Loss of organ

[spleenless]

I had a work related injury October 8,2008 which resulted in a open splenectomy. Had surgery November 22, 2008 to remove my spleen. Returned to work December 15,2008 on light duty. Declared at MMI on January 8,2009 with a 0% impairment rating. Since there is no impairment rating there is no award? My nurse/case manager at the time informed me the insurance adjuster would be in contact with me in 8-10 weeks after receiving all my medical information. What should I do now? I live in Tennessee. Thanks for any help you may have:)

[finz]

Most people are able to function fully after a splenectomy, so working is usually not a problem. If you can work, WC should not be giving an award.

WC is designed to help people who have been disabled because of a work injury, not to compensate for pain and suffering after surgery.

Do you have cause for a civil suit against your employer for that ?

[spleenless]

Most people are able to function fully after a splenectomy, so working is usually not a problem. If you can work, WC should not be giving an award.

WC is designed to help people who have been disabled because of a work injury, not to compensate for pain and suffering after surgery.

Do you have cause for a civil suit against your employer for that ?


Can I receive money for scarring or bodily loss of function?
The worker's compensation law will provide compensation as long as the scarring or disfigurement is on the worker's face, neck or hands. If a worker suffers a permanent loss of function to a body part such as a back, knee or shoulder, then he can receive payment in addition to his weekly check. If a worker loses an organ such as a spleen or a kidney he is entitled to additional monetary benefits.

Is there any fact in this? As for a civil suit I have no idea.

[Abbie]

Here are some things from TN Department of Labor and Workforce Development.
http://www.tn.gov/labor-wfd/wcfaq.html#IEA

RESOLUTION PROCESS
A medical impairment rating and date of maximum medical improvement by the treating physician, and information needed to settle a claim shall be documented in writing.

Insurers shall make an offer of settlement in writing within thirty (30) days of receipt of information specified above, 0800-2-14-.06(1). The claimant shall sign the offer of settlement indicating approval or rejection of the offer.

An agreed settlement shall be finalized by order of a court or approval by the Division as required by TCA §50-6-206. A copy of the court order or division approval shall be filed with the Commissioner of Tennessee Department of Labor.

If settlement is not agreed upon a Benefit Review Conference may be requested pursuant to TCA §50-6-237.

The injured employee should be offered a settlement in writing within thirty (30) days of receipt of the medical impairment rating. This applies only to those employees whose injuries result in permanent disability. It is unlikely a offer of settlement will be made if an employee recovers completely from the injury.

How is a settlement determined?
A settlement is appropriate when, after an injured employee reached maximum medical improvement, the employee retains a disability resulting from the work-related injury. The employee’s treating physician will determine in writing a percentage of Impairment and state the part of the body affected. This is called an “impairment rating.” There are many variables in the computation of a rating but the percentage will be based on standard criteria used by all physicians to determine the percentage of impairment retained. A Workers' Compensation Specialist can assist in figuring an appropriate range of settlement for vocational disability, however, the Specialist will need to know the exact wording the doctor used when giving the rating, percentage of Impairment the treating physician assigned, which body part was injured, and Employee's weekly compensation rate.




Since you have an impairment rating of 0% it is unlikely that you will be offered a settlement.
In many states an injured employee can not bring a civil suit against their employer.... If there was a third party involved it is possible to sue this third party for negligence. I believe that Tennessee is a state where you CANNOT sue your employer.
I hope this helps...
:)
Abbie

[finz]

Spleenless......where did you find that info about loss of a spleen or a kidney ?

On the site Abasaki noted, I also found this.............

C. Permanent Disability and Final Settlement
· When the injury has healed, the injured employee will be released from the physician's care.
· If the injured employee does not recover completely, the employee will reach maximum medical improvement (MMI) and the physician will assign an Impairment rating.
· This Impairment rating, combined with vocational factors, may result in a permanent partial disability (PPD) rating.. A settlement from the workers' compensation insurance company or Employer may then be agreed upon.
· Not all injuries result in a permanent impairment; however, Workers' Compensation specialists with the Tennessee Department of Labor and Workforce Development do provide, at no cost to the parties, informal Benefit Review Conferences to assist the parties in reaching a final agreement or settlement of the claim. Please complete a C-40B Request for Benefit Review Conference and submit it to the Workers' Compensation Division.

Scheduled Injuries

Thumb

First or index finger
60 weeks

35 weeks

Second or middle finger
30 weeks

Third or ring finger
20 weeks

Fourth or little finger
15 weeks

Great toe
30 weeks

Any other toe
10 weeks

Hand
150 weeks

Arm
200 weeks

Foot
125 weeks

Leg
200 weeks

Eye
100 weeks

Hearing (one ear)
75 weeks

Hearing (both ears)
150 weeks

*Body as a whole
400 weeks




That makes it sound like there would be no monetary award because there is no permanent disability/impairment

[spleenless]

I found that information on a lawyer site Karsner and Meehan P.C. Attorneys at Law. I reached my MMI January 8,2009 and haven't heard from anyone since. I was told I would be contacted in 8-10 weeks. I have e-mailed the insurance adjuster to see if the case is closed, if it is then I guess it's finished. I thought I would be notified either way. I thank everyone for their help and I will keep you guys updated. Thanks again:D

[Abbie]

Karsner and Meehan P.C. Attorneys at Law - are located in Massachusetts.

Work Comp is directed by each state... Therefore wc laws in Massachusetts can be and most likely are WAY different than wc laws in Tennessee.

From what I understand from reading the TN Department of Labor and Workforce Development site.... they don't have to contact you if there is no settlement offer.

I understand your frustration.... work comp laws are supposed to be for the employee...but in many states they favor the employer.

[spleenless]

Are there any lawyers on this site that deal with comp cases. The only reason I ask is my accident was of a freak nature. Basically caused by a crack in the seam of a concrete floor that brought the crate I was pushing to a abrupt stop and sent me on top of it causing a fractured spleen. Usually we'd use a hand jack to transport the crate (about the size of a large toy box) to it's next destination. The aisle in which I had to travel was obscured by full crates to my left and machinery to my right thus preventing me from using the hand jack to carry the crate the full distance, which was approximately 30 feet. Pushing the empty crate along the smoothe concrete was permitted for short distances at the time. After my accident we all had to sign a training document forbidding anyone from sliding a empty crate. The company I work for does not own the warehouse.

[Abbie]

I have not come across anyone here on the Neurotalk forums that is a lawyer.

The majority of members here are patients. Though many are caregivers, family, or a friend of someone with a neurological disorder.

We can only give you our experiences and direct you to links that may help you.

I suggest you contact a Work Comp Lawyer where you live. Many lawyers offer free first consultations and should be able to let you know if you have a case or not.

Look for one that mainly deals in Workers Compensation cases.

I sincerely wish you the best.
:)
Abbie

[spleenless]

Thank you Abbie:D you seem to be a very nice person.
PS...don't feel lonely, I really appreciate your help:hug:

Spleenless:)

[Abbie]

You are welcome Spleenless!! :)

I'm sorry I couldn't be of more help... I do hope you will stick around our little corner of the web... feel free to roam around and join in anywhere :) Help where you can and ask for help if you need it!

Even though we are thousands of members strong... we love having new member!!!

I hope to see your around the boards!!!
:hug:
Abbie

[lefthanded]

Although I am unfamiliar with the W/C laws in Tennessee, I did handle W/C in Iowa, Ilinois, Wisconsin, Missouri and Washington state over the course of 15 years. In a couple of instances just the fact that the injury precipitated the need for a surgery was suffiicent for a finding of 2-3% body as a whole PPD (Permanent Partial Disablity). The philosophy was that you can't be 100% is you have had a surgery which may leave behind scar tissue, adhesions, etc. Because surgical techniques continue to improve, however, it is no longer assumed in many instances that ANY residual disabilty will result from surgeries. I would think that your question might be: Even though the "rating" said no disaibilty resulted, is there any compensation for the fact that a previously whole body was subjected to surgery, and specifically, the removal of an organ, even one which the body can function without?

I would probably be a little more concerned with the statute of limitations for reopening the claim, should you ever experience adhesions or other post-surgical and post-healing changes that require treatment.

Your injury description is actually not all that bizarre. Most back strains occur when workers try to catch themselves or try to keep themselves from falling, and not from lifting things that are beyond their strength or capability as is thought. Repetitive strain injuries to the hand have occurred from everything from having to pinch the packages of hamburger or hotdog buns to move them, four per hand, from the line to the tray . . . or using tin-snips or knives to trim "slag" or excess plastic from molded plastic items . . . or pushing the same button, in the same position, repetitively for a period of time.

[spleenless]

This a recieved via e mail from my adjuster today:

I am processing your request for mileage reimbursement.

Concerning a settlement, Dr. Adams advised you did not have any permanent impairment. I am checking on some other options and will be getting back with you.

Any future covered medical treatment would be with Dr. Adams, for any complications of the splenectomy.

I'll get back with you with additional info as soon as I receive same.

Thanks,

Cindy

I wonder what she means by "other options"?

[spleenless]

I recieved a e mail today from my claims adjuster. She wants to speak to me on the phone tomorrow at work to discuss my case. Should I just listen to their proposal? and what questions should I be asking?:confused:

[spleenless]

I was offered $5000 to close out the medical from the Insurance Adjuster. No award for the injury as there was a 0 impairment rating.
:confused:

[lefthanded]

I was offered $5000 to close out the medical from the Insurance Adjuster. No award for the injury as there was a 0 impairment rating.
:confused:

Have all the medical expenses been paid?
Does your doctor anticipate any further expenses at this time?

According to the Oxford Journal http://occmed.oxfordjournals.org/cgi/reprint/47/2/112.pdf , a loss of the spleen results in approximately 2-3% disability. You can find out if the $5000 offered comes close to this figure by multiplying your weekly benefit rate (TTD rate) by the number of weeks that 2-3% of the body as a whole represents. For instance, in Illinois a spleen is worth 10 weeks, so if your weekly benefit was $500, the $5000 offered would be the equivalent of getting permanent disability for the loss of your spleen. Some states pay much higher, some not at all, and Tennessee may be one of the latter. Some states "settle' with lump sum payments like you have been offered. However, I do not understand "closing out medical" when they are suppose to pay all your medical expenses for treatment before closing the claim. I have been unable to find, online, a TN schedule of PPD benefit calculations.

I would ask if this "settlement" means you would not have the ability to reopen in the future, say, should your surgical site develop an abcess or other complication. Has your physician adequately explained what the loss of your spleen means for you medically? This is what I have found on Merck's site:

People can live without a spleen. Sometimes the spleen must be removed surgically (splenectomy) because of irreparable damage (for example, due to an injury sustained in a car crash). When the spleen is removed, the body loses some of its ability to produce protective antibodies and to remove unwanted microorganisms from the blood. As a result, the body's ability to fight infections is impaired. People who do not have a spleen are at particularly high risk of infections because of the spleen's role in fighting certain kinds of bacteria, such as Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae. Because of this risk, people receive vaccinations to help protect them from infection with these organisms. Yearly vaccinations against influenza are also recommended after a splenectomy. Some people take antibiotics to prevent infections, particularly when they have another disorder (such as sickle cell disease or cancer) that increases the risk of developing life-threatening infections.

Despite these problems, however, the spleen is not critical to survival: Other organs (primarily the liver) compensate for the loss by increasing their infection-fighting ability and by monitoring for and removing red blood cells that are abnormal, too old, or damaged. http://www.merck.com/mmhe/sec14/ch179/ch179a.html

Sounds like "future medical expenses" may include vaccinations, particularly against pneumonia.

[spleenless]

I read the Oxford Journal explanation. That may be so there in the UK but here in the US under the AMA guidelines 6th edition I have no impairment from my splenectomy. I would only have an impairment if I suffered from a illness that was a result of the surgery. The loss of the organ itself warrants nothing. They (Workmans Comp) paid for my surgery and care. Since WC is a no fault insurance that pretty much protected my employers *** in my opinion. If this were a personal injury case I'm sure the outcome would have been much different. Isn't capitalism great:rolleyes:

[spleenless]

I've been looking for a lawyer but none seem to be too interested in my case. Probably because there isn't any big money involved in this case. If anyone knows of any good WC lawyers in the Crossville area I would appreciate it. I wouldn't be so pissy about this accident if it weren't for the circumstances in which it occured. I feel I need to discuss these details with a good lawyer. To add insult to injury the insurance adjuster low balling me on the medical just ****** me off more.

[lefthanded]

If your condition is resolved, and your medical bills are paid, all your time loss has been paid, and you have no residual disabiity resulting from your surgery, then w/c has done its job. An attorney can not change that. If your state does not find any disability for simply having a surgery as part of your treatment, there is not much else you can do. I could pump up your expectations and tell you otherwise, but that would not be honest and it would not be kind.

The Oxford schedule of benefits was just for illustrative purposes. The spleen would likely be valued at no more than 2-3% to the body as a whole (2-3% of 400 weeks = 8-12 weeks worth of benefits) , and as I calculated, that could be in the range of what you have been offered, if not even a little more. In most states a full and final settlement, or even payment of scheduled PPD benefits, are to be seen as compensation for future medical costs, as well as any resideual pain, loss of motion or use, etc.

As for the circumstances of your injury, unless it was intentially caused by your employer, or there is a third party responsible, I do not understand how you feel that the cicumstances should make a difference in the "settlement." It is ok to be upset about the fact that your life has been impacted by a work accident (this is, in fact, the nature of "accidents"), however, anger will not gain you any more than the law and the coverage allows. Unless this crack was open and obvious, had been cited as a hazard, and the owner of the warehouse refused to repair it, it is likely one of those things that you will not win. Now, if your employer directed to you to do the task in the exact manner you did it, knowing you had a likelihood of injury, there may be an issue. The threshold is pretty high, though, for them to be liable beyond w/c benefits. Sounds like your accident was the first one with regard to this crack in the floor, thereby precipitating training for all on how to avoid this in the future.

I am not a lawyer, but worked with w/c attorneys for over a dozen years, and I know that no two cases are alike, in spite of the stories that circulate about "someone else who got a big settlement" for an injury that you believe is the same as yours. I would consider seeking a second opinion regarding resonably-anticipated medical residuals as a result of your spleen removal, at the most. The $5000, based on the facts I see here, seems in the ball-park, and should be in your pocket, and not an attorney's.