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Back injury inPA questions??? Pennsylvania

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  • Back injury inPA questions??? Pennsylvania

    My job requires me to travel alot. I was injured while traveling for work in MN at the airport. I fell and tripped over bags and fell backwards into a parking barricade. Long story short...I was approved for workmans comp I was out of work for a month then returned (office work) I've been going to PT up to the 1st week back to work. I commute to work via train and the entire commute and sitting thru work has made me worse. I've been expierencing pain again, and numbness in my leg. It has gotten so bad that my Dr recommedned that I try to make arrangements to either stop working or work from home. Work has alloweded me to work from home for at least two weeks,otherwise, I would be out of work again.

    Workmand comp is paying for all my medical bills up to this point. Now here is the problem...I have had previous back injury dating back to 1984 and had surgery. I have not had any related problems from the 84 injury. I know I informed WC but they claim that I did not. I have repeated the story of my injury so much that I'm tired of talking about it. Now the wc insurance company is claiming I had a pre exisiting issue and they are calling into doubt that I was hurt at work. I have witnesses that saw me fall and that it was an accidnet. I have been treated from time to time by my Dr for back related issues ,usually from doing something stupid on my part, slipping in shower, sleeping an a hard bed...etc, but nothing that relates to the 84 issue.
    The WC doctor has requested two further test, and suggested that I go to inventional pain mgmt. WC has approved the test, but now have denied the pain mgmt. They also have requested all my medical records going back to 1984.

    Now I guess here is my question..I am so frustrated..I just want to get better, I can't afford to stay out of work and by going back to work I've gotten worse. Since my job requires me to travel, and I can not, I am looking to get a job internally that would not require travel, but the only thing avalible is a step backwards.Should I contact and attorney?? Do I have any recourse.
    Last edited by karnick; 09-21-2006, 01:34 PM.

  • #2
    OK, the only question I see is should you contact an attorney. If you want to you certainly may. I don't see that an attorney is going to solve the majority of your problems though.

    If you've had back surgery and back problems throughout the years, then it is unlikely that any organic cause of the injury is related just to this most recent spill. WC is only responsible for care and treatment of your problems resulting from the injury you sustained at work, not any underlying medical problems there may be. Having dealt with way more of these claims than I care to think about, I can say that anyone with a history of problems, is going to have their claim scrutinized. It isn't so much that they don't believe you fell, it is that they aren't certain that whatever problems you are now experiencing are the result of the fall. To determine that, they need your prior records. This is incredibly common.

    As an example, if you had DDD or a herniation before the fall, and in the fall sustained a strained lumbar, WC would only be responsible for the sprain. The underlying medical problem would not be covered under WC. Not knowing what your injury was or what you are treating for now or in the past, it is hard to advise you. Going on a limb I'll guess that you are having an ENG and or the test where they inject the dye into your spine (the name escapes me at the moment). Pain Management won't be authorized until the tests are done and the results indicate that it is called for. As for work, it sounds like you are working from home. If you go into the office, are you not able to get up and walk around at all? Perhaps asking to adjust your work station would help. What do you do at home for relief?
    I post with the full knowledge and support of my employer, though the opinions rendered are my own and not necessarily representative of their position. In other words, I'm a free agent.

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    • #3
      Wow thanks for the quick response...

      My work from home enables me to avoid the travel and allows me to lay down and rest my back thru out the day. The 2hr round trip train ride was just too much on top of the 8 hours sitting at a desk. I would expierence leg numbness about 85% of the day. When my back hurts, my leg goes numb and i end up limping as I walk.

      The two test I have scheduled are a emg and a ncs (?) my main issue at this point is numbness and tingling in my leg. I have been treated from time to time for various aligments with my back but never had any leg numbness as I am expierencing now. Now that you've explained the need for all of my records, it does make sense. Should I be concerned that they have denied my pain mgmt. (although I have no Idea what it is, their doctor recommneded it) They also stated that I was approved for wc for 90 days which is quickly approaching. I guessing they are looking for a reason to no longer pay for my treatment.

      So far thru all of this I have taken a loss in wages for being out, since the state max payment only paid approximately 1/2 of my wages, and I'm not geting better.. Thus very frustrated. What worse, and not wc related, but my company offers shor term diab pay which , had I been hurt outside of work, would have been covered 100% for loss wages, and my own insurnce would have covered medical expenses. So I really don't see how workmans comp has helped me at all, and now threaten to deny my claims...Am I missing something.

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      • #4
        Unfortunately, for those at the higher end of the pay scale and with generous benefits, WC may seem like a penalty. The system really was designed to provide basic coverage for those not so fortunate who were injured through no fault of their own at work. While created with good intentions, you now get what we got. Check with your disability carrier to see if they will supplement what you are receiving from WC. Some plans will, particularly the more generous ones.

        Pain management is generally a "maintenance" solution, not a treatment solution. If for instance, surgery were not indicated or not an option for you, or post treatment you stil had pain, a formal pain management regimine may be recommended. For now, if you are on pain meds and they are still figuring out what is wrong and what treatment may be appropriate, it's a bit soon for Pain Management. It is almost never recommended before the ENG and NCS. Both tests are meant to test the nerves and diagnose radiculopathy. They aren't a big deal and should help pinpoint the problem.

        90 days is sort of default for accepting a claim. Meaning, they can test you and treat you for 90 days before they must decide whether to accept or deny the claim. Once you've hit the 90 days mark, it is much harder for them to contest it. This is done because it isn't always easy to tell whether the injury occurred at work or what the cause is. The 90 day window allows you to be treated under WC, without locking the carrier into accepting compensibility if it turns out to not be related.

        For now, get the tests, and worry about whether it will be accepted or denied later. I know, easier said than done, but you don't have a choice at this point and aside from the wage issue, which you may be able to work out with the disability carrier, you'd be in the same boat, WC or not.
        I post with the full knowledge and support of my employer, though the opinions rendered are my own and not necessarily representative of their position. In other words, I'm a free agent.

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        • #5
          ElleMD you have been very helpful...thank you...

          First off, my company use to allow for STD to supplement wc but since changed policy and std carriers..I tried and was denied.

          I guess the frustration of feeleing this way and as you said penalized has gotten the best of me and their reaction and statement that I wasn't hurt put me over the top. I can understand the need for seeing the records, but find it absurd that , as they indicated that I had this pre-exisiting issue for 22 years and waited for this exact moment

          What I'm not clear on, as you mentioned is whether or not they will accept the claim after the 90 days. I thought I was approved since they paid for lost waged and have been paying my medical so far...do I understand you correctly in assuming that they may not pay medical bills after the 90 days if they feel that they have proved I had a preexisiting issue?

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          • #6
            I have no way of knowing what they will decide. What I'm telling you is that the first 90 days of treatment and payment does not obligate them to accept the claim ultimately as compensible. A pre-existing injury doesn't disqualify you from any treatment or lost wages now. Just that only the portion that is related to the injury you sustained would be covered. The only time treatment for the underlying condition is included is when it can't be separated from the current injury.

            The biggest hurdle to compensibility I see if the fact that you fell over your own bags while on a trip. In many cases , it would not be covered. In my state, it wouldn't be. Just had a similar case last year where the commission denied it. Since that part isn't being challenged, and you clearly could work and weren't in regular pain before, and are now, and there are witnesses to what happened, I would not be overly concerned that the claim will be denied. You'd have a good case for appeal if it were.
            I post with the full knowledge and support of my employer, though the opinions rendered are my own and not necessarily representative of their position. In other words, I'm a free agent.

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