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

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Unread 04-16-2009, 09:43 PM   #41
Dew58
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....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

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 .

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.

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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
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WC Injury 03/24/07;Two Right Knee Surgeries on 5/22/07 and 01/16/08. Surgeons and Physical Therapists ignored my concerns of burning pain, swelling, and no improvement and getting worse. Diagnosed RSD/CRPS I/Sympathetically Mediated Pain Syndrome/Chronic Pain on 06/2008 by family doc;on 08/2008 and 12/2008 diagnosis confirmed by two WC PM Doctors: Both legs;hips; hands; and spine effected by this culprit. SSDI granted 01/2009.
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Unread 07-01-2009, 12:46 PM   #42
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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
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Unread 07-04-2009, 09:22 PM   #43
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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 . . .


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Originally Posted by screwballpookie View Post
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
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Unread 07-04-2009, 11:55 PM   #44
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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...

Abbie
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Unread 07-06-2009, 07:13 PM   #45
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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
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Unread 11-11-2009, 01:01 AM   #46
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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!!!!!!!!!
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Unread 11-13-2009, 06:13 PM   #47
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Originally Posted by redrose51 View Post
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!!!!!!!!!
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!
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Unread 03-14-2010, 10:27 PM   #48
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Originally Posted by lefthanded View Post
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 . . . . . ."
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
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Unread 03-16-2010, 03:25 PM   #49
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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.
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Unread 09-15-2010, 06:19 PM   #50
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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
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