Originally Posted by lefthanded
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. . . . .