knee pain
04-08-2004, 07:31 PM
shoreline, I was injured at work, settled my case but had the right to reopen it if I needed more care due to the initial injury. I reopened my case 10 years later and they, after going back to court, are paying for any of my medical bills (surgery, medications, pt ect). You said on another post that you no longer have coverage thru wc for meds, why not? Is it different with different states? I have no coverage for lost time from work because I settled my case but all my medical bills are being paid. Just wonderin' . (you don't have to reply if I am being too intrusive.)
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Shoreline
04-10-2004, 10:39 AM
Hi KP, Things are different from state to state, For example,If you live in FLA No matter what the injury, say your paralyzed by a work accident, IF your covered under the interstate workman's comp program the absolute most you could ever recoup in lost wages is 5 years, It's actually 3 years but you can request a hearing to extend out to 5 years. So if your paralyzed, medical may be covered indefinitely depending on the settlement agreement but lost wages would only be covered for a max of 5 years and it's only 2/3 at that.
In VA where I live, we have 6 different comp programs that fall under different categories of work. The interstate system, the one I was covered by would only cover lost wages for a max of 10 years regardless of the injury, State and fed workers each have their own system, Postal workers have their own, Longshoreman have their own system and people in private shipping industry fall under the Jones act.
So it really depends on the type of work you do as far as what the limitations of benefits are. In my case, once I settled and the 2 years had passed I had no recourse although a lot of the decision to settle was based on false info provided by the comp docs themselves. After the 2nd surgery "fusion" I was told it was solid, fusion was fine etc etc. I shouldn't be in pain and wouldn't need additional surgery.
That's not quite how things worked out but considering the circumstances, not being able to work and comp withholding my salary I was squeezed into a settlement hoping just getting out of the comp system would improve the care I received and reduce the stress level of constantly being told I was fine when I wasn't and being called a drug seeker when that fusion never grew at all.
When they went back in to revise and replace the broken hardware, none of the fusion had taken and all the remaining donor bone that hadn't been reabsorbed had to be flaked out like dry fish in order to start from scratch.
I can't really blame the docs for being wrong about my fusion being solid and alive, because there isn't a single test known that will tell you if the donor bone is alive and growing or dead and just sitting there. MRI don't show, CT's don't, Bone scans won't tell you, so they based their success on the initial X-rays of flexion and extension when the hardware was still in in tact. I can be angry that they put more belief into a black and white film than actual patient reporting.
The hardware didn't move under flexion and extension X-rays so the fusion was called a success. That was their theory.
In actuality, I crunched and squeaked and had severe pain but there isn't a test that validates pain either so once again, Everything was based on comp docs opinions and Xrays before the hardware snapped. If they don't give the opinions employers insurance companies want, they won't keep their lucrative comp contract long. So every one gets better, all surgery is successful and everyone is returned to work regardless of what the patient says.
If your in the comp system just be careful of taking a comp docs word that you are fine, It's their job to tell you that your fine and don't need any expensive therapy,testing, surgery or medication. You were fortunate to be able to reopen a comp case, It's something that won't happen under the comp system I was covered by.
I appreciate the heads up, but things are very different from state to state unless you are a fed or postal worker.
Take care, Dave
In VA where I live, we have 6 different comp programs that fall under different categories of work. The interstate system, the one I was covered by would only cover lost wages for a max of 10 years regardless of the injury, State and fed workers each have their own system, Postal workers have their own, Longshoreman have their own system and people in private shipping industry fall under the Jones act.
So it really depends on the type of work you do as far as what the limitations of benefits are. In my case, once I settled and the 2 years had passed I had no recourse although a lot of the decision to settle was based on false info provided by the comp docs themselves. After the 2nd surgery "fusion" I was told it was solid, fusion was fine etc etc. I shouldn't be in pain and wouldn't need additional surgery.
That's not quite how things worked out but considering the circumstances, not being able to work and comp withholding my salary I was squeezed into a settlement hoping just getting out of the comp system would improve the care I received and reduce the stress level of constantly being told I was fine when I wasn't and being called a drug seeker when that fusion never grew at all.
When they went back in to revise and replace the broken hardware, none of the fusion had taken and all the remaining donor bone that hadn't been reabsorbed had to be flaked out like dry fish in order to start from scratch.
I can't really blame the docs for being wrong about my fusion being solid and alive, because there isn't a single test known that will tell you if the donor bone is alive and growing or dead and just sitting there. MRI don't show, CT's don't, Bone scans won't tell you, so they based their success on the initial X-rays of flexion and extension when the hardware was still in in tact. I can be angry that they put more belief into a black and white film than actual patient reporting.
The hardware didn't move under flexion and extension X-rays so the fusion was called a success. That was their theory.
In actuality, I crunched and squeaked and had severe pain but there isn't a test that validates pain either so once again, Everything was based on comp docs opinions and Xrays before the hardware snapped. If they don't give the opinions employers insurance companies want, they won't keep their lucrative comp contract long. So every one gets better, all surgery is successful and everyone is returned to work regardless of what the patient says.
If your in the comp system just be careful of taking a comp docs word that you are fine, It's their job to tell you that your fine and don't need any expensive therapy,testing, surgery or medication. You were fortunate to be able to reopen a comp case, It's something that won't happen under the comp system I was covered by.
I appreciate the heads up, but things are very different from state to state unless you are a fed or postal worker.
Take care, Dave