|The original version of this page can be found at : http://www.healingwell.com/community/default.aspx?f=16&m=898418|
|Posted By : mexximelt - 8/23/2007 10:15 PM|
|Hello to all. I hurt my back in 1999, had fusion at L4/5 in 2002, learned to live with pain these years but now am in a situation I have never been in so looking for all of you for help. I have never hurt my back at work but recently did just that at a great job with a great company (or so I thought) and only 3 weeks into it hurt myself while working. I am getting the cold shoulder and have been told in so many terms as soon as they denie my claim (was not even set up yet) I will be out of a job . Anyone have some good advice for this situation. I have handled about every aspect of my care without a problem over the years but this one has me somewhat freaked out. My rights? What I should watch out for? I have a feeling and it was told to me today by the WC adjuster that I am basically working the system and they will find a way to get out of it be referring back to my back surgery in 2002 in order to deny. Any advice any of you that has been through a workers comp claim with a possible pre existing would be appreciated.
|Posted By : Chutz - 8/24/2007 8:59 AM|
|Hi Mex and welcome!! What a mess you're in, but I'll share with you my thoughts. Don't let them intimidate you. Write down what they've said and when. Be quiet about it but keep a record of everything they do and say to you that feels intimidating or threatening. Next, call your state department of Labor and ask where to file a complaint. Also, you can talk to a lawyer for free for like 30 minutes, especially if it's an injury case. If you do need a lawyer for personal injury they usually don't get pain unless they win on your behalf. Don't let them walk over you. Stand up for your principles. I can't guarantee that you will win, but at least you have your integrity and honor in tact.|
Keep us posted,
Co-Mod Fibromyalgia & Chronic Pain Forums
Fibromyalgia, Ulcerative Colitis, Insulin dependent diabetic, collapsed disk, dermatitis herpetiformus, osteo arthritis in spine and other locations.
The only difference between genius and stupidity is that genius has it's limits. Albert Einstein: (1879-1955)
|Posted By : mexximelt - 8/25/2007 10:51 AM|
thank you Chutz,
Your right , intimidation is the tool they are using and it is just getting worse. I have confronted everything in my life head on but this one has me somewhat out of control. When someone controls your paycheck and if you have a place to live or not you tend to back off. What saddens me is that the mass of people out there that have been through worse I am sure and still suffer the consequences. I did contact a lawyer and had a mini session and he said "I can help you only if they deny your claim, then call me cause I am good". At least he has confidence. I wonder how many people that go through the whole process are pennyless and without resources. My employer has jumped on the "ignore her" bandwagon. Because they did just that I sent an email to corporate requesting a contact person and WOW........the email was forwarded to my boss and I got a condensending lip lashing over it as I am sure she got a hand slap for acting like I don't exist. Even if all works out well, I get better and they have to take me back to work my life there won't be worth a plub nichol as they will make my life a living hell now that I have "gone over" my bosses head for help. Can't win but thank you for your support and I won't give up. As Bugs Bunny would say "he don't know me very well, does he?" Having a support group means everything for us cronic pain survivors!
|Posted By : straydog - 8/25/2007 1:34 PM|
|Hi Meximelt & I too want to welcome you to HW. I worked for 20 yrs plus as a paralegal for atty that handled W/C claims and personal injury claims. I think Chutz gave you some excellent advice.
Now to the brass tacks. When were you released to return to work by your dr? Is this your 1st job since the injury? How did you get injured? How much medication were you taking at the time of your release? Did you get an impairment rating on your first injury? At the time of being released to return to work how much improvement had you made per dr doctor? How often had you been seeing the dr prior to rtw? Did the new job fit your working restrictions? Get a copy of your medical records from the dr that did your surgery. I assume he was your treating physician. Who is treating you for the new injury? If its the dr that did your surgery, did you put on your paperwork when filling it out that this is a new injury? If its the same dr make sure he makes a new chart on you with date of injury. Be sure any dr that see's you know this is a new injury. It would be very good for your surgeon to write a letter stating at the time of your release to rtw you had reached maximum medical improvement to whatever degree and how much backwards in numbers the new injury has created.Tell him they are trying to deny your claim and blame everything on the old injury, he will understand what you need. Was there any witnesses to the new injury?
I do not know what state you live in. Most states have different laws that apply to w/c claims. In most states an employer has so many days to report your claim to the insurance company. Who did you notify at work of the injury? Did you report the injury per the employers instructions on reporting an accident? Your insurance adjuster can tell you how many days the employer has to report an injury. If they go over the time line, they can be fined by the state.
Now for the bad news. Yes, an insurance company can get credit for a old injury in terms of impairment rating. If you were say given a 10% impairment rating on the old injury and the dr came up with 10% on the new injury. Since you already have 10% on the old claim you would not be entitled to more. In other words you can not double dip on the back claim. Before all the laws changed, people would be paid over & over, for basically the same injury, and the insurance companies wanted to put an end to that practice.
Whenever you decide to hire an atty, please look for a Board Certified Worker's Compensation atty. Either look in the phone book of cal the state bar for a referral. By law you cannot be fired for filing a worker's comp claim, however, people are fired every day for it. Employers are very smart and they know the laws too. They always manage to get around things. Thats why its important to keep a journal. In the event you get fired, talk to your atty about
a possible Wrongful Termination claim. Sorry for the long length. Good luck and anymore questions I will try to answer if I can. Susie
|Posted By : mexximelt - 8/26/2007 12:35 PM|
Wow, what incredible information you have taken the time to give me. Please allow me to answer your questions.
I have not been released yet. I have an MRI Monday. I had my back surgery in 2002 and since then worked non stop with no days missed due to back and no other injuries. Life as usual with some adjustments to my life is all. basically I move alot which keeps the back in check and know how to take care of it. I got a new job a month ago and hurt myself while squating, bending, lifting, twisting to work on a project. I went home with pain and rested on my days off thinking would get better. In my state you have 3 days to report to employer so I did so within 3 days. They waited one more day to print form for me after I reported it. My employer dropped the ball and did not report to their carrier for 4 days. Got bad hand slapping for that I think as they chewed me out for not reporting it to them myself. One interesting conversation (yes I journal every conversation date and time) I had with my boss was 4 days after reported she told me "do not worry we have plenty of time to train you and follow through with our plan and we will accomodate you anyway we can until your better." 2 days later she says "if your claim is denied your leave is not covered and you will be let go ". That was the same day I got a release to return to work with accomodations and she said "no accomodations will be made". WOW, obviously she had a talking with someone who set her straight on what to say and not say to me. I have not seen my surgeon from previous surgery becasue no current need except the WC carrier in my conversations with them keeps referring back to "my old injury". They make these comments without any knowledge of what I did , dr reports, etc. It is pure intimidation I think at this point. My initial diagnosis from chiro and my family dr from this recent incident , with exams was SI joint injury with no sign of disc problem (like previous) but now my doctor feels she should do MRI to rule out disc problem. My concern is that since 2002 surgery will probably find some degeneration or arthritis at surgery sight and that they will contribute it to this injury. Does that make sense? Also, no witnesses to my injury. Originally there were several of us working on project but ended up with me finishing myself. I did not feel a moment when I hurt myself but when done and i went to sit down I knew I was in trouble but it was time to go home so I left and went downhill from there. I also was not given any rating for prior surgery as it was not a WC claim and I was returned to work with no restrictions and have done fine until this. The only thing I have done since surgery is take vicadin for occassional pain after long day on feet. Nothing else and surgery complete success. So if not given an impairment rating from previous surgery how does that effect the new one? We both know where my fear comes from, they will find anyway possible to get out of paying for this. For the record at this new job and my previous jobs I have never missed as much as one days work due to back and never requested any accomodations but did all work assigned as job description states. I have to call the state WC division Monday because I have been off work 3 weeks and only received 1/2 one weeks pay. Also, my doctor did not require MRI with contrast but I requested it when I made the appointment. My doctor also told me that there is no way they can tell new injury from old injury on MRI....is this correct? I would think the contrast would tell the difference? I am taking my old MRI prior to surgery, should I? Don't they want something to compare it to? It seems if we don't look out for ourself no one will! Well, there is my book LOL You know I read horror stories everyday about how people are left out in the cold with no income and blah blah blah, you have heard it all before. These chat rooms are vital to keeping sane and having the support needed to not fall into deep depression over cronic pain and such problems. I have one more question for you.......I belonged to a chat support for a long time in 2002 and your nic sounds so familiar to me. Have you been online supporting people for that long?
For all in chat who read this..............I am thankful to have found pain support again and hope in some way I can contribute as well to help another person and not just gain support. Blessings to all of you!
|Posted By : straydog - 8/27/2007 12:25 PM|
|Mexximelt, yes its all a game of intimidation. But, what is so surprising is this person at your work is really helping you unknowingly, you are being told everyhing they plan to do. I am quite sure if the higher ups knew what this person was doing they would be in hot water because of liability issues. That part is funny.
My questions on the release to return to work, was meant for back when you had your surgery in 2002. Since its been quite some time since surgery and I gather you returned to work after surgery with little problem, it will make this claim really easier on your part. I say that because you will have a paper trail from your old surgeon, if you have not seen him a long time, thats good. That way the ins co, cannot say "well you were still seeing your dr on the old claim and obviously still having problems". That kind of thing will muddy up the waters, trying to separate two claims.
From what I am reading, if the employer presses the ins co to deny your claim they can, although legally they are not suppose to. The ins co will want to see your old medical records too, that usual. Then again, it may all backfire on this employer with the ins co and your claim may not get denied. If the ins company wants a recorded statement from you, alot of them do these days, by all means give them a statement, it will help you and let you give your side of the story.
Yes, it is a good idea to have your old MRI handy for comparison. Don't know what your dr is thinking. Did you say you are being treated by a chiro? I don't know where you live, but here in Tx ins comp hate chiro's cause they run the bills up and keep the people coming forever & ever. Under comp, ins co only pays usual & customary for the area. They are a real thorn in their sides. Some have caused more damage than what they started with. For you, I would be very careful since you have already got one surgery under your belt. I am not anti-chiro by no means, alot of my friends are chiro's but, I have seen the diff on a claim with an MD versus a chiro.
Regardless of what shows on your new MRI, as far as degeneration, you can have a new intervening injury super imposed upon the old injury. It happens every day to people. The fact that you have injured your back once does not mean you can not have another injury to it. How long does your WC ins have to make a determination on your claim? I think here its 10 days.
I have never belonged to any forums except HW. I stumbled upon them by accident after having a resection and being dx'x with crohns disease in 02. I am so glad I found them, because I was a babe lost in the woods when it came to crohns disease. I learned so much and got so much support its unbelieveable. We are a very unique group here at HW I think.
Let us know how things go and if I can help you in any way, let me know. Susie
|Posted By : mexximelt - 8/27/2007 1:46 PM|
I was so excited to hear from you today before my MRI. I hate them anyway and was nervous about the outcome as I have not had one since 2002. Yes, I have NOT seen any surgeon or dr regarding my back since I was released one year after surgery. So, what you say puts my mind at ease. I gave the insurance company a recorded statement the day my employer finally reported it. What happened with the chiro is I went there first. AFter a detailed exam he advised me immediately to see my regular MD before seeing him again to confirm his diagnosis. He does not do adjustments but uses pressure point treatment with deep massage. He told me insurance will only pay 12 visits for him and he would only work with me as long as I was seeing my MD mainly. I only went to him about 6 visits as it was not helping more than relaxing the muscles effected but no help to main pain. He was fine and agreed except he loaned me a tins machine to use if needed. My MD agreed with his diagnosis that the SI joint was probably the culprit , although now the MD is ordering the MRI to rule out disc problems. My chiro says he does not take WC business , like you stated, insurance companies dont like them but he made an exception cause I was in so much pain and could not get into my MD right away. I was informed by the insurance company they have 60 days to denie or accept claim. In the meantime they have to pay all medical bills and 2/3 pay. I thank you very much for putting my mind at ease at least about the fact that you can have a new injury on top of an old one. They still might denie it and if their nasty conversations with me are any indication at least I will be prepared. Yes, it was obvious when my manager told me off the bat that it would be denied that is because they told her they would probably do just that based on an old injury or at least they planned on trying to denie. I do have one question.....you made reference to "if the employer presses the ins co to deny"....I thought it was totally up to the insurance company but if that is the case they have made it clear they will push that way. i had only been working there 3 weeks before this happened and have no benefits and I was hired as an executive and was on a strict timetable for training and placement which has now all gone to hell. Thank you so much for your help. You have answered questions I have not been able to get answer to. Sometimes I live in this fantasy world thinking people will take care of people first and all will be well...........................Oh, I have one more question.....because my employer told me day one that they would do anything to accomodate me and we had plenty of time to finish my training after i was better and then 2 days later told me if denied i would be termed.....could her actions and statements help me out if i have to fight denial? Thanks again and blessings to all here who suffer cronic pain!