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  • Denied in MA

    Just received letter of denial of benefits from the State today. Here's the short of it:

    In a law enforcement Academy(State), during a mandatory physical fitness run, on a Thursday my knee gives out. I don't initially say anything as the environment is not one where complaining is good. I "suck it up" for a day, Friday, knee starts to swell, more pain, etc. Saturday I can't take it anymore as I can hardly walk correctly. ER puts me in a immobilizer, inflamation meds, see an Orthopedist on Monday. MRI show meniscus has degenerated, Effusion, etc. Doc orders office work only, which is not possible at an academy. This is the third week, still resting knee, as prescribed, doing PT exercises(light), letter comes today.

    State claims: No injury occured, Injury did not happen while employed, no casual relation with disability and injury.

    Lawyer time I'm guessing. Typical from a State agency? Anyone have simular experience or guidance? All info is welcome, thank you in advance. I figured it was an easy WC case, at the very least discharge me from class and put me in the next one they run...silly me.
    Last edited by Burner1; 10-06-2007, 09:06 AM.

  • #2
    Burner are you already certified and this is simply a physical fitness run/test to make sure you are keeping up to snuff? Or is this the training academy and you haven't yet POST certified? Are you on the payroll while participating in this mandatory PF run?
    Information posted by me is my "OPINION". I do NOT give legal advice to anyone as like most here I am NOT an attorney.

    Comment


    • #3
      This is a training academy, this has nothing to do with POST certification, as most LE agencies in MA are not POST certified anyways. Yes, I am a paid employee according to my job classification while in the academy, at my position rate. I'm actually certified in MA as a PO, but that was years ago. I changed LE careers more in tune to my educational background. This is more for a treatment position than actual law enforcement, but here in MA, we still have to go to an agency academy, even if we went to an academy for a different LE position (i.e Municipal Police, State Police, Dept. of Corrections).
      Last edited by Burner1; 10-06-2007, 03:51 PM. Reason: spelling

      Comment


      • #4
        OK Burner thank you for clarifying. I was not aware that POST wasn't a universal criteria for LE. Given that you were a paid employee and injured while participating in a work related activity your employer's insurance company should be responsible for paying you benefits for your injury. Don't matter if it is a private employer or state agency nor if they are self insured, (most state run agencies are), or not. They are most likely on the hook for your injury.

        You would be wise to consult with several attorneys that are board certified WC specialists. Do your homework and check out any attorney you intend to sign a contract with. PI attorneys "might" be certified as a WC specialist and then again they might not be. One size does not fit all so to speak. Having trial experience as a WC specialist is a very important attribute for a WC attorney to have. You want to find the best attorney possible to represent you when your employer or their insurance company attempts to shirk the responsibility of taking care of your injury. Do NOT put off hiring an attorney if that is what you plan to do as your are working against a ticking clock for filing a claim or appeal is concerned. If you were to run out of time, exceed SOL, you will surely be SOL.

        By the way if they try to pull the pre-existing crap on you don't buy it. Even if you had an old injury that was aggravated during this mandatory training it is still covered as a new injury. The difference comes in when PPD is rated. Any preexisting damage will be apportioned and you will only be paid for what "new" damages exist. Medical treatment on the other hand is NEVER apportioned.

        Good Luck to you Burner.
        Last edited by Kick Me; 10-06-2007, 04:10 PM.
        Information posted by me is my "OPINION". I do NOT give legal advice to anyone as like most here I am NOT an attorney.

        Comment


        • #5
          Actually, in a case where there was nothing work related that caused the knee to go out (didn't trip on anything or step in a hole) it is far from obvious it will be covered by WC. In fact, the odds are it will not. It is the same as someone passing out at work from low blood sugar. It wasn't work that caused it, it was a personal medical condition. In order to be covered, the injury must arise out of and occur in the course of employment. While this would meet the "course of employment" standard, it does not appear to "arise out of" employment. It wasn't the running that caused your knee to give out, it was the degenerative condition of your knee.

          You can run it past a lawyer if you like, but getting it covered is iffy at best. Ideopathic events are pretty hard to get covered under WC.
          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


          • #6
            Just an fyi...

            Guess the insurance company figured on me not fighting (which the majority don't).

            Because I had no previous history of injury, added to the physical demand of "thier" mandatory training program, it is being considered an "on-the-job" injury and awarded my compensation. The degeneration was argued, but the counter argument was their program exaserbated the condition, which in the normal course of my "specific" duties, would have never occured.

            Thanks for the responses...

            Comment


            • #7
              These situations are always a gamble. I've had nearly identical scenarios where it was denied even on appeal. If the medical evidence was that this was caused by the program, then it was the right decision. I'm glad it worked in your favor.
              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


              • #8
                ElleMD,

                I guess that's the point, the insurance companies have the deck stacked in their favor. They "gamble" that most won't even fight it, and the one's that do, they have just a good a shot at winning. They have nothing to lose. The corporate lobby has crushed the workers rights. If there were a chance that an employer could be fined, say $25k, for indiscriminately denying a workers claim, they may think twice about it. Wishfull thinking...

                Comment


                • #9
                  A decent number of states do have provisions to sanction employers, insurers and their attorneys if they deny an obvious claim. Actually, I'm not aware of any state that does not have such a statute. There is a difference though between a claim that is questionable due to the nature of the incident or because of differences of medical opinion and one that is denied for no good reason. For the former, there is the WC adjudication process which is much faster and lower cost than court, and which is available in every single state to provide a neutral third party decision on whether or not the claim should be covered. In the latter, there are repercusions, though they vary by state.
                  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


                  • #10
                    Burner, Congratulations on hanging in there and standing up for what you believed to be right. Good for you for seeing it through. It is not at all uncommon to have the IC's determination overturned once the facts of the claim are brought to light. You are very right in your analysis of most people just aren't willing to put up a fight with the IC. That is what the IC's bank on when they deny an otherwise obvious work related injury claim. When someone sustains an injury be it off the job or on the job they are usually very vulnerable.

                    [B] A select few, certainly not a huge portion, of WC IC's prey on the injured workers vulnerability. It is a total disgrace to humanity, IMHO, for them to even attempt to deny a legitimate claim least of all when they get away with it due to the IW simply not having the strength to fight it out with them. Unfortunately by the time most IW's are healed and might otherwise be in a position to bring the IC's to task the SOL have run on the claim and they are simply left in the lurch. Many IW's have no idea that a WC attorney can not charge the fee up front and that they work on contingency.

                    At any rate I am very pleased to hear that you have gotten your WC claim approved, I am just sorry you had to fight for what you were entitled to all along.
                    Information posted by me is my "OPINION". I do NOT give legal advice to anyone as like most here I am NOT an attorney.

                    Comment


                    • #11
                      A select few, certainly not a huge portion, of WC IC's prey on the injured workers vulnerability

                      What a crock. Most WC IC's prey on vulnerable injuried employees. That's how they freaking stay in business and make a profit. That's the very nature of the insurance business.

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                      • #12
                        If there was an underlying instability in the knee (a pre-existing condition), then all WC would be responsible for was to return the knee to the previous condition. It would not include totally fixing the knee better than it was before you started training.

                        I just dealt with one of these with an employee with degenerative disk disease which was aggraveated by her work. Our WC covered it until she was back to the condition it was prior to being aggravated. She will eventually need surgery but thats due to the aging process and wont be covered by WC for that portion.
                        I find that the harder I work, the more luck I seem to have.
                        Thomas Jefferson

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                        • #13
                          Morgana how would one be able to determine what the condition of the knee was prior to the injury so as to know when he was restored to previous condition? It is my understanding, for most states WC laws, that medical treatment can not be apportioned like the PPD is.
                          Information posted by me is my "OPINION". I do NOT give legal advice to anyone as like most here I am NOT an attorney.

                          Comment


                          • #14
                            There was never any evidence of any kind of a pre-existing condition. Most of medical history(very short) was well documented. Not to mention that their doctor and fitness specialist cleared me well before any of this became an issue.

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                            • #15
                              Originally posted by Kick Me View Post
                              Morgana how would one be able to determine what the condition of the knee was prior to the injury so as to know when he was restored to previous condition? It is my understanding, for most states WC laws, that medical treatment can not be apportioned like the PPD is.
                              Very often the doctor can tell from the reports and images what conditions have been there for some time and what is a new injury. There are certain things that just can't be caused by a traumatic event and other indicators that the condition has been in existence for some time, as opposed to recent.
                              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

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