other doctor in the same office. I went in alone with him and he asked me 3 times what I was taking for pain, I told him Ibreprofin. He told me 3 times that if I were trying to get pregnant and taking Ibreprofin, that's not good. Mind you...I am presently having serious problems. I thougght maybe he had the wrong patient? I believe he was coming on to me and trying to find out if I was having sex with anyone?? So...I told him I wouldn't be coming back to see him again.
Now WC gets me a third doctor. I have gone to this doctor with some serious symptoms and eighteen months later she still insists there is nothing wrong with me and the only reason I am doing this is because I have a WC case.l have not been symptom free for ONE day since I hiy my head.
THe first WC report states in his impression that I am suffering from post concussion. He is correct!! The second doctor says nothing!! The third doctor absolutly says there is nothing wrong with me? I think this is a fraugulent, scaming, malpractice. I just want help and know how to protect myself for I am surely suffering. I live in Florida. Any advise...very appreciative.

ginnie
04-07-2012, 11:11 AM
Where do you live in Fla.? I do have a rep. in my area who works with these kinds of cases. Sounds like even another doctor opinion may be needed. ginnie

Jo*mar
04-07-2012, 11:31 AM
Lefthanded...I'm curious, were you disabled because of a head injury? I have a problem and am beginning to see it being a fight. Yesterday, I had my mediation. The employer never even made it into our room, I told my attorney "NO" to a settlement that would have been in the $7500.00 range. Accident was in 2010, fell, hitting my head. When I attended my first WC Neurologist appointent, the case manager went into the room with me.(I know now, not to let them in the room). Well, both the case manager and my self got thrown out of the doctors office that day, while I stand there begging for help. Evidently the doctor and case manager had issues from past patients, so then I get another appointment with the other doctor in the same office. I went in alone with him and he asked me 3 times what I was taking for pain, I told him Ibreprofin. He told me 3 times that if I were trying to get pregnant and taking Ibreprofin, that's not good. Mind you...I am presently having serious problems. I thougght maybe he had the wrong patient? I believe he was coming on to me and trying to find out if I was having sex with anyone?? So...I told him I wouldn't be coming back to see him again.
Now WC gets me a third doctor. I have gone to this doctor with some serious symptoms and eighteen months later she still insists there is nothing wrong with me and the only reason I am doing this is because I have a WC case.l have not been symptom free for ONE day since I hiy my head.
THe first WC report states in his impression that I am suffering from post concussion. He is correct!! The second doctor says nothing!! The third doctor absolutly says there is nothing wrong with me? I think this is a fraugulent, scaming, malpractice. I just want help and know how to protect myself for I am surely suffering. I live in Florida. Any advise...very appreciative.

Don't expect to get much medical help from the wc doctors, they are there to check up on you and mostly will be on the wc ins & employers side.

Do you have your own treating dr?
Do you have a wc atty on your side?
If you don't have a wc atty yet- interview & have a free consult with some good ones, then do some searches on them after you get home to see if good things are written on line or not.
Then choose one and let them help you with finding a good doctor/team for your claim.
Check thru the sticky threads at the top of this forum too.

Hybernating
04-07-2012, 12:25 PM
Against my attorneys...I didn't settle. I feel thata my attorneys will drop me next week, then I don't have a clue what to do next?



I am not at all familiar with Florida's worker's compensation system. And I am very sorry I did not get back to you before your mediation. All I can do now is ask how it went.

Jo*mar
04-07-2012, 01:51 PM
I certainly wouldn't settle a PCS/ TBI claim for such a small amount...:(:eek:

I got 35k for a chronic repetitive strain injury & didn't even have a good atty or
highly rated MDs.
Luckily I was recovering due to being off work and finding a good chiropractor as well a my own self care work.
So I wasn't in severe circumstances.

I'm sure with the slow economy every system like this is clamping down & getting backlogged.
So I suggest you read about changing atty before this old one dumps you. sounds like they are not up on head injuries and long term effects.

You need a dr that can state how this can be a long term thing and may affect you for years or more.

Do you have a doctor or 2 of your own to oversee your treatment now?
specialists?

Read on your state website in the work comp section, you may be able to get help from an ombudsman or find other help since wc is often state specific.

sticky threads-
http://neurotalk.psychcentral.com/thread124924.html
http://neurotalk.psychcentral.com/thread1117.html

Hybernating
04-10-2012, 05:10 PM
I would appreiate someone to help, I wouldn't mind talking with your friend.


Where do you live in Fla.? I do have a rep. in my area who works with these kinds of cases. Sounds like even another doctor opinion may be needed. ginnie

ginnie
04-10-2012, 07:31 PM
I can give you the name of the attorney office I went to, and or my doctors down this way. Ledger and Flynn is 2027 Manatee Ave. 748-5599. They have some really good reps. that deal only with SSD etc. I have several good doctors, no actually great doctors. Neuro, PCP and a pain specialist. Do you want their numbers? I would be glad to provide them to you. Also at this attorneys office they have several Reps, that all they do is litigate for disability. I saw two there, and both follow through the whole time my case was in the system. I was not let down by this office. Let me know if you want the docs. names etc, and even a councelor. I wish you all the best, I will be on line again tomorrow. ginnie

Hybernating
04-11-2012, 08:44 AM
Thank-you Ginnie. It usually takes me a while to figure out this forum (or at
least how it works), I am truely cognitively disabled. I do appreciate the help

and will give Ledger/Flynn a call to see if they will take my case.

Thank-you so much. How many months have you been healing? Any noticable
changes in your PTS symptoms?



I can give you the name of the attorney office I went to, and or my doctors down this way. Ledger and Flynn is 2027 Manatee Ave. 748-5599. They have some really good reps. that deal only with SSD etc. I have several good doctors, no actually great doctors. Neuro, PCP and a pain specialist. Do you want their numbers? I would be glad to provide them to you. Also at this attorneys office they have several Reps, that all they do is litigate for disability. I saw two there, and both follow through the whole time my case was in the system. I was not let down by this office. Let me know if you want the docs. names etc, and even a councelor. I wish you all the best, I will be on line again tomorrow. ginnie

ginnie
04-11-2012, 08:51 AM
You are doing fine in figuring out how to use the forum. It has been two years for me and I am still at it, learning how to navagate.

Mr. Benjamin is the name of the exact person who helped me with my case from Ledger and flinn. I had second spinal fusion C3-7 22 months ago and I am doing fine. I still take pain meds, but a really low dose.

Do you need reference to any doctors? Feel free to contact me any time. where are you living? keep in touch. ginnie

picobill
05-27-2012, 02:26 AM
Lefthanded, I can see from your posts that you really believe in the System, Sadly I cannot afford to evtend my belief that far, I must deal with the System as I see it.

For me the Workers Compensation System while it may have a grand history and for all of it's cutting edge care for the worker when it was implemented has now become outdated, outmoded, and an outright insult to the forward thinkers who framed it.
Additionally despite the propaganda disseminated by the Insurance companies the average American worker is not looking for a "Free Ride" from a system that at best will pay them 20% less than they were making while working! Make it 20% more and I could see people trying to scam the system but less? when most workers are jumping at any chance for overtime? No Way.

Today the biggest problem with WC is the Insurance Industry and their Bean counters... IE: Since we carry the cost of Attorneys on staff we might as well use them to save a buck or two.
The Insurance Industry's major commitment is to neither the Employer or the Employee, no it's to their Shareholders, and keeping costs down whether it hurts the worker or the employer is the main concern of the Insurance Company.
Plus, most employers (who's main commitment is to their shareholders) care less about the employee and more about their Insurance costs and if not poking their nose into the WC process will keep those premiums down why SEE NO EVIL!

The basic design of the WC system despite updates over the years contains flaws that ignore basic economics and the basis of our Judicial System.
Basic Economics - WC Benefits paid as a % of workers Take home pay.. on the surface it's fair, the worker has fewer costs and the benefit is tax free. Economic reality check.. With the withholding and tax laws many workers claim 0 dependents or even a minus number so they owe no income tax or even have a refund due.. factors that are not accounted for by the WC Law.

A Felon has better protection than an injured worker.. Why? Because He's INNOCENT UNTIL PROVEN GUILTY... Just One IME from a Dr CHOSEN by the INSURANCE Co. and the worker can have all benefits cut off pending a hearing... PENDING?? My Pain is not PENDING.. my bills are not PENDING.. But Hey it's a great incentive to get the worker to "settle" for any amount... Especially if the alternative could mean something like ohh I don't know DEATH maybe??
I mean if a workers injury put him on life support having those machines cut off for non-payment well that's what I'd call an incentive to settle!
OK over the top but really is reality much different? Lost income no food, no pain meds, OWW! if I hadn't had a fallback coverage for all the meds my CRPS has me on I'd have had to settle just to avoid the effects of withdrawal!
Sorry long as this post has taken me and much left unsaid but even with breaks my hands are on fire... positive side.. my PT for the day is done.. :) Please take no offense this is how I see the system. BTW I'm left handed too

Joy6
06-01-2012, 08:46 AM
Lefthanded, I can see from your posts that you really believe in the System, Sadly I cannot afford to evtend my belief that far, I must deal with the System as I see it.

For me the Workers Compensation System while it may have a grand history and for all of it's cutting edge care for the worker when it was implemented has now become outdated, outmoded, and an outright insult to the forward thinkers who framed it.
Additionally despite the propaganda disseminated by the Insurance companies the average American worker is not looking for a "Free Ride" from a system that at best will pay them 20% less than they were making while working! Make it 20% more and I could see people trying to scam the system but less? when most workers are jumping at any chance for overtime? No Way.

Today the biggest problem with WC is the Insurance Industry and their Bean counters... IE: Since we carry the cost of Attorneys on staff we might as well use them to save a buck or two.
The Insurance Industry's major commitment is to neither the Employer or the Employee, no it's to their Shareholders, and keeping costs down whether it hurts the worker or the employer is the main concern of the Insurance Company.
Plus, most employers (who's main commitment is to their shareholders) care less about the employee and more about their Insurance costs and if not poking their nose into the WC process will keep those premiums down why SEE NO EVIL!

The basic design of the WC system despite updates over the years contains flaws that ignore basic economics and the basis of our Judicial System.
Basic Economics - WC Benefits paid as a % of workers Take home pay.. on the surface it's fair, the worker has fewer costs and the benefit is tax free. Economic reality check.. With the withholding and tax laws many workers claim 0 dependents or even a minus number so they owe no income tax or even have a refund due.. factors that are not accounted for by the WC Law.

A Felon has better protection than an injured worker.. Why? Because He's INNOCENT UNTIL PROVEN GUILTY... Just One IME from a Dr CHOSEN by the INSURANCE Co. and the worker can have all benefits cut off pending a hearing... PENDING?? My Pain is not PENDING.. my bills are not PENDING.. But Hey it's a great incentive to get the worker to "settle" for any amount... Especially if the alternative could mean something like ohh I don't know DEATH maybe??
I mean if a workers injury put him on life support having those machines cut off for non-payment well that's what I'd call an incentive to settle!
OK over the top but really is reality much different? Lost income no food, no pain meds, OWW! if I hadn't had a fallback coverage for all the meds my CRPS has me on I'd have had to settle just to avoid the effects of withdrawal!
Sorry long as this post has taken me and much left unsaid but even with breaks my hands are on fire... positive side.. my PT for the day is done.. :) Please take no offense this is how I see the system. BTW I'm left handed too



Your post is so true and rings loud and clear for me right now. I pray that most workers do not get injured at work and have to deal with this broken broken system. Your so right our situations are NOT pending....its madness.

ginnie
06-01-2012, 12:00 PM
I read your post, waiting for a realtor. I got sick with NO insurance, as I had pre-existing condition. All two generations saved for, and tried to protect me with I was not allowed to keep to pay my taxes on my paid for home. Medicare/medicaid, granted NO benefits till all I had was gone. Now that these funds are gone, I cannot pay my property tax. I loose my home because I got sick. Section 8 here I come. I am sick over the whole insurance industry, no matter if it is WC or the other insurance for those who could not get insurance to begin with. The whole system is flawed, all insurance is flawed, and so many suffer because of this. I am sorry that these insurance issues exist at all, and that fairness doesn't even enter the picture. I am sorry for all of us who paid into a system, then get turned away for treatment to save our lives. If I had not used those funds to my medical benefit, I would not be here now. I would have died. Disability didn't really care about that part. I do not have answers, but I do have tears, and lots of them. I worked 30 years to be reduced to a begging, poor, person waiting for food stamps, and public housing. Is this the reward for a life time of doing my best, and others that do their best too? I pray alot, but it does not take away the facts of systems out whack with what really happens to people. I keep NT and the folks here in my prayers all the time, and will continue to do so. ginnie

lefthanded
06-01-2012, 09:21 PM
Lefthanded, I can see from your posts that you really believe in the System, Sadly I cannot afford to evtend my belief that far, I must deal with the System as I see it.

...

Sorry long as this post has taken me and much left unsaid but even with breaks my hands are on fire... positive side.. my PT for the day is done.. :) Please take no offense this is how I see the system. BTW I'm left handed too

I absolutely agree that the system is broken. It didn't break on its own, either. The original GOOD intents have been eroded in the same way worker's rights and union protections are being chipped away today. Same with healthcare. The problem is profits . . .

When I first became an adjuster in Iowa, we as claims adjusters had complete control. We chose the docs and we authorized the treatments and we paid the bills. We had the power to deny claims from our desks.

I always worked with self-insured clients, those who retained a huge "deductible" (usually between $10,000 -50,000) before the insurance company would get involved. Employers with that much power believe that claims should be handled as they see fit. Many times I got called on the carpet for putting injured worker's needs first. The pressure to deny, reduce, close claims prematurely was certainly a constant battle.

then along came "case management" ... almost always done by nurses and counselors employed by the insurance company, billing hours to the claims for "cost saving" measures . . . . which rarely if ever saved as much as they cost! But the profit from handling claims rose, because billable hours are billable hours . . . :(

The system is broken and yes, there are many claims people who just follow the company line. But there are many who actually would like to see injured workers treated for their injuries and compensated when they are left less than whole.

And I totally agree about IME's. I used to pick docs I would have agreed to see personally, but even then sometimes you get garbage. I also filed many complaints about IME's . . . even when doing so meant pissing off people I had to work with every day. I don't know when IME's started trumping AP's . . . that is a travesty unless a quack is providing the worker care in the first place.

But even with all that acknowledged, W/C is still better than nothing. Not having unrealistic expectations and knowing how the system can work is your best defense. One truth most injured workers tend to ignore is that your worker's compensation claim is not a guarantee that you will be good as new. Too often the anger I would face would be because the worker expected to be made 100% whole. PPD awards do not replace that wellness, but it is the best we can do. And no two bodies -- or injuries -- are identical.

I have watched as my own partner has been screwed by the system, regardless of what I have tried to do to help. Her COPD is from pre-existing asthma (never any prior history or diagnoses, ever, before working in a dusty environment); she can only file for temporary aggravations. The IME doc ignored her records . . . I was there! Currently we are fighting for PPD not awarded in a closed claim, when the medical report specifying a category rating was right in the closing medicals! The adjuster said she "must have missed it." Now we have to sue for it. What a crock. I hear ya.

The best advice I can give is keep great records of every incident, every thing that happens during your claim, and every conversation. Treat being a w/c claimant like it was a career. Learn your state's laws as best you can. And try to always be polite.

I violated that one one. I suggested an angry claimant might want to "park her attitude" when she was chewing me out for something another adjuster did before me on her claim. i was overheard and written up. I wanted to tell her to shove it, she was being so rude to me, so I thought "park it" was a milder way to slow down the discussion. I was wrong. I apologized. So did she. It goes both ways.

ginnie
06-02-2012, 07:55 AM
It is legler and Flynn, with Mr. Benjamin on Manatee avenue in Manatee county florida. 941-748-5599 . This gent stuck with my case, and did not give up. ginnie

ginnie
06-02-2012, 07:58 AM
I am late to some of the talk on the forums too. I also have a personal friend who is a phychologist that would talk to you on e-mail if you need help. Hope Mr. Benjamine can help you with your claim. The system is broken, of that I have no doubt. Just don't give up hope. ginnie

Holles
06-03-2012, 06:45 PM
I copied this to a thread of it's own - here-
http://neurotalk.psychcentral.com/showthread.php?t=170955


The doctor who first examined me for work comp (their pick) sent me to physical therapy. Great therapist but I saw him only once before work comp called & said I had to go somewhere else. Can they do that if it's someone their IME assigned? I have TOS & a cervical rib - first of all P/T isn't going to do much for that & 2nd it's rare - I seriously doubt the storefront outfit has even heard of it.

I live in Omaha, NE. If anyone knows of a good doc for TOS in the area, please let me know!

Many thanks,
Mary

happiedasiy
07-25-2012, 09:17 AM
I am new to nt
I am permanently 100% disabled due to work related injuries.
So I came here to see if there is any new information out there or if I can be of help to others.

ginnie
07-25-2012, 10:23 AM
Welcome to Neuro Talk. We need you! Many people come here looking for information and help. I can't tell you how many people there have been for direction, hope, some kind of support. NT needs good people all the time to pitch in and give folks a fighting chance. Thank you for coming here. You will meet alot of friend here too. I have stuck around for two years now, just love the site, and the people I have met. Again welcome, feel at home, hope I get to know you better in the near future. ginnie:D

megashark2015
12-05-2012, 06:14 PM
Hello,

I worked at the same company for 9 years with broken office chairs. I kept asking for new chairs, I brought it up at every staff meeting, submitted requests in writing, I was told it was being considered, but it never happened.

I was the supervisor of 3 people, one counselor was behind on her files, I asked her to get caught up before I went on vacation at the end of the week. Half hour later she came to me stating "I'm under too much pressure, so I went to the director to quit, and the director gave me a 2 week leave of absence." She then walked out and left me holding her 30 files that had to be closed out in 3 days.

I got to work on it, in my broken chair, I was under a great deal of stress, I was leaning forward, I felt a pop in my neck, then searing pain, then my left arm, left side of my face went numb and a spasm underneath my left eye started. I filed a workers comp claim (05/31/11).

I was very dedicated to my job, so when the Dr asked if I felt I could still work, I said I could, and have not received any disability payments.

My official diagnosis was: disc degeneration, stenosis, narrowing of the chord, were all aggravated by spraining my neck the date of injury. I received acupuncture, physical therapy, and when I was referred to a surgeon to discuss an epidural he said the only thing that would help is surgery (which I declined). That was in January 2012, I moved south (200 miles) and I never heard from workers comp again. I have been living with chronic pain since this all began, I have difficulty performing the work I once did. I planned to contact my claims adjuster to request medical treatment, but then I received a letter from her requesting that I see a QME. She stated I could still get treatment, but wants a QME. She approved me to see a physician about my injury, but insisted that I also pick a QME. I didn't know at the time that no new physician will see me if my QME is already scheduled, so I didn't get to see anyone about my searing pain, which seemed pretty wrong of my claims adjuster to mislead me like that. Anyways, she said my primary physician never gave her a final physicians report.

So I saw the QME Dr, as I was trying to tell him my story he kept his back to me and continued to cut me off. He seemed very much in a hurry to be done with me, and expressed the "inconvenience" of the appointment. He didn't have any of my MRI/XRAY's on hand (he noted in his report that he will re-evaluate if those are provided) and said he couldn't give a full evaluation without those. He had not reviewed any of my medical records so he actually asked me what I was there to see him for!

Today I recieved a copy of the report he sent to workers comp:
He states I had pre-existing degernation/arthritis/stenosis (non-industrial)
He states it was aggravated by a neck sprain (industrial)
He states I received adequate medical treatment (maximum medical improvement)
He states the extent of my injury is unlikely to be caused by leaning over.

He states I am
0% industrially disabled
100% non industrially disabled

What does this mean? Does it mean he is saying that my chronic neck pain wasn't caused my work injury? I never suffered from chronic pain until the day of my injury. I believe I have an occupational disease. Any feedback?

rmschaver
12-05-2012, 08:49 PM
The QME is saying your obvious damage is pre-existing not caused by a work injury. He is also saying the neck sprain is all the injury that occurred at work. Also you have reached what is known as max medical improvement, or medicine can not improve you anymore. As well as in his opinion that the injury could not have occurred by leaning over.

First keep in mind the QME works for the insurance company and has one goal. To manage cost, so of course he/she will try to minimize the case. Secondly you do not have to accept his opinion.

I also was injured at work 6/4/2012, my case is still open. I would recommend a few things. Get yourself a lawyer NOW. Every state has a time limit that you must consider when you have a work comp case. Learn as much as you can about the workers comp law in your state. Most libraries have a law library. Go there and ask for help, most librarians will be glad to help. DOCUMENT EVERYTHING including your own interactions with your lawyer.

Keep in mind there are different players involved. You, the employer, the work comp insurance company, lawyers and even the work comp commission. Each party has their own interest which may or may not be the same as your own at different times. One last thing and it is very important do not, DO NOT under any circumstance allow the nurse case manger from the insurance company to accompany you into the exam room. That person has no right or need to go into the exam room. They can and will get a report from every doctors appt you have.

If you have any questions private message me. I could go on for hours. Find yourself a GOOD doctor you trust don't let the work comp ins co pick one for you if you can do anything to stop that.

GarytheSnail
01-10-2013, 07:06 PM
The PTP I am going to right now has said he wished he had a patient who worked as a former "adjuster" or the "UR". He said if they had horrible pain he would love to prescribe them aspirin or something ineffective, to pay them back for all the nasty games insurance companies played with his patients.


I know he is kidding because my PTP has the biggest heart of all, thanks for posting your story and sharing your experience with us.













Jo55 said:




I understand, because even with my experience we were unable to get my partner's COPD claim allowed as an industrial injury. She had never exhibited any signs of asthma or lung issues, including she never had bronchitis or pneumonia in her entire life. However, after working a couple years at her new employer, following her period of unemployment during my surgeries and recovery, she developed bronchitis and pneumonia which was followed by asthma. Her place of work is an extremely dusty environment, which would be like working in a chalk factory where they grind the mineral into fine powder right there before forming it into the little sticks. (This is not what she does, but a spot-on analogy . . . I don't want to reveal her employer, as her claim is ongoing. She essentially works with the same materials, and comes home dust covered almost every day.)

She now uses two types of inhaler and takes oral meds as well as prednisone when it flares up. But the independent doctor said it was only an aggravation of her preexisting asthma and not brought on solely by the dust at work. We know that is bull, but even her own doc agreed! Short of hiring our own lab to to air sampling (Labor and Industries will only do this if they think they will find a toxic substance, but copious amounts of dust don't matter!) and pulmonologists to evaluate her complete medical history, which we would have to ay for, and hire and attorney, we were sunk.

So I understand the challenge of, say, TOS which is either caused by repetitive movements at work, CTS, which is both work related and can come on in mid-life and later without work aggravation, back issues, etc. I have handled them all. The sad part is if the employer is self-insured, in many states they can be, they are usually more responsive to these kinds of claims and injuries. I know her claim had better chances of being an ongoing, work-caused claim if her employer had been self-insured. The state might have practically forced them to accept it, but the state operates here by complete different standards. I find this reprehensible, ad two people, one who works at employer A (state fund) and the other at employer B (self-insured) get completely different handling of their claims. i wish I had the power to work to stop this. . . .


The best advice I can give is that you never want to rely on anyone handling your claim. This is not about trust so much as being able to manage your claim as much as possible. This means you find a doctor who will support your claim, (or give you a good, clear explanation why it might not be covered.) However, if if it is not found caused by work, you might still be able to say the aggravation was caused by work. Then this is where you will have to direct all of your efforts, to prove that work is making your condition worse or not allowing it to get better.

I am sorry that there are health issues that are either caused, aggravated by, or arise during one's work life that are not found covered under worker's compensation. The program initially was set up to cover accidents, and over the years has evolved to cover other illnesses, like black lung, etc. Even today attorneys advertise for clients for some of the difficult lung issues, which indicates to me that workers still have an uphill battle proving work caused their illnesses.

That said, each and every person here with a difficult diagnosis, and a correspondingly difficult workers compensation issue, would need an individual evaluation of the situation. This is because, as I have said, every state's laws are different, and every employment is different, and every worker's physiology is different.


The steps I would take to approach filing a claim for TOS (I have handled several that were covered back in Iowa) or other repetitive injuries, would be:

1. File the claim with an onset date when you first noticed symptoms. If the statue has passed it is likely you may only get an aggravation claim with a more recent date date.

2. Gather all the medical history on yourself that you can to show you were never seen or treated for this condition before your work for this employer. If it began with a former employer, but continues to be aggravated by the current one, you may have to file against both.

3. Gather job descriptions from each task you perform (or performed, if a prior employer), with specific details as to the physical requirements and the amounts of the repetitive activities you do that you believe caused the condition.

4. Get medical testing that defines the nature of your conditions. I believe TOS requires some kind of Doppler exam, as well as x-rays or other means of pinpointing where the impingment is.

5. If the claim is denied, I believe it may be in your best interest to hire a good attorney who specializes in the condition you are filing for. Hiring a friend or you own personal attorney is a waste of time, and if the attorney you do hire finks out on you, fire them and look elsewhere. We have experienced this personally, with an attorney who held our file for review right u to the deadline then declined to take the case. Gr-r-r-r!

I know the above sounds like something the claims person should do. . . but they have been known to include only that which will support their position, and sometimes doctors even leave out incriminating information. Record will cost you, but it is often worth it.

The hardest thing for me to say is that it is always possible that the facts and records and symptoms simply do not compute to enough convincing evidence of an allowable claim no matter what you do. TOS, CTS, and many spinal issues carry that "normal aging" curve with them, that medical "don't know the cause" reputation, and are resisted as work related with great frequency.

The "system" was originally set up to allow filing of legitimate work injury, but over time it has been fraught with the reputation of being rife with fraud, unfairly hard on the employer (I say, what about the worker's bodies?), and an expense that must be reduced or controlled by any means possible. The ergonomics laws passed in the 90's have been so watered down or eliminated by disuse that we do not see the workplace evaluations of potential injuries that were intended to come out of the legislation.

Another factor that doesn't help is the political climate we live in. I believe beginning with the onset of big breaks to industry when they began whining about profitability, we saw a steady decline in their responsibility to the workers of America. We are back to being machines parts, expendable and replaceable. Rare is the employer who truly cares, and whose corporate structure includes safety and prevention on a large and honest scale. Most do it to front the impression that they are complying with any applicable laws. Hopefully we will see a change in this as the political climate warms under a new administration.

Imagine how universal healthcare might alleviate this. At least the treatment part. I envy workers in some European countries whose employers insist on taking care of their employees. I am afraid with our influx of workers willing to undercut everything in our system -- wages, living standard, working conditions -- we do face an uphill battle.

I will do what I can to help. W/C is not cut and dried. Being an examiner has some horrible stressors attached to the salary: we had to close claims to get paid for our work, we had a greater workload than we could handle (and we had them by client, and I had some of the tougher clients), there was constant pressure by the clients(employers) to reduce costs, and every one of our files had to be highly detailed and in perfect order (a full-time job in itself), and we were expected to sit in b.s. meeting that were no more than marketing for our service providers (nurses, vocational counselors, attorneys). In an 8 hour day were we supposed to review all diaried files, return all phone calls, monitor all medical and legal aspects, make sure all checks were issued (very important) and file an endless stream of paperwork with the state or suffer penalties. In addition, some phone calls would take much longer than average, and we were always ridden to cut them short. However it was my philosophy that if I explained claim issues to a claimant and listened to their frustrations, I could help avoid issues by increasing communication. Think so? Heck no . . , I was always under scrutiny for spending a little time with a hurt worker rather than giving quick replies and hanging up!



Enough about why claims are frustrating and why your claims person is not warm and fuzzy all the time. Enough about the reality of claims. If anyone has a question I will do my best to help you find some answers. . . . .

mphillips
02-24-2013, 04:29 PM
I wanted to ask I have a workmans comp claim in Tennessee I have had rotator cuff surgery and carpal tunnel surgery it has been a year and a half on the rotator cuff and almost a year on the carpal tunnel doctor released me said nothing else could be done, got a second doctor and he told me that my shoulder never healed, my problem is that after doctor released me I quit my job because hours were cut and was not making the money I made before now I have to have surgery again will I still get the weekly benefits for being off if I had surgery have not settled my case yet.

lefthanded
03-29-2013, 11:30 AM
I wanted to ask I have a workmans comp claim in Tennessee I have had rotator cuff surgery and carpal tunnel surgery it has been a year and a half on the rotator cuff and almost a year on the carpal tunnel doctor released me said nothing else could be done, got a second doctor and he told me that my shoulder never healed, my problem is that after doctor released me I quit my job because hours were cut and was not making the money I made before now I have to have surgery again will I still get the weekly benefits for being off if I had surgery have not settled my case yet.


That is a question best asked of your claims examiner.

Lonely_5555
08-11-2013, 11:53 PM
I've had 2 EMG tests and both came back negative for carpal tunnel from my last 2 previous doctors. However, My right hand feels numb and tingling very bad theref I decided to
Go to different orthopedic doctor (diplomate American Board of Orthopaedic Surgery and he is also fellow American academy of Orthopaedic Surgeons) to get the 3rd opinion.
The EMG test still came out negative but this doctor wrote me a report confirmed that I has Carpal Tunnel syndrome, it is worked- related.
Do you think the w/c will accept my case without any possitive test beside just my doctor report.
Please give me advise.
Thank you so much.

lefthanded
08-17-2013, 05:29 PM
I've had 2 EMG tests and both came back negative for carpal tunnel from my last 2 previous doctors. However, My right hand feels numb and tingling very bad theref I decided to
Go to different orthopedic doctor (diplomate American Board of Orthopaedic Surgery and he is also fellow American academy of Orthopaedic Surgeons) to get the 3rd opinion.
The EMG test still came out negative but this doctor wrote me a report confirmed that I has Carpal Tunnel syndrome, it is worked- related.
Do you think the w/c will accept my case without any possitive test beside just my doctor report.
Please give me advise.
Thank you so much.

I read your other post. Have you seen a neurologist? Had an MRI head & neck? Also you may want to ask for a job analysis from your employer, to see if your duties support your claim for repetitive injury. The negative tests are a bit of a hindrance, though. Industrial insurance really relies on medical tests a lot to make determinations of allowance and disability.

Do you have any other ares of numbness?

achingback
09-07-2013, 06:31 PM
I was involved in an auto accident while at work. Someone ran into the back of the vehicle I was driving. Two days later my back started hurting and I informed my employer I asked if I could see my own doctor and got told I had to see the workers comp doctors. Well the medicine they put me on did nothing for the pain and I told them. The second medicine they gave me only made me feel like I was high and still in pain. My arms started shaking badly after the 3rd day on that medicine. The workers comp doctors said I could return to work under restrictions. So I am at work...High...IN PAIN...and shaking...I want to see my own doctor. I live in North Carolina.

lefthanded
09-08-2013, 08:52 AM
I was involved in an auto accident while at work. Someone ran into the back of the vehicle I was driving. Two days later my back started hurting and I informed my employer I asked if I could see my own doctor and got told I had to see the workers comp doctors. Well the medicine they put me on did nothing for the pain and I told them. The second medicine they gave me only made me feel like I was high and still in pain. My arms started shaking badly after the 3rd day on that medicine. The workers comp doctors said I could return to work under restrictions. So I am at work...High...IN PAIN...and shaking...I want to see my own doctor. I live in North Carolina.

First of all, get to know your rights under NC comp law: Link (http://www.ic.nc.gov/ncic/pages/statute/97-25.htm)

I have to state I have never seen NC law before and it is rather different form anything I have seen before. Apparently there is a procedure for seeking treatment with a doctor of your own choosing. I would press for that immediately. However, your comp laws are heavily pro-employer, it appears, from this wording:

(c) Provided, however, if the employee so desires, an injured employee may select a health care provider of the employee's own choosing to attend, prescribe, and assume the care and charge of the employee's case subject to the approval of the Industrial Commission. In addition, in case of a controversy arising between the employer and the employee, the Industrial Commission may order necessary treatment. In order for the Commission to grant an employee's request to change treatment or health care provider, the employee must show by a preponderance of the evidence that the change is reasonably necessary to effect a cure, provide relief, or lessen the period of disability. When deciding whether to grant an employee's request to change treatment or health care provider, the Commission may disregard or give less weight to the opinion of a health care provider from whom the employee sought evaluation, diagnosis, or treatment before the employee first requested authorization in writing from the employer, insurer, or Commission.

Also know you have a right to seek damages from the party that caused the accident, and your employer probably also has a right to recover their claim costs from that third party as well.

And you can always contact an attorney if you are not getting the treatment you need to heal from your injury, and your employer is not cooperating.

I wish you good luck.

ginnie
09-08-2013, 09:14 AM
I have a friend in SNY who is having some of the same issues you are. The WC program he had, sent him to a doctor who I believe to be a quack. He was on the employers side. He has been denied surgery that his main doctor wants him to have. He now has a lawyer and has to appeal it. In the mean time he is in pain as you are. I find it disturbing, that a person can work for a company, and that if you are injured or sick, that company decides your medical care. Something is wrong with that picture. I hope you get the help you need. ginnie:hug:

lefthanded
09-11-2013, 12:58 PM
I have seen instances where an injured worker has gone ahead with the surgery and then when their claim was finally allowed, they or their insurance company were reimbursed. However, this has been over a decade ago, and I am not sure if laws have changed since then.

I always recommend getting the treatment you need and fighting the legal battles later. Easier said than done, however, if you do not have health insurance, or if they won't cover it.

Joepublic
10-25-2013, 06:01 PM
I was injured in an auto accident, their fault, just over a year ago. After getting chirp, or, and suffering for months, I requested an mri, which lni denied. They got an ime to say I only had subjective complaints of pain after additional months of treatment. They closed my claim. I am currently preparing pi case with attorney. Just went and had an mri on my personal insurance that found issues. Can I hold lni liable for turning the request down 10 months ago. I have them in writing talking down to me when I appealed the close of my claim saying my complaints were subjective. Also, my if I reopened my claim would time loss be computed at the same rates as the initial calculation. I now making less money with the same employer.

Joepublic
10-26-2013, 11:54 AM
I was injured in an auto accident, their fault, just over a year ago. After getting chirp, or, and suffering for months, I requested an mri, which lni denied. They got an ime to say I only had subjective complaints of pain after additional months of treatment. They closed my claim. I am currently preparing pi case with attorney. Just went and had an mri on my personal insurance that found issues. Can I hold lni liable for turning the request down 10 months ago. I have them in writing talking down to me when I appealed the close of my claim saying my complaints were subjective. Also, my if I reopened my claim would time loss be computed at the same rates as the initial calculation. I now making less money with the same employer.

sorry physical therapy and chiro, and suffering for months...

lefthanded
10-27-2013, 06:28 PM
I was injured in an auto accident, their fault, just over a year ago. After getting chirp, or, and suffering for months, I requested an mri, which lni denied. They got an ime to say I only had subjective complaints of pain after additional months of treatment. They closed my claim. I am currently preparing pi case with attorney. Just went and had an mri on my personal insurance that found issues. Can I hold lni liable for turning the request down 10 months ago. I have them in writing talking down to me when I appealed the close of my claim saying my complaints were subjective. Also, my if I reopened my claim would time loss be computed at the same rates as the initial calculation. I now making less money with the same employer.

You don't say what state you are in, and reopening or challenging claim closure is different state-to-state. Your attorney would be better able to answer that question. The states I worked in the TTD rate was based on wages at the time of injury, however it may be different in some states or it may have been changed since I was a claims examiner. Best to ask your attorney.

jbcodora
11-22-2013, 03:10 AM
I have talked with you on the forum previously, 1x when they tried forcing me MmI which was rightfully thrown out, and another time when the applied to stop temporary total, also rightfully thrown out. Well I'm still off 2 years exactly later, and financially we are a mess, especially since we had just had our first child when I got injured, and now she is pregnant again. I have a few questions I hope you can shed light on. Oh and I'm in Ohio

1) since I have been off so long I am no longer covered on my companies inaurace plan, and more importantly more 2 year does not have insurance. If I apply for myself could it effect my benefits? If so I just apply for my son, and by apply I mean for Medicaid through Job and family services.
A). Since we aren't married she wasn't covered so she has to go to job family services and get medical for her pregnancy, so I'm hoping they will cover my son as well!! While she is there she will apply for food stamps for the period of the pregnancy, if I apply wht her we would get $100 more a month, but will that effect my TTD pay weekly? I know each time my dr extends my time off work the paper I fill out it ask if I recieved public assistance.
B). Will applying for HEAP, the electric bill help through state, could that effect my TTD pay? Prior to injury I brought home between $950 and $1500 a week now I make $665 a week, so we not only have gotten behind we are in last place.

2) through my job I had 3 weeks paid vacation per year, since my dr took me off work I have lost a total of 7 weeks paid vacation, does workers comp let injured workers apply for compensation of that lost income? Since my vaca pay is my yearly average my pay of Those lost weeks would be at the same rate of $665 a week.

3) my injury was bc of a sofa which was standing up on its side and that weighed between 350-450 pounds fell over and hit me in the back and took me to ground while landing ontop of me. It happened on the back loading dock which in the state of ohio is suppose to be pressure treated with a grip friendly non slip surface, it never had been still. Should I apply for VSSR award! Certainly unsafe work conditions since it's Oshaa Requited, and had it not been a slick surface and treated properly I may not have gone to the ground which then would of luckily resulted in less seriously life long issues I am dealing with now!

Any advice on those issue you can give will be appreciated!!

lefthanded
11-22-2013, 11:46 PM
I have talked with you on the forum previously, 1x when they tried forcing me MmI which was rightfully thrown out, and another time when the applied to stop temporary total, also rightfully thrown out. Well I'm still off 2 years exactly later, and financially we are a mess, especially since we had just had our first child when I got injured, and now she is pregnant again. I have a few questions I hope you can shed light on. Oh and I'm in Ohio

1) since I have been off so long I am no longer covered on my companies inaurace plan, and more importantly more 2 year does not have insurance. If I apply for myself could it effect my benefits? If so I just apply for my son, and by apply I mean for Medicaid through Job and family services.
A). Since we aren't married she wasn't covered so she has to go to job family services and get medical for her pregnancy, so I'm hoping they will cover my son as well!! While she is there she will apply for food stamps for the period of the pregnancy, if I apply wht her we would get $100 more a month, but will that effect my TTD pay weekly? I know each time my dr extends my time off work the paper I fill out it ask if I recieved public assistance.
B). Will applying for HEAP, the electric bill help through state, could that effect my TTD pay? Prior to injury I brought home between $950 and $1500 a week now I make $665 a week, so we not only have gotten behind we are in last place.

2) through my job I had 3 weeks paid vacation per year, since my dr took me off work I have lost a total of 7 weeks paid vacation, does workers comp let injured workers apply for compensation of that lost income? Since my vaca pay is my yearly average my pay of Those lost weeks would be at the same rate of $665 a week.

3) my injury was bc of a sofa which was standing up on its side and that weighed between 350-450 pounds fell over and hit me in the back and took me to ground while landing ontop of me. It happened on the back loading dock which in the state of ohio is suppose to be pressure treated with a grip friendly non slip surface, it never had been still. Should I apply for VSSR award! Certainly unsafe work conditions since it's Oshaa Requited, and had it not been a slick surface and treated properly I may not have gone to the ground which then would of luckily resulted in less seriously life long issues I am dealing with now!

Any advice on those issue you can give will be appreciated!!

?

I do not know Ohio comp law. Any questions that concern your Ohio w/c benefits should be directed to your claims handler, or if you have an attorney, to your attorney. But I do know that w/c is usually calculated based on your time of injury wages, which usually include vacations, bonuses, etc. averaged and calculated by a formula set by each state.

I don't see why applying for insurance coverage would affect your comp. I am not in a position or qualified to suggest what kinds of insurance you might qualify for. You will need to turn to Ohio resources for that.

I am not sure how any state benefits (food stamps, heat assistance) would affect your comp benefits. And your marital status may nor may not make this a more complex question . . . I don't know. As a claims examiner, I had the responsibility of making sure the claim was handled within the law, that benefits got paid on time and that medical bills were paid. I also had to monitor the medical treatment to make sure it was proper, that the records supported the treatment, and to catch any problems as soon as possible (like the possible need for consultations, etc.) And all the while I was being pressured to save money for our client (the employer) and to close the claim (my employer, because that is how they got paid) . . . I was trying to be a kind, helpful and understanding as I could with my injured workers. But as a claims person, my job was work comp . . . not state benefits, insurance questions, and financial issues that were inevitable in many injury situations. So, as I have said, your claims manager is the one to ask many of these questions because they are the one who would be making the decisions if your benefits are affected.

I have no idea what a VSSR award is. No state I have ever worked in awarded employees anything even in the case of employer fault, as all the comp laws I have had to adjudicate were no-fault. This must be an Ohio thing, and I am not qualified to venture a guess about it.

I am sorry, but to most of your questions I have to confess . . . I don't know.

jbcodora
11-23-2013, 01:25 AM
?

I do not know Ohio comp law. Any questions that concern your Ohio w/c benefits should be directed to your claims handler, or if you have an attorney, to your attorney. But I do know that w/c is usually calculated based on your time of injury wages, which usually include vacations, bonuses, etc. averaged and calculated by a formula set by each state.

I don't see why applying for insurance coverage would affect your comp. I am not in a position or qualified to suggest what kinds of insurance you might qualify for. You will need to turn to Ohio resources for that.

I am not sure how any state benefits (food stamps, heat assistance) would affect your comp benefits. And your marital status may nor may not make this a more complex question . . . I don't know. As a claims examiner, I had the responsibility of making sure the claim was handled within the law, that benefits got paid on time and that medical bills were paid. I also had to monitor the medical treatment to make sure it was proper, that the records supported the treatment, and to catch any problems as soon as possible (like the possible need for consultations, etc.) And all the while I was being pressured to save money for our client (the employer) and to close the claim (my employer, because that is how they got paid) . . . I was trying to be a kind, helpful and understanding as I could with my injured workers. But as a claims person, my job was work comp . . . not state benefits, insurance questions, and financial issues that were inevitable in many injury situations. So, as I have said, your claims manager is the one to ask many of these questions because they are the one who would be making the decisions if your benefits are affected.

I have no idea what a VSSR award is. No state I have ever worked in awarded employees anything even in the case of employer fault, as all the comp laws I have had to adjudicate were no-fault. This must be an Ohio thing, and I am not qualified to venture a guess about it.

I am sorry, but to most of your questions I have to confess . . . I don't know.


Thats ok, i appreciate you taking the time to read it regardless. I was up late stressing out about both BWC and trying to figure out how all the insurance stuff will work. I know she will get it, and if i cant so be it, but my son is almost 3 and needs it. I actualky thought they couldnt kick a child off whike still 'employeed'

The VSSR is basically a violation of a Specific Safety Regulation. I know that oshaa requires any loading docks or docks inwbich employees work that are outside be treated safely, wether that means roughing the cement so it grips or using apoxy spray. Ours is smooth like cement so a person could spit and its slick. Its slick when it is dry, and i know it is a safety Violation bc my regional manager broufht it up numerous times. But since my injury happened there, well anywy yeah i have be spending as much time as i can reaearching it, but information from the source is often confusing to read thru plus since the internet is overloaded with both bad info that makes it harder. Im just beyond ready to put this behind me and finalky wake yo from this horrible nigjtmare that both my employeer and Ohio BWC put me in!! This has seriously effected ecery part of my life, im fat now bc i cant workout or do much of anything anymore. I can hardly carry my almost 3 year old son and if i do i pay for it for days, i have days i can hardly move im in so much pain, other days i dont want to move or do anything bc now im starting to have depression from probably a mixture of the financial stress i have plus the fact i cant do the things i want to with my son and me putting on weight i dont want to go out into public family memever tbink i have antisocial issues now. Everytime i make improvement in either location injured that day(neck and lower back) sometbing happens, exple last oct i had a epidural pain block done in my lower back then a few months of traction therapy and then another 10-12 visits working on stretchkng and stregnthening. I was starting to feel 1 my posture getting better, i was walking with less of a limp, pain was a little more tolerable, the lower back was improving!! So i ran out of Physical therapy apts approved so like they do they put in paper work to extend more appoints, keep in mind my therapist was sure to document that i was gaining ground and improving, and of course they denied ext. so sincecthen my back went back to what it was and im so misserble again, the little confidence i gained back is gone, and my depression is worse. I probably should try to get on meds and or talk to someone about it, but my employer who i have worked for, for over 7 years pulled my insuracne lol, WHY COULDNT I HAVE BEEN IN A CAR WRECK AND OBTAINED THESE INJURIES? Atleast then i wouldnt be at the mercy or a handful of other people!! I think the worst part of all this is going to family functions, both my family and hers, and people asking if im back to work, Nope. Rather embarrassing, even though i know they know im a genuinly injured person it sucks. My boss acts like i went out of my way to shop for a dr, even Workers comp tried saying that, but the funny thing about that is the dr who took me off work and still sees me was the Dr my employeer took me to, so yeah.

jbcodora
11-23-2013, 01:39 AM
?

I do not know Ohio comp law. Any questions that concern your Ohio w/c benefits should be directed to your claims handler, or if you have an attorney, to your attorney. But I do know that w/c is usually calculated based on your time of injury wages, which usually include vacations, bonuses, etc. averaged and calculated by a formula set by each state.

I don't see why applying for insurance coverage would affect your comp. I am not in a position or qualified to suggest what kinds of insurance you might qualify for. You will need to turn to Ohio resources for that.

I am not sure how any state benefits (food stamps, heat assistance) would affect your comp benefits. And your marital status may nor may not make this a more complex question . . . I don't know. As a claims examiner, I had the responsibility of making sure the claim was handled within the law, that benefits got paid on time and that medical bills were paid. I also had to monitor the medical treatment to make sure it was proper, that the records supported the treatment, and to catch any problems as soon as possible (like the possible need for consultations, etc.) And all the while I was being pressured to save money for our client (the employer) and to close the claim (my employer, because that is how they got paid) . . . I was trying to be a kind, helpful and understanding as I could with my injured workers. But as a claims person, my job was work comp . . . not state benefits, insurance questions, and financial issues that were inevitable in many injury situations. So, as I have said, your claims manager is the one to ask many of these questions because they are the one who would be making the decisions if your benefits are affected.

I have no idea what a VSSR award is. No state I have ever worked in awarded employees anything even in the case of employer fault, as all the comp laws I have had to adjudicate were no-fault. This must be an Ohio thing, and I am not qualified to venture a guess about it.

I am sorry, but to most of your questions I have to confess . . . I don't know.


Also i asked abouf the vacation time bc at the time i was imjured i still had 2 weeks i hadnt used, therefore I just started wonder if the value of those weeks should of been added to my claim. Like i said i had 2 left but got 3 a year, so not only have i started wondering if they migjt owe me back pay for that, what about the 2 years i have been off, had i been working thats 6 weeks fully paid vacations,

808_Warrior
06-04-2014, 05:38 AM
Aloha Lefthanded,

I'm from Hawaii and have a few questions I'm hoping you might have answers to. I was injured on the job doing construction work about two years ago. I sustained serious injuries to my head, shoulder, chest, ribs, cervical and lumbar. I'm still fighting for injuries to my thoracic which the insurance said was not caused by the industrial accident. Anyway the insurance is trying to wrap up my claim prematurely even though my doctors have said I'm "certainly at risk" for surgery to my neck, low back and shoulder. I had an IME two months ago but the insurance is obviously not satisfied with the doctor's ratings and recommendations for treatment. Today I found out they want me to go to another IME next month. I know what's gonna happen. That insurance picked doctor will counter all the recommendations/ratings of my previous IME doctor and probably say things like I'm 100% MMI and no longer at risk for surgery and no further treatment is necessary. This will hurt my worker's comp claim badly because my claim is already complicated. If I refuse to attend the second IME the Department of Labor will suspend my TTD and medical benefits. My lawyer is encouraging me to close out my medical and do a global settlement. I am totally against it. I wanted to know if my lawyer gets a cut if I close out my medical? From other stories I read, seems like lawyers encourage this practice even when their client may require future surgeries and ongoing medical treatment. My other questions is do you know if your PPD rating drops by 15% if your employer kept you on modified duty after the work related injury? I look forward to your response. Mahalo!

808_Warrior

lefthanded
06-04-2014, 02:03 PM
Aloha Lefthanded,

I'm from Hawaii and have a few questions I'm hoping you might have answers to. I was injured on the job doing construction work about two years ago. I sustained serious injuries to my head, shoulder, chest, ribs, cervical and lumbar. I'm still fighting for injuries to my thoracic which the insurance said was not caused by the industrial accident. Anyway the insurance is trying to wrap up my claim prematurely even though my doctors have said I'm "certainly at risk" for surgery to my neck, low back and shoulder. I had an IME two months ago but the insurance is obviously not satisfied with the doctor's ratings and recommendations for treatment. Today I found out they want me to go to another IME next month. I know what's gonna happen. That insurance picked doctor will counter all the recommendations/ratings of my previous IME doctor and probably say things like I'm 100% MMI and no longer at risk for surgery and no further treatment is necessary. This will hurt my worker's comp claim badly because my claim is already complicated. If I refuse to attend the second IME the Department of Labor will suspend my TTD and medical benefits. My lawyer is encouraging me to close out my medical and do a global settlement. I am totally against it. I wanted to know if my lawyer gets a cut if I close out my medical? From other stories I read, seems like lawyers encourage this practice even when their client may require future surgeries and ongoing medical treatment. My other questions is do you know if your PPD rating drops by 15% if your employer kept you on modified duty after the work related injury? I look forward to your response. Mahalo!

808_Warrior

Let me start first with your PPD question. PPD is determined from an objective exam to include measuring certain things such as range of motion, strength, the need for related surgeries for the injury, etc. It also includes medical findings on MRI's, X-rays, etc. Nowhere in the medical exam book does it instruct physicians doing the rating to take into account things like light duty worked. This is my experience, which is over tens years in the past, I must add. But I don't think that your light duty should affect it at all. Oh, by the way, pain is included, but not in the sense of pain and suffering, but medical evidence of limiting pain.

As far as Hawaii comp and what is your best avenue, I would have a hard time commenting with any certainty. Unless the settlement is huge enough to cover future surgeries, however, I would would feel as you do, that I don't want to shoulder that cost on my own sometime down the road. I would ask your A/P or attorney if you could also request a second opinion or surgical consult from a doctor you both trust, but remember that often after rendering such an opinion a physician may not want to actually be the one to do the surgery. I think I would push for open medical if you are pushed to settle, if that is an option.

808_Warrior
06-30-2014, 04:11 AM
Aloha Lefthanded,

I got some rating information like for example 10% whole person impairment for the DRE Category III lumbar condition and would like to know if you know how much that comes out to approximately in dollar signs. Also if you could provide me any links to websites where I might be able to research that information I would appreciate it. Mahalo!

lefthanded
07-02-2014, 01:37 AM
Aloha Lefthanded,

I got some rating information like for example 10% whole person impairment for the DRE Category III lumbar condition and would like to know if you know how much that comes out to approximately in dollar signs. Also if you could provide me any links to websites where I might be able to research that information I would appreciate it. Mahalo!

Google "Hawaii industrial insurance PPD tables" . . . I have no idea what that would yield. Some states have a flat rate for the %, and some use your TTD rate and multiplier to figure it out. Every state is different. It would be easier to just call your claims examiner and ask, however.

Also, I am not familiar with Hawaii comp, but I would also ask if you could reopen the claim if your condition worsens sufficiently to require further treatment. In that case a full and final settlement may not be the best option, if you actually have options.

Sorry, I really don't know your state's laws. heck, my own state's laws have changed int he 12 years since i worked in comp!

kainegaroo
09-16-2014, 02:21 PM
Dear left handed,

I am so confused. I have dealing with w/c for over a year now. I was injured when my boss dropped a 200lb heater on my arm and it broke in 3 places work said I only had a sprained wrist I worked everyday and 4 months later I/c finally approved me to go to an ortho doc who saw the damage in my mri that was done 2 months out and said I need surgery. I/c canceled the first surgery saying why did I need surgery when I only had a sprained wrist I told them my arm was hurt the whole time and going 5 months till the first surgery my bones don't even line up correctly.first surgery failed and the second one I think failed but they wont give me another MRI. went to the doc yesterday he said I am done and I have to get a FCE. the thing is my are in at-30-35degress from being strait I have numbness on one side of my arm and 2 of my fingers are numb. I am still on no left hand use from the doc. my questions are : what is the purpose of a FCE what do the results mean to the I/c. My doc said I will not be able to work in the field I do what will happen with that will I get fired? I went to school for computers and now with two fingers that are numb no one will hire me what can i do about that? I am 34 and live in Indiana. thank you in advance.

Kitt
09-16-2014, 03:37 PM
Welcome kainegaroo. :Wave-Hello:

Someone will be along to help.

kainegaroo
09-16-2014, 09:30 PM
thanks kitt I look forward to it :)
Welcome kainegaroo. :Wave-Hello:

Someone will be along to help.

lefthanded
09-20-2014, 01:01 PM
Dear left handed,

I am so confused. I have dealing with w/c for over a year now. I was injured when my boss dropped a 200lb heater on my arm and it broke in 3 places work said I only had a sprained wrist I worked everyday and 4 months later I/c finally approved me to go to an ortho doc who saw the damage in my mri that was done 2 months out and said I need surgery. I/c canceled the first surgery saying why did I need surgery when I only had a sprained wrist I told them my arm was hurt the whole time and going 5 months till the first surgery my bones don't even line up correctly.first surgery failed and the second one I think failed but they wont give me another MRI. went to the doc yesterday he said I am done and I have to get a FCE. the thing is my are in at-30-35degress from being strait I have numbness on one side of my arm and 2 of my fingers are numb. I am still on no left hand use from the doc. my questions are : what is the purpose of a FCE what do the results mean to the I/c. My doc said I will not be able to work in the field I do what will happen with that will I get fired? I went to school for computers and now with two fingers that are numb no one will hire me what can i do about that? I am 34 and live in Indiana. thank you in advance.
First, what is I/c? I am not familiar with that abbreviation.

Have you contacted an attorney yet? You sound like the kind of case that might need one. I am sorry, but my expertise has been fading lately, as I have learned that work comp laws in many states have become less about the worker and more about the employer . .. not good. And since I have not even kept up with the local laws, and never did know the laws of each state (Indiana included) I am afraid I don't know how yours works. It sounds like your employer had lots of pull. An accident like that should have put you in an ER immediately, and an ortho-surgeon's office pronto. I think I owuld be finding the best attorney you can. Unfortunately an attorney can't fix the physical damage that has been done by delaying your treatment, but hopefully can help with your other issues.

An FCE is a functional capacity evaluation, to see what you can and can't do physically.

kainegaroo
09-27-2014, 02:42 PM
First, what is I/c? I am not familiar with that abbreviation.

Have you contacted an attorney yet? You sound like the kind of case that might need one. I am sorry, but my expertise has been fading lately, as I have learned that work comp laws in many states have become less about the worker and more about the employer . .. not good. And since I have not even kept up with the local laws, and never did know the laws of each state (Indiana included) I am afraid I don't know how yours works. It sounds like your employer had lots of pull. An accident like that should have put you in an ER immediately, and an ortho-surgeon's office pronto. I think I owuld be finding the best attorney you can. Unfortunately an attorney can't fix the physical damage that has been done by delaying your treatment, but hopefully can help with your other issues.

An FCE is a functional capacity evaluation, to see what you can and can't do physically.

I do have an lawyer she had hoped that the damage would be corrected but I have since the first post finished my FCE. the findings stated I can only do sedentary work. my heart rate went from a resting rate of 85 to 185 from pain during my test. I m not sure where it goes from here. he also noted that I have numbness in my 4th and 5th fingers. my job is a union job and I am sure they will fire me because they wont have any work for me to do. I m worried as I am they only source of income for my family. will the I/c except the findings? do you have any idea what kind of PPI I am looking at?
thanks in advance!

kainegaroo
09-27-2014, 09:01 PM
I do have an lawyer she had hoped that the damage would be corrected but I have since the first post finished my FCE. the findings stated I can only do sedentary work. my heart rate went from a resting rate of 85 to 185 from pain during my test. I m not sure where it goes from here. he also noted that I have numbness in my 4th and 5th fingers. my job is a union job and I am sure they will fire me because they wont have any work for me to do. I m worried as I am they only source of income for my family. will the I/c except the findings as they sent me to this dr? do you have any idea what kind of PPI I am looking at?
thanks in advance!

P.S. sorry I/C is insurance company

lefthanded
09-28-2014, 12:43 AM
I do have an lawyer she had hoped that the damage would be corrected but I have since the first post finished my FCE. the findings stated I can only do sedentary work. my heart rate went from a resting rate of 85 to 185 from pain during my test. I m not sure where it goes from here. he also noted that I have numbness in my 4th and 5th fingers. my job is a union job and I am sure they will fire me because they wont have any work for me to do. I m worried as I am they only source of income for my family. will the I/c except the findings? do you have any idea what kind of PPI I am looking at?
thanks in advance!

Questions for your attorney. She is supposed to be making sure that everything that can be done, is due you, and is indicated by your condition is addressed before or within the conclusion of your claim.