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  • WC Unfair Decision

    Can someone please help me with any information regarding a work related injury that took place while performing my normal work activities. The proper channels were informed of my injury within the required time frame, and all forms were filled out. I was treated by the insurance company's medical doctor, and still continued to work. The doctor placed me on restricted work duties for approximately three weeks pending the approval of a MRI. A few days later I was declined on my claim based on a pre-existing condition from nine years ago. Reason given was that my prior injury was the primary cause of the current complaint. Also that my injury did not meet the definition of an "accident" or of an "injury".Since then I voluntarily resigned my position for good cause Unhealthy Work Invironment (harassment/intimidation) at the work place by my department head regarding prior personal issues which I reported to human resources. In regards to my last doctors appointment I was left with work restrictions pending a MRI to further asses my condition. I did not go back to the doctor because of no medical insurance, and now I'm wondering if I am eligible for UI or appeal the wc claim.
    Last edited by Love77; 10-27-2006, 03:51 PM. Reason: Revised

  • #2
    What state? What was the accident? What was the injury? What is the pre-existing condition? Has it been treated or symptomatic recently (when was it last treated or examined)? What are the restrictions? What do you do for a living?

    I'd needthe answers to give you any advice that is even remotely reliable.
    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
      Hi ElleMD

      In reply to my situation which took place while working as a Surveillance Agent for approximately 21 months in the state of Nevada.
      I sustained a lower back injury while in the course of my employement. I stooped down to pick up a total of 12 VHS video cassettes from a lower shelf. At that point I felt a sharp pain in my lower back. I continued to finish the job which is required for us to change out a total of 233 tapes for a vcr tape change. I had a prior pre-existing injury of my lower back area about nine years ago. I was treated and released to work with a restriction of no lifting over 30 pounds. For the recent doctor that was treating me for the current injury. Indication was made by him for me to take 2 days off from work, and prescribed me with pain medications for my injury. He released me back to work after two days off with restrictions: no bending, no stooping, and no lifting pending a MRI approval. The doctor felt that I may have pinched a nerve in my lower back, and he felt I needed an MRI to further asses my injury. The insurance declined my claim for the reasons mentioned above on my first posting. I hope this has helped you in regards to my incident.

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      • #4
        I maybe wrong Elle, but isn't 9 years a long time to claim pre existing? OP, did you ever see the doctor on your pre-exising injury, before the new one, in the last 9 years?

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        • #5
          I seeked medical attention back in June 2006 for anxiety in regards to my department manager harassing, and intimidating me while at work. At that point I was placed on a Medical Leave Of Absence for about 5 weeks. Other than that I have not seeked any medical advise or treatment on the prior existing back injury.
          Last edited by Love77; 10-27-2006, 09:16 PM.

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          • #6
            I'll do some check on Nevada tomorrow if I get a chance but in most states the "accident" you describe wouldn't be considered an accident per WC. Nothing about the job caused it. If you had been carrying the tapes and felt the pain, or slipped on water on the floor and twisted funny, then it would be covered. If you bent down and your back went out or was injured and it was just coincidence it was at work, then it would not. Not everything that happens at work is covered by WC. If you had a pre-existing condition and restrictions when you had this reaggravation, then it is even harder to claim anything about work caused it.

            Pre-existing is pre-existing. There isn't any time limit on how long it can be considered relevant. Obviously the longer a condition remains asymptomatic and the milder the incident the less impact it is going to have on any future injury. But if you have say arthritis, it doesn't just magically go away or no longer affect future injuries.
            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.

            Comment


            • #7
              This is true about the arthritis. I guess I was thinking more along the lines of when applying for medical insurance, they say if you have seen a doctor on an injury in the last 6 months, it is considered pre-existing, this is why the 9 year time limit surprised me. Your post makes a lot of sense, thank you!

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              • #8
                With regards to health insurance, the law specifically limits how long a condition can be considered pre-existing.

                Not so workers compensation.
                The above answer, whatever it is, assumes that no legally binding and enforceable contract or CBA says otherwise. If it does, then the terms of the contract or CBA apply.

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                • #9
                  Originally posted by cbg View Post
                  With regards to health insurance, the law specifically limits how long a condition can be considered pre-existing.

                  Not so workers compensation.
                  Thank you so much for that information.

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                  • #10
                    Thanks everyone for sharing your insight to my situation, and now I'm curious if I would qualify for UI

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                    • #11
                      Unemployment is typically available for those who are laid-off or terminated for no-cause. Voluntary separations and discharge for misconduct often lead to benefit denials. Also you must actively be seeking employment in order to qualify. Ultimately it the UI board for your state that will issue the final ruling.

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                      • #12
                        Thanks Rob for your input ...

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