WCPI
12-22-2005, 09:57 PM
I posted an inquiry on this some time in October I believe but wanted to do a follow up in case the info helps someone in a similar situation...
A brief synopsis of my case: I was injured over a year ago in a fall on concrete/steel steps during a power outage at work. No emergency lighting came on and in total darkness I fell and fractured my L5. I was overweight and the injury left me unable to do much of anything and I put on another 50#. I tried everything they could offer; 4 – epidurals, multiple pain and muscle relaxer meds, pain patch, PT and aqua PT but nothing helped. My treating physician and the IME doctor both said I would need surgery or would be disabled the rest of my life. I was too heavy for spinal surgery so they both also said the WC carrier should pay for bariatric surgery so I could lose the weight and have the required surgery. When presented to the WC carrier they sent back a two word reply to my attorney; "Absolutely not!" We requested an administrative hearing in November to have a judge decide.
After the work comp carrier obtained local representation and my case reviewed by their attorney they have agreed to the bariatric surgery and the spinal surgery when I have lost enough weight. Apparently their attorney pointed out that they would be paying over 25 years of total disability if I did not receive the surgeries and that is a lot more than a couple of operations to get me on my feet again. I attended an introductory class on the bariatric surgery and I am a very good candidate. I should have the surgery by spring if all goes well.
My posting is just to let others know that this is possible. I was told the bariatric surgery was not the WC carrier’s responsibility by others on this board and by the carrier but they were wrong. Because I cannot receive the surgery I must have to return to a normal life the WC carrier knew that with their own IME doctor (an orthopedic surgeon at that) saying I needed it they would most likely lose the hearing and be required to pay anyway. I waited about 7 months until the work comp carrier denied an epidural injection before I got an attorney but it turned out to be the only thing that helped me. Don’t wait to long to choose one if you need an attorney!
A brief synopsis of my case: I was injured over a year ago in a fall on concrete/steel steps during a power outage at work. No emergency lighting came on and in total darkness I fell and fractured my L5. I was overweight and the injury left me unable to do much of anything and I put on another 50#. I tried everything they could offer; 4 – epidurals, multiple pain and muscle relaxer meds, pain patch, PT and aqua PT but nothing helped. My treating physician and the IME doctor both said I would need surgery or would be disabled the rest of my life. I was too heavy for spinal surgery so they both also said the WC carrier should pay for bariatric surgery so I could lose the weight and have the required surgery. When presented to the WC carrier they sent back a two word reply to my attorney; "Absolutely not!" We requested an administrative hearing in November to have a judge decide.
After the work comp carrier obtained local representation and my case reviewed by their attorney they have agreed to the bariatric surgery and the spinal surgery when I have lost enough weight. Apparently their attorney pointed out that they would be paying over 25 years of total disability if I did not receive the surgeries and that is a lot more than a couple of operations to get me on my feet again. I attended an introductory class on the bariatric surgery and I am a very good candidate. I should have the surgery by spring if all goes well.
My posting is just to let others know that this is possible. I was told the bariatric surgery was not the WC carrier’s responsibility by others on this board and by the carrier but they were wrong. Because I cannot receive the surgery I must have to return to a normal life the WC carrier knew that with their own IME doctor (an orthopedic surgeon at that) saying I needed it they would most likely lose the hearing and be required to pay anyway. I waited about 7 months until the work comp carrier denied an epidural injection before I got an attorney but it turned out to be the only thing that helped me. Don’t wait to long to choose one if you need an attorney!