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Treated, labelled partially disabled, WC says no more treat Delaware

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  • Treated, labelled partially disabled, WC says no more treat Delaware

    I injury myself in April of this year. Lifted up a BOC Edwards pump weighing 100lbs and my back went out. Diagnosed as a Herniated disc (L5-S1). 3 medical doctors and a chiropractor diagnosed this. I went for 4 months of physical therapy. My doctor, orthopaedic surgeon specializing in spinal injuries, felt PT was the best route b/c he does not want to do surgery. A few weeks ago WC insurance had me go to a DME. Saw this guy for 10 minutes and he said nothing to me with regards to a diagnosis. So we ended physical therapy and did an FCE. Based on the FCE results, I am able to go back to work but labeled permanently partially disabled and their are lifting restrictions.

    My employer has been great and said they don't want me lifting. They are looking for a new position for me. I have never received check from WC insurance because my employer has provided me with sedentary work since my injury.

    So being we are done treatment (with my current doctor), I sent an email to my claims manager asking can I seek chiroparctic treatment or orthopaedic treatment if my back starts to hurt. Her reply verbatim was:
    "Unfortunately we would not provide authorization for treatment related to the herniated discs as these are due to degenerative disc disease and not associated with the diagnosis related to this claim, which is Lumbosacral strain/sprain."

    My doctor and 3 other medical professionals have all said a herniated disc. I never injured my back before and never had back pain before this incident. I assume their DME (docotr of osteopathy at that) is the one who came up with this lumosacral strain/sprain. The MRI clearly shows a herniation.

    Should I talk to a lawyer about this? I don't want to make waves, yet I feel the insurance company and their doctor are lying about this now and being deceiptful. I want to make sure they pay for future doctors visits and treatment related to this injury.

    Thanks,
    Ted

  • #2
    I think since this was a workers comp claim, that if anything in the future aggrivates it, and you have to miss work again, you can reopen your claim. This does not mean that they would except the claim, it just means that you can reopen it. You can pay for an attorney if you wish, but I don't think that the attorney would do you any good unless you found that you needed to reopen the claim. I don't think they have to offer continuing care, if your doctor states that you are medically stationary, but I am not a lawyer and unsure. You may be able to get a free consultation from a workers comp attorney? They work on a contingency basis (which means no money for you, no money for them). I would also assume that if you have xrays that show a herniated disk, then it is a herniated disk.
    Last edited by turbowray; 10-07-2006, 07:21 AM.

    Comment


    • #3
      Herre's the deal, you may very well have a herniated disk but the doctor you went to does not beleive it happened when you lifted the pump. The doctor felt it was herniated as a result of DDD, which is not covered under WC. This doctor felt that what you did was sprain/strain your back, superimposed on a pre-existing herniation.

      Having a permanent partial disability rating and restrictions does not change anything. You can have a PPD award and restrictions and still work. Most do. It is great that your employer is willing to be accommodating. That certainly helps.

      At this point, if treatment has been cut off, I would assume that the doctor you went to found you to be at maximum medical improvement. In other words, as healed as you are going to get. Since that is the case, unless the doctor feels that ongoing care of some sort if called for, the carrier isn't going to cover the medical care. If down the line you need care related to the back injury you sustained, then you would need to contact the carrier for authorization. This nearly always entails a return to the doctor you saw previously to get their opinion as to whether the requested treatment is related to the injury or not.

      If you disagree, and more importantly the doctors you have treated with all along disagree and feel the herniation happened when you lifted the pump, then you will need to file issues with the commission to get it covered. This will require a hearing almost certainly. It also means, you really should get yourself represented by an attorney. While you can do this pro se, I would strongly discourage you from doing so. I would also strongly discourage you from accepting a PPD award or signing a settlement of any sort without contacting a lawyer first.
      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


      • #4
        update

        So the insurance company changed their minds. After reviewing my file they said future treatment will be authorized.

        As far as work goes, I recieved a letter from the HR Manager stating "up until this point we have been accomdating your restriction but are no longer able to. Effective Friday, November 10, 2006 will be your last day on modified duty.

        At this time we will need to re-evaluate the job and fuction and consider how we may be able to accomdate the permanent restriction with alternate work or a modified position. In the meantime, you should contact Travelers to learn about any benefits that may be due to you."

        I have never missed a day due to my injury. I worked from home doing tech support. Now that I have been labeled permanently partially disabled, the sent the statement above. If they can't find me work or a modified position, do I get workers compensation (money)?

        Comment


        • #5
          If they can not work you, with your limitations, then yes you will recieve benefits, also, WC will try to help you get a job, or go to school, to get a different kind of job, so you can get off the benefits asap. This is to my understanding,

          Comment


          • #6
            Not quite Turbowray.

            If you are at MMI (and if treatment is over then you probably are) this is no longer a temporary situation and you would not be entitled to Temporary Total Disability or Temporary Partial Disability benefits. Your employer is also correct to now evaluate your condition and employment options per ADA.

            You need to sit down with your employer and discuss whether you can perform the essential functions of your job with or without a reasonable accommodation. If you can not, then it might be reasonable to transfer you to a vacant open position for which you are qualified. It does not have to be the job you want, nor the duties you performed while healing, nor do they have to create a position for you.

            If you are unable to continue working there, you may be able to get vocational rehabilitation benefits. This is what turbowray was referring to with job placement assistance and training. It isn't a given and exactly what benefits are available to you depends upon your situation.
            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
              So what happens if they don't have alternative or mdoified work for me as of Friday? The HR manager said if that's the case I will still be an active employee, but will not have my psotion anymore. She's telling me WC insurance should be compensating me, but due to the fact I have already stopped treatment, that doesn't sound right.

              Comment


              • #8
                Originally posted by ElleMD View Post
                Not quite Turbowray.

                If you are at MMI (and if treatment is over then you probably are) this is no longer a temporary situation and you would not be entitled to Temporary Total Disability or Temporary Partial Disability benefits. Your employer is also correct to now evaluate your condition and employment options per ADA.

                You need to sit down with your employer and discuss whether you can perform the essential functions of your job with or without a reasonable accommodation. If you can not, then it might be reasonable to transfer you to a vacant open position for which you are qualified. It does not have to be the job you want, nor the duties you performed while healing, nor do they have to create a position for you.

                If you are unable to continue working there, you may be able to get vocational rehabilitation benefits. This is what turbowray was referring to with job placement assistance and training. It isn't a given and exactly what benefits are available to you depends upon your situation.
                Thanks Elle, I'm still trying to learn all about this, with my husband going through this with 3 ruptured disks right now. Thanks for pointing things out!

                Comment


                • #9
                  Originally posted by Ted and Natasha View Post
                  So what happens if they don't have alternative or mdoified work for me as of Friday? The HR manager said if that's the case I will still be an active employee, but will not have my psotion anymore. She's telling me WC insurance should be compensating me, but due to the fact I have already stopped treatment, that doesn't sound right.
                  Elle would be able to answer this the best, but I gathered that if they can not work you anywhere at your job, then you would be disscussing the vocational rehabilitation benefits with your WC insurance company (if you do indeed qualify for this help).

                  Comment


                  • #10
                    What happens now depends on quite a few factors. If you are technically able to do your former job but are just waiting for a vacancy, you would need to file for unemployment.

                    If you are still treating or have limitations and that is why you are waiting for a job to open up, then TTD might still cover you. You will have to ask the carrier.

                    Voc rehab would only be an option if your employer does not forsee an opening in the near future and the reason you can not return to work is because of your disability. If you lost your position simply because time ran out and they could not hold the job any longer, then you would not be eligible.
                    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


                    • #11
                      So I finally got some answers from HR, but I am still thoroughly confused.

                      HR said I will be an active employee, meaning I get benefits. They are looking for alternative work/new position for me. However, in the interim I will not be paid by them and was instructed to contact the WC insurance carrier. The insurance carrier (Travelers) says that I will not be compensated because I am not "totally disabled," just PPD.

                      So even though I am still employed, I am not getting compensated in any way. How can you get hurt on the job and not be compensated when you can't do your job? How the hell am I suppose to live? How can the laws permit such a fiasco? Even though they are giving me benefits, how do I pay for my share?

                      Comment


                      • #12
                        Do you have a lawyer? I think you should have one. I might be wrong, but if you are still considered employed, but they can not work you due to your limitations (yet), I feel like the WC company should replace your lost wages, since it is due to your injury. I hope Ellemd can shed some light on this, I myself am confused.

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                        • #13
                          I have a lawyer, and they are waitng for my HR manager to call them back to discuss the situation. Travelers told my lawyer I would not be compensated due to my disability being permanent partial, not total. My case manager referred my attorney to the HR manager for clarification with respect to the game plan for finding me a new postion. We have 30,000 employees, so I'm sure there is something available as I am also willing to relocate.

                          The attorney is gathering all the facts right now, but for me the anxiety of not knowing what's next is excruciating. Especially since my company can just say "your gone" at any time. WC laws are a joke, IMO.

                          Comment


                          • #14
                            In that case, file for unemployment. WC will not pay you while you wait for a position to come available if you are not off work due to being medically unable to work. You should qualify for UC however.
                            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


                            • #15
                              I guess that's where I'm confused. If I can't do my job as a result of my work related injury, doesn't that make me medically unable to work?

                              I was hoping my attorney would shed some light on this, but the reply I get from him was "lets meet next Wednesday." That's seems like a slow approach, or is it just me?

                              Comment

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