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    Old 12-24-2004, 12:55 AM   #1
    Michale
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    A Workman's Comp Issue (Very Long)

    Hello. New here to this forum and I have a problem. Actually, I think I have several problems and frankly, I do not know where to turn. I wasn't even sure if this was the proper forum for my question.

    But here goes. Please bear with me as to the length of this. I want to be thorough in my description as to what has transpired.

    This is a Workmans Comp case. I work at a distribution warehouse in Florida. My job was to receive merchandise into the warehouse, restack it on other pallets and then move it to a staging area to be stocked. The work involved repitive lifting of sometimes very heavy boxes and items, sometimes in excess of 50-60 lbs. Quite a bit of this repitive lifting required over head lifting. This occurred 5 days a week for 10-12 hours a day. I am employed since 1 Jan of 2003

    My official date of injury is 23 Oct 2003. In the week or two prior to this date, I had many sleepless nights due to arm pain. I would wake up from a sound sleep (often induced with the aid of Tylenol PM(s) and my shoulders and arms would ache incredibly hard. In the days leading up to the official date of injury the pain became unbearable and it was not just during the night and not just confined in my shoulders and arms. I would have shooting pains down thru my wrists into my hands and my hands would become numb. On the morning of the 23rd of Oct 2003, I called into work and told them I would be seeing a Doctor that morning. My regular health care provider.

    After some tests, it was concluded within a day or so that I had Carpal Tunnel of both hands. W/C insurance carrier set me up with an Orthopedic Clinic in another town approx 60-70 miles away. During the course of seeing them (every six weeks or so for 4-6 months or so) the whole gambit of treatment for carpal tunnel. First the hand splints were tried. No luck. Then they tried cortisone-like shots into my wrists. Nope. Didn't help. Finally, they tried a cortisone like shot into my elbow that was giving me particularly bad trouble at that time. (Interestingly enough, that very evening, I developed what was later diagnosed as a Lipitoma Tumor on my right shoulder about the size of an egg. The same side that the cortisone-like shot was given in my elbow. I was told that they could not possibly be related.)

    In any case, after six months or so of seeing this doctor the pain grew steadily worse. Although I was placed on work restrictions, my employer violated the work restrictions daily. And when I mentioned this to the doctor he was of the opinion that the treatment of the time should fix the problems and more restrictions would not be required. When none of the treatments he had done, he simply stated he has done all he can do and wrote up a statement placing me at 30% disability due to Carpal Tunnel.

    At the same time, I had requested (and was granted) a switch to a new doctor that was closer to my home. Although my dates are schetchy, I believe we are now in Jun or Jul of 2004. Keep in mind, this has been going on since Oct of 2003. The new doctor looked at the Nerve Conduction tests and did confirm that I had bad carpal tunnel in my right hand and worse carpal tunnel in my left hand. But the symptoms I had did not seem to match up. At this point, I was experiencing shooting pains from my fingers on up thru my wrists and elbows and into my shoulder and neck.
    The doctor took me off work status completely and he ordered and MRI. Lo and behold, it was discovered that I had a tear in my rotator cuff.

    A surgery for the carpal tunnel on the right hand and to repair the tear in the rotator cuff was scheduled for the first week of October 2004. That was almost a year from the date of original injury. I was still off of work status. Along about mid Sep of 2004, I received a call from my employer telling me that the doctor had okayed a return to work under very restrictive conditions. Basically, I was not allowed to lift anything at all with either hand. I thought it kind of strange that I would be asked to return to work just a couple weeks before my surgery. I had gotten the impression that my doctor was being pressurred by the insurance company to get me back to work so that they (Insurance company) would stop having to pay me disability. But that is just my opinion based on what I observed.

    My dutys upon returning to work was to simply walk around the warehouse and do "quality control" (I place that in quotes, because this is nothing but busy work for the workman's comp people) I was not to lift anything. I was constantly walking for 10, 12, sometimes 16 hours a day for that couple weeks. Sometimes I logged as many as 25-30 miles of walking a shift. This was verified via a pedometer that I wore. During all this walking a very strange thing happened on my right arm. During the duty shift, my hand would swell up noticibly, would become a very dark purple with red splotches, was very cold to the touch and ached considerably. As the shift wore on, aches and pains would develop in my elbow and shoot up thru my shoulder into my neck. This got so bad on one occasion that it necessitated a trip to the emergency room. They could not figure out why my right arm was like that, even with the torn rotator cuff and it has remained a mystery to this day.

    I stuck it out for the couple weeks and then reported for my surgery. I found out that day that the W/C Insurance carrier had OKed the Rotator Cuff surgery, but did not OK the carpal tunnel surgery. The doctor's office stated they would keep trying to get an OK and, I assume they did, because they went ahead and did the carpal tunnel surgery in addition to the rotator cuff surgery. Everything went OK. The doctor told my wife after the surgery that the tear in my rotator cuff was rather large and he had to secure it to the shoulder bone with a metal pin. That is a layman's interpretation of what was said. Any errors are my own.

    So, I had the surgery and started physical therapy the following week. I must backtrack here a little and state that the plan, as I understood it, was to do the carpal tunnel and rotator cuff surgery first and when that was healed, we would do the carpal tunnel surgery on the left hand. We're at mid Oct of 2004 right now.

    Upon going to PT for the first time, I was told that the W/C carrier would not authorize any PT for the carpal tunnel. Only for the rotator cuff. I thought that strange, but hey.. OK..whatever... So I went thru PT for 6 weeks. Had my post op appt with the doctor and he said everything looked good and to continue the PT. PT was going ok until we hit a snag. At 8 weeks or so, I developed moderate to severe pain on certain motions of my arm. I was told this was likely due to scar tissue that had developed on the muscle and it was being inpinged by the shoulder blade (again, this is my layman's understanding of what has occurred). It has gotten so bad that I can barely move my arm under it's own muscle without sever pain in the shoulder and elbow area.

    I relayed this info to the doctor on my next followup appointment that was on or about 15 Dec 2004. He said it was OK and I would just have to work thru it, thru PT. We also tentatively scheduled a Pre OP appt for the surgery on my left hand (carpal tunnel) for the first or second week of Jan 2006.

    On 16 Dec 2004 (the morning of a PT appointment), I was contacted by my PT office and was told that the W/C Carrier has been contacted on several occasions and had not returned calls to authorize further PT visits. Therefore they would not be able to continue my PT until such time as the Insurance Carrier authorizes more visits. It is now 24 Dec and I have yet to hear about any rescheduled PT visits.

    To bring this long diatribe to a close, I was contacted by my employer on 22 Dec at approx 1700hrs and told that the doctor had authorized my return to work under the previous restrictions (no use of my hands at all) I was to report to work the following day at 1130 hrs on 23 Dec. Even though I am less than two weeks away from another surgery. The job was the same. Walking the warehouse doing "quality control". And the same thing happened with my right hand and arm. It turned purple with red splotches, swelled up noticibly, was cold to the touch and was aching.
    I got home about 2130hrs and went straight to bed, but could not sleep due to the ache in my hand and arm on my right side and severe ache in my upper legs and thighs. I took some medication that should have knocked me right out, but here I am at 0340 hrs wide awake.

    Since it does not appear that I will be able to avail myself of PT anymore, I am afraid that I will never have proper use of my right arm. Because of that, I will be resigned to doing this busy work job that is murder on my upper legs. I am 42 years old and not in the best of shape (much to my chagrin) and walking 25-35+ miles a day for the rest of my employment does not look like too much of a bright future.

    I am not sure how I should proceed. I really don't want to go a legal route. I don't even know if what has transpired would allow that route. I do know that my job now is so far beneath what I was doing prior to my injury and on a completely different shift besides. It's like a day-shift executive being reduced to doing janitor work on the midshift.

    Do I have an rights or options here, other than just grinning and bearing it or quitting and finding other employment? The company has good benefits otherwise and I would not wish to lose those. Plus I am not sure how my W/C case would be affected if I moved to other employment.

    Any advice anyone can give would be most appreciated.

     
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    Old 12-24-2004, 09:54 PM   #2
    Terri43
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    Re: A Workman's Comp Issue (Very Long)

    I have been dealing with florida W/C for 6 months. I hurt myself at work and herniated 2 discs in my neck and 1 in my back. They sent me to their doctors and all 3 said surgery which by the way took 4 months to get the neuro approved. Then they denied the surgery. I got a lawyer. They are fighting me all the way. and trying to drive me nuts and doing a good job at that. Sometimes I think the guy from W/C is the devil... and when this is all over I intend to file a formal complaint with the insurance commisioner.All I wanted was to get back to work. now I have lost my insurance at work and when I get signed off to go back to work I don't think they will keep me. They gave me a wonderful christmas gift ( nothing ) I haven't even had a phone call in 6 months to see how I was feeling. Anyway sorry for the rant just sometimes I have to get things off my chest. I would talk to a lawyer. the first visit is free. what part of florida?

     
    Old 12-25-2004, 09:35 AM   #3
    Michale
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    Re: A Workman's Comp Issue (Very Long)

    Thanx for your input and I definitely feel for you. I am in North Florida.

    One thing that I have learned is that there is no Workman's Comp insurance per se... It is simply an insurance company that handles Workmans Comp injuries. In my case, it is Traveler's Insurance. Out of Orlando, I believe.

     
    Old 12-25-2004, 04:36 PM   #4
    Sandson
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    Re: A Workman's Comp Issue (Very Long)

    I am going through a whole lot of WC drama. Speaking from expereince, I can't empahsize enough to get you to get a WC Attorney ASAP and a damn good one otherwise these WC Insurance Companies/MC)'s will treat you like crap if you let them.

     
    Old 12-26-2004, 06:43 PM   #5
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    Re: A Workman's Comp Issue (Very Long)

    Amen to that!!! I am living proof of them doing their dirty deeds!! They have messed with me for going on 6 years!! Thank God, I still have my job, they just moved me to the office where I wouldn't have to do repetitive work anymore. But when I first started having problems, they wouldn't approve the surgery on my ulnar nerve and carpal tunnel until a year after it started bothering me. My doc told me that if I had the surgery done when it was diagnosed, that I may not have had as much nerve damage. Work Comp people are so evil!! To you Michale, I'd hire an attorney ASAP!! Or you'll end up with nothing plus all your hurting to go along with it. I'll keep you in my prayers because I know what you're going through!! God Bless!!

     
    Old 12-28-2004, 04:49 PM   #6
    mander
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    Re: A Workman's Comp Issue (Very Long)

    Most attorney's will do a consultation for free. You may have a couple of options about getting your claims paid. Do you have health insurance? Sometimes health insurance companies will pay if wc denies. Also, have you gone to your employer about your unpaid bills? Getting them on board may help. Find out if your company is "self insured" for wc or health ins. That means they pay the money out of their own pocket and they are essentially the ones not paying the claims. Finally, it doesn't hurt to get the state's commissioner of insurance involved. Most have websites that will guide you through the process of filing a complaint.

     
    Old 12-29-2004, 10:33 PM   #7
    Sandson
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    Re: A Workman's Comp Issue (Very Long)

    Quote:
    Originally Posted by mander
    Most attorney's will do a consultation for free. You may have a couple of options about getting your claims paid. Do you have health insurance? Sometimes health insurance companies will pay if wc denies. Also, have you gone to your employer about your unpaid bills? Getting them on board may help. Find out if your company is "self insured" for wc or health ins. That means they pay the money out of their own pocket and they are essentially the ones not paying the claims. Finally, it doesn't hurt to get the state's commissioner of insurance involved. Most have websites that will guide you through the process of filing a complaint.


    I agree with most of Mander has stated. However, it is very unlikely that your health insurance would pay for a WC related medical related claim and would only complicate things in your case. Your best bet is to secure a good WC Attorney and find out what kind of WC Insurance packaage your employer is carrying is getting your case on the road and file immeadiately.

    Last edited by Sandson; 12-29-2004 at 10:35 PM.

     
    Old 01-01-2005, 09:25 AM   #8
    Michale
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    Re: A Workman's Comp Issue (Very Long)

    Thanx to everyone for all of the advice. Things have transpired in the last couple days since I posted that have convinced me that this has to enter the legal arena.

    I found out from my employer's HR rep that the W/C insurance company will deny the second surgery to my left hand and will be seeking a "second" opinion. I explained to the HR rep that this is actually the THIRD opinion regarding my carpal tunnel. The rep shook her head and said that the other opinions were for my right hand and this "second" opinion is for my left hand. I told her this was not accurate. There is company paper work from many months ago that state that the issue with my injuries is "both wrists". So they will not be able to claim one opinion is for one wrist and THIS opinion is for the other.

    My concern here (well, one of them) is that a third opinion will require a third Nerve Induction test. For those of you that have had to endure such a test, you will understand my desire NOT to have a third one. It is 20-30 minutes of the most painful time you can imagine. I would rather go thru a root canal without anesthesia than to do another Nerve Conduction test. Can they FORCE a third opinion like this? Force me to go thru a third Nerve Conduction test? The first Dr said I was 30% disabled. The second Dr said I needed surgery. Now the insurance company wants a THIRD opinion? What are they doing? Doctor shopping until they find a doctor that says I am perfectly healthy?

    Again, thanx for all the advice.

     
    Old 01-05-2005, 08:38 AM   #9
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    Re: A Workman's Comp Issue (Very Long)

    W/C insurance will try to pull what ever they can to try not to pay. believe me I have been dealing with them for over 6 months. all they have done is deny everything. and 3 of their own doctors have said that surgery is the only thing that will fix my problems. good luck and I'm glad you got a lawyer.

     
    Old 01-07-2005, 12:20 AM   #10
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    Re: A Workman's Comp Issue (Very Long)

    I have been a Workers Compensation insurance Adjuster for the past 13 years. I completly understand what you are saying. That is why I recently quit my job, with no job to go to. Have been unemployed for 1 week. I am a mother of 2 children, and can not sleep at night, because of the horrible job/career that I feel into. I was a Senior Workers Comp Claims Adjuster. Handling all sorts of claims, just like yours. Unfortunatly, I have been through at least 8 employers in my 13 years of expierance trying to find an employer, with the same morals that I have.
    Guess what.....there is not an Insurance Co. out there that represents the same morals that I have.
    My job was to control claim costs. In doing that, you have to get 2nd opinion's until they say what the bosses what to hears. Have surviellance done. Always having to second guess the need for further treatment, as it appears to be medically unreasonable and/or necessary to the injury.
    The Insurance Carriers are working on cost control. Your employers will help push you back to light duty, in any position, just to control thier Work Comp Ins. Premium. The doctors can prolong treatment and soak up lots of $$$$. Lawyers are looking for the money.
    Who is helping the claimants? Who is helping you???
    My advice..... before seeking legal councel, contact your State's Workers Comp Commission and discuss your complete case. Try to work as your own W/C adjuster, advocate, before seeking an attorney. If all else fails, then legal councel is what is next.
    * Insurance Companies reasons for disputing treatment: Pre-existing condition; Unrelated to compensable injury; Natural disease of life; Natural process of aging, not related to injury; intervening injury; Treatment no longer reasonable and/or necessary, as compensable injury is resolved; Maximum Medical Improvement. *

    *** It is a constant battle to get and maintain Work Comp Benefits. ***

    More advice: Stay on your doctor. Get him to document heavily the nature of the injury related to the accident; treatment options; treatment plan; what he plans to do if option A or B does not work. Ins. Co. gets the medical records, and will know what is going on. Keep copies of your medical records. You will need them.
    Insurance Co. will tend to fight more when your doctor is not properly documenting treatment goals, plans, options, etc. Because that is when they need a 2nd opinion, because your doctor is not giving them any information.

    Im sorry.....this could go on forever. I really wish you the best of luck, and I hope that you are able to get the medical treatment needed for your relief.
    * Keep fighting for yourself!

     
    Old 01-07-2005, 04:36 PM   #11
    Michale
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    Re: A Workman's Comp Issue (Very Long)

    Well, an interesting turn of events have transpired...

    I met with an attorney today to discuss my issues. While I was waiting for the attorney to show at the local SUBWAY, where we had agreed to meet. I had my paperwork all in order in two large file folders on the table in front of me. Before the attorney showed up, one of my supervisors happened to show up and saw me there. I am sure he was able to discern my reason for being there.

    The attorney showed up, we had our meeting and then the attorney dropped me off at work. This was about 1500 hrs or so. My shift did not start until 1630 hrs, so I hung around the breakroom and read a book.

    I punched in at 1630hrs and went about my shift. Along about 1830 hrs, I was called in to the head honcho's office and the same supervisor that saw me at Subway, fired me. The said that I had not used proper procedures when I called in sick the previous day.

    The interesting points are :

    1. I was fired the same day I spoke to an attorney.
    2. I was fired by the same supervisor who saw me waiting for my attorney.
    3. If I was really being fired for an alleged transgression that occurred the day before, why did they wait 3.5 hours before firing me? Surely the termination paperwork could have been done and presented before I even clocked in for the day.

    Needless to say, I am somewhat perturbed by these developments. I have a feeling that this is definitely headed for the courts.

    One question I have w/ regards to Workmen's Comp. Is my injury still covered? Now that I have been terminated, I am assuming I cannot collect disability anymore. But I cannot see how I can do a work search to meet the requirement to collect unemployment. I doubt there are many jobs I can get that do not require any use of my hands or arms.

    I am not sure how to proceed here and any advice would be most appreciated.

     
    Old 01-08-2005, 10:18 PM   #12
    Sandson
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    Re: A Workman's Comp Issue (Very Long)

    Quote:
    Originally Posted by Michale
    Well, an interesting turn of events have transpired...

    I met with an attorney today to discuss my issues. While I was waiting for the attorney to show at the local SUBWAY, where we had agreed to meet. I had my paperwork all in order in two large file folders on the table in front of me. Before the attorney showed up, one of my supervisors happened to show up and saw me there. I am sure he was able to discern my reason for being there.

    The attorney showed up, we had our meeting and then the attorney dropped me off at work. This was about 1500 hrs or so. My shift did not start until 1630 hrs, so I hung around the breakroom and read a book.

    I punched in at 1630hrs and went about my shift. Along about 1830 hrs, I was called in to the head honcho's office and the same supervisor that saw me at Subway, fired me. The said that I had not used proper procedures when I called in sick the previous day.

    The interesting points are :

    1. I was fired the same day I spoke to an attorney.
    2. I was fired by the same supervisor who saw me waiting for my attorney.
    3. If I was really being fired for an alleged transgression that occurred the day before, why did they wait 3.5 hours before firing me? Surely the termination paperwork could have been done and presented before I even clocked in for the day.

    Needless to say, I am somewhat perturbed by these developments. I have a feeling that this is definitely headed for the courts.

    One question I have w/ regards to Workmen's Comp. Is my injury still covered? Now that I have been terminated, I am assuming I cannot collect disability anymore. But I cannot see how I can do a work search to meet the requirement to collect unemployment. I doubt there are many jobs I can get that do not require any use of my hands or arms.

    I am not sure how to proceed here and any advice would be most appreciated.
    From the looks of it, you not only need the council of your WC attorney but you also need to retain a employment attorney as well. Your termination was done in retalialation of you filing for WC and thats illegal. Don't get me wrong, I am no legal expert but it sound like you may have a good case on your hands.

     
    Old 01-08-2005, 10:55 PM   #13
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    Re: A Workman's Comp Issue (Very Long)

    I agree! Legal councel is needed at this point.
    That should not have happened.

    Your termination should not effect your actual workers comp claim at all. They are 2 seperate issues. But legal councel will help you with this.
    I agree with an employment lawyer as well. I do no not feel you have been treated fairly at all.

    Good luck

     
    Old 01-08-2005, 11:31 PM   #14
    Sandson
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    Re: A Workman's Comp Issue (Very Long)

    Quote:
    Originally Posted by Renee123
    I agree! Legal councel is needed at this point.
    That should not have happened.

    Your termination should not effect your actual workers comp claim at all. They are 2 seperate issues. But legal councel will help you with this.
    I agree with an employment lawyer as well. I do no not feel you have been treated fairly at all.

    Good luck

    Renee:

    Michale definetely not only has a good WC case but a wrongful termination lawsuit as well.

     
    Old 01-09-2005, 05:59 AM   #15
    Michale
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    Re: A Workman's Comp Issue (Very Long)

    Quote:
    Originally Posted by Sandson
    From the looks of it, you not only need the council of your WC attorney but you also need to retain a employment attorney as well. Your termination was done in retalialation of you filing for WC and thats illegal. Don't get me wrong, I am no legal expert but it sound like you may have a good case on your hands.

    I was going to mention that. When I relayed this news to my attorney he said something along the lines of that they are just handling the W/C lawsuit. Which made me think that I will have to get another attorney to handle a wrongful termination suit.

    Is it a conflict of interest for the same attorney to handle both?


    Michale

     
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