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Thread: Loss of a thumb

  1. #1
    azgem Guest

    Default Loss of a thumb

    My husband's thumb was amputated below the knuckle in a work related accident two months ago. We've received a few small checks for the time he missed from work. We have been waiting for the "Final Doctor's Report" so that he can start receiving his permanent partial disability payments. My questions are:

    1. Does the state of AZ consider this to be a full or partial loss of his thumb. The statute is very vague. His doctor says that he has a 65 to 70% loss of his thumb. On top of this his doctor told him that since a person's thumb is such an intregal part of your hand that he's putting it down as a 20% total loss of his hand.

    The AZ statute states that if it is a full loss of his thumb that he will receive 15 months @ 55% of his assessed wage. If it is a partial loss he will receive half of the above mentioned reward. But, would the 20% total loss of his hand have any bearing on how much his compensation will be?

    2. How long after State Fund receives the "Final Doctor's Report" do they have to start issuing checks?

    3. Can we request for the entire amount be commuted to a lump sum or would we have to go before the Industrial Commission to do this?

    4. Will State Fund send us retro checks (checks for the past two months he has been without his thumb) or do the payments start from the date that they receive the Final Doctor's Report?

    Any help on any of these questions would be greatly appreciated.

  2. #2
    azgem Guest

    Default

    I'm back again. State Fund is STILL giving us the run around. It has been more than two weeks since my husband received his final injury report from his hand surgeon. State Fund has had his paperwork since 7/15.

    I called the week ending 7/18 and they say they have not yet received his paperwork - or perhaps they did but it had not been "scanned" into the system yet.

    I call the next week, now they have his final injury report which denotes the amount of loss, etc. They tell me that they have to forward it on to their in-house loss committee for approval for permanent partial disability checks to begin being issued. From there, they have to forward it on to the Arizona Industrial Commission for approval. They said the whole process could take up to 90 days.

    Okay, my husband calls his case worker, who is busy and gets handed off to someone else, and is told that all of his paperwork has been sent off to the Industrial Commission. He tried all day to get through to them. I finally had success late in the day and spoke directly to a very knowledgeable person. She said there was no reason why State Fund should have been forwarding on his reports to them. The final determination is made by the insurance carrier. Only if we have a problem with their decision would it go before them. She also said that they had about 30 days after receiving the final doctor's report to issue their decision (not a check).

    I did ask about having the amount commuted to a lump sum and they are sending me the paperwork. There are two catches though: 1). You must prove that you need the money by showing past due bills, etc and 2) You will lose 1% of your settlement. They will be mailing the paperwork to us tomorrow. I would expect this to take at least 2 months before we receive a court date (according to the Industrial Commission's web site). Does anyone know if they have any sort of an "emergency hearing" available for those who are in dire straits? We're 3 months behind on our house and if we don't get caught up soon we're going to lose everything.

    Anyway, after hanging up with the Industrial Commission I called State Fund to speak to his case worker who had already left for the day. The person who answered the phone had no answers for me other than she would leave our case worker a message to call us. She said she did not see any checks scheduled to go out.

    Why all the run around? Why can't they just pay?
    We had a brand new roof put on through our homeowner's insurance faster than this is taking us! Why is worker's compensation insurance so slow compared to other forms of insurance?

  3. #3
    anonymous Guest

    Default

    It's someone else's money; you don't pay the premiums, your employer does.

  4. #4
    anonymous Guest

    Default

    AzGem

    Be careful of your Case Worker and if you have a lawyer why not let him/her make these calls for you? Just a little advise,your Case Worker can only go into the doctor's examining with your husband if he permits it.

    Good Luck

  5. #5
    n.j Guest

    Default

    AzGem

    Sorry, I left out the word room in the above post.

    One Day at a Time.

  6. #6
    azgem Guest

    Default

    At this point I don't feel that we need a lawyer. If we do not receive the compensation letter from State Fund by 8/15 I guess we will have to file a complaint with the Industrial Commission. I'm hoping we'll get a check by the end of this month but somehow, I doubt it.

    In other news, we received the commutation to a lump settlement paperwork from the AZ Industrial Commission. We can't even file this paperwork until we get the final settlement paperwork from State Fund (catch 22 - again).

    Unfortunately, the paperwork makes you state what you are going to use every penny for (ex: Start a new business, Invest, Pay off bills (this was way down on the list incredibly). And, the amount they deduct is 1.32% annum from the total settlement.

    What I don't get are two things:
    1. You're going to get monthly checks no matter what and you don't have to describe what you've done with the money, so why in a commutation should you have to. This is a settlement. If we were injured in a car accident would we have to explain where every penny of the settlement was going to go?

    2. Why the 1.32 annum deduction from the commuted amount. You would think that the insurer would save money by paying out in one lump sum by not having to follow the case for 15 months (employee time, envelopes, checks, postage, etc.).

    What I am worried about at this point is that they will try to rate his injury as a 1/2 loss and not a full loss even though the doctor's paperwork clearly states 70% loss. If this happens we well definitely have to go to court.

  7. #7
    anonymous Guest

    Default

    I would just state that I was planning to bank it and draw off it as expences came forth.

    I would really run this by an attorney, you have valid questions that need answereing. If you go for a consult the visit is usuaaly free and you can get info to direct question. You do not have to enter into a contract with him if you are not ready. Tell him/her you are interviewing a few attorneys to see who you communicate with best.

    edk

  8. #8
    anonymous Guest

    Default

    1. the law only allows a lump sum commutation for specific reasons. In the early days of comp they wanted to protect society from those that "wasted" their comp payment and went on welfare.

    2. If your calculate the interest and investment income you'll worth more then stamps or envelopes, etc.

  9. #9
    azgem Guest

    Default

    We've decided to not commute the amount to a lump sum settlement. What we were hoping to do with the money was to get a few months ahead on our bills in case something were to happen in the future (another injury, loss of job, etc.).

    Has anyone else in this forum had problems with State Fund paying out on Permanent Partial Disability payements? I'd like to hear other people's stories and what they had to go through to start getting compensated.

  10. #10
    azgem Guest

    Default

    I'm back again. I spent all day yesterday on the phone with various representatives of State Fund. Each gave me a different answer as to why there had been no movement on my husband's case.

    I finally got through to the assistant to our case worker who said that they were waiting on further paperwork from the hand surgeon. They needed something stating that he had been discharged from medical care (we received a notice from State Fund the week ending 7/25 stating that his medical benefits had been cut off and that his permanent partial disability payments were still being determined). They said they sent the doctor a letter on 7/30/03. As of yesterday 8/5/03 the doctor's office had received nothing from them. It doesn't take the mail that long to go from Phoenix to Scottsdale.

    I called the hand surgeon's office and spoke directly with his nurse. She said the paperwork (AMA disability form) is all they have EVER had to send in for a case like this and that they had not received any letters from State Fund regarding the need for further paperwork.

    I did a little research and went to the Secretary of State's web page in regards to workers compensation injuries. The AMA document is one requirement but the doctor must also fill out a statement of how he came to his conclusions about the disability ratings. I guess this is the piece of paperwork that is holding up the whole thing. I faxed over the statute to the hand surgeon's office and they promised to have the paperwork completed as of today.

    After hanging up with the hand surgeon's nurse, I once agian tried to get in touch with my husband's case worker - only to get her voice mail again. I left a message stating that we need to be kept apprised of what is going on with his case and that at this point we were ready to hire an attorney and file a bad faith claim with the Industrial Commission if some movement wasn't made soon on his case. I told her I expected a return phone call before 5 p.m. at my work number so she could tell me exactly what was holding up the case. I received no call. Big surprise there.

    It seems like every time we call we get a different answer from the idiot on the other end of the phone with State Fund. Do they have a list of excuses they go down each time you call and do they ever run out of them?

    It's particularly aggrivating because this is a simple case. My husband lost 70% of his left thumb. Per AZ statute this is a scheduled injury which would pay 55% of his established wage for a period of 15 months. It's not like a back, shoulder or more difficult injury. This is a simple amputation. What's so hard about getting this case through?

    I know everyone keeps telling me to get an attorney but we really don't want to pay someone 25% of his settlement for doing the same things I'm doing (calling to check on his case, gathering medical records, etc.).

    Anyone else been through a battle with State Fund and how did it end?

    Thanks for letting me rant again.

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