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Complicated WC situation in IL Illinois

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  • Complicated WC situation in IL Illinois

    I have had problems with my knee dislocating my whole life, not job related. I had surgery Feb 20 to correct the problem. On one of my follow up visits, the Dr scheduled more surgery (which I had) Monday the 14th. On Friday May 11, I slipped on some chemicals that were spilt and not throughly cleaned up, while I was at work. In the process of falling, my knee dislocated and I was taken to the emergency room for an MRI. The ER Doc said the MRI didn't show any damage. My orthopeadic Dr was aware of the situation. Since this happened Friday and I was already scheduled for surgery Monday there was no need for an emergency appointment with him.

    During the procedure I had Monday, the Dr ended up doing more surgery than what was planned due to the fact that I fell. The MRI looked fine but once he actually got into my knee, he saw that the ligament which was replaced 2/20 had been stretched due to the fall and dislocation I had the previous Friday.

    I'm not sure if I'm on the right track with my thinking or not. I called my employer and got the paperwork started to file a WC claim. Because the surgery was more extensive than what was planned, I need a little more time off work.

    Does anyone have any idea who's liable? I'm afraid that WC will argue the situation and try to pass the cost on to my medical insurance... who will say some of the charges should be paid by WC. I'm mostly worried that some or all of the cost will fall back on me until the situation is resolved. I was already told by my workmans comp representiative that this is going to be a "very complicated situation". That statement makes me a little nervous!

    What might my chances be of getting this covered under workmans comp? Is it in my best interest to try to seek legal counsel? Or take a "just wait and see" attitude?

    Any and all opinions would be greatly appreciated!!

  • #2
    Seek council. The initial consultation is usually at no charge. At least that way you will have an unbiased answer and if need be already be lined up with a firm to handle your wc ic.

    Hope you heal well and feel better soon.

    Comment


    • #3
      I just researched this as I had a similar claim not long ago. In 99% of cases, it depends on the degree to which the work injury aggravated the pre-existing condition and whether there is any proof that it was the re-aggravation that caused the problems or something else. Typically the carrier is entitled to a Independent Medical Exam if they doubt the causation. In this case they could argue that they were prejudiced by the fact that they never got the opportunity to have a doctor of their choosing examine you and render an opinion on whether it was the slip that caused the problem with the ligament or not and also whether surgery was required to fix the problem.

      Generally speaking, unless the work injury was so severe that it overshadows the pre-existing problem and or it is obvious that the work injury is what caused the damage (tendonitis pre-existing but then arm broken at work), it is hard to get it covered. Even then, WC is only responsible for the work injury portion of the claim.

      As the others have said, this is one for a lawyer. It is going to be highly situation specific.
      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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      • #4
        Thanks for the responses! I called a lawyer this morning to set up a counseltation. He didn't make it sound like it's as complicated as I think it is.
        I'll keep you posted on what happens!

        Comment

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