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  1. #1
    Join Date
    Sep 2007
    Posts
    2

    Question Herniated Disks, SAIF and Settling

    Ah!

    We need some advice! My husband hurt his back lifting a refrigerator, two herniated disks, a muscle strain.. Saif denied the claim for the disks (really can't believe that), he has been to so many doctors, now we are trying to figure out what to do!! We are waiting to see what they might offer him as far as settling, but with the disks being denied, what would they really offer? We don't get it. ANd our lawyer is never available, only his assistant.

    We're wondering what other people have experienced? Should we take them to court? How do we afford that? We are falling more and more behind on everything, how would we pay to have all the reports and things done to take them to court? Does anyone have any advice on this? Anyone have a similar experience? Even our claims adjuster (at SAIF) personally recommended that we take them to court... Our lawyer said it only really makes sense to take them to court if you think you want to have surgery or will have major medical expenses later?

    Any advice/tips/ etc would be much appreciated! THANK YOU!

  2. #2
    Join Date
    Mar 2007
    Location
    Georgia
    Posts
    1,930

    Default Re: Husband's herniated disks, SAIF and settling??

    There should be no expense to you upfront for "taking them to court". What kind of lawyer do you have? IF you attorney is not a board certified WC specialist you may want to reconsider which attorney to use for your WC claim. Only an attorney that specializes in WC law will know the right course of action to take. Of course if you are not getting the needed medical care then your attorney needs to ask for a hearing with BWC to try and get the needed medical care ordered paid for by the WC IC.

    As far as settlement if they are denying responsibility for the ruptured disks what is the authorized treating physician saying? Does the ATP not relate the ruptured disks to the work related injury? IF that is the case you need a second opinion with a doctor that can/will associate the ruptured disks with the work injury.

    You also would benefit a great deal by going to your states WC web site and learning all you can concerning the laws and what your husband is or is not entitled to under WC laws in Oregon.

    http://www.workerscompensationinsura...nks/oregon.htm

    http://www.cbs.state.or.us/wcd/

    Good luck to Ya'll and be sure and come back and let us know how things are going.

    Steel
    "He who is his own lawyer has a fool for a client"
    Abraham Lincoln


    Take Care and Be Well.

  3. #3
    Join Date
    Oct 2006
    Posts
    9,109

    Default Re: Husband's herniated disks, SAIF and settling??

    You can't sue the employer in civil court; they are protected by work comp insurance.
    Your comp atty can take the matter before a work comp judge.

    I'm a bit confused about the denying part of the claim and also advising you to have the dispute resoved by a comp judge.
    You refer to them like they are different; it appears that both actions come from SAIF.
    SAIF has to follow the law and can't pay for a claim that is not work related so they maybe are telling you that unless you get a comp board decision their hands are tied.
    I would assume that the issue can be settled with a buyout.

  4. #4
    Join Date
    Sep 2007
    Posts
    2

    Angry Re: Husband's herniated disks, SAIF and settling??

    Every doctor he has been to has clearly stated that they believe the disks to be herniated due to the injury. EXCEPT, of course the "independent" evaluation done by a doctor my husband was sent to by SAIF, who he only saw for half an hour, EVER, this "independent" doctor stated that he believed the disks were not related to the injury, only a coincendence and that a certain percent of people have herniated disks and dont know it right away, and that he believes my husbands disks were already herniated?! my husband has not had any previous injuries that would cause this.
    His current attending physician disagreed with the "independent" evaluation but that did not change Saif's decision.
    Saif accepted the claim for a lumbar strain, but not for the disks. Now my husband cannot get treatment for his pain because it is related to his disks.

  5. #5
    Join Date
    Oct 2006
    Posts
    9,109

    Default Re: Husband's herniated disks, SAIF and settling??

    He can if the comp court says he can.
    Neither SAIF nor any carrier has the authority to make a legal finding; that power is with the court.
    When there are differing medical opinions it's up to the court to decide.

  6. #6
    Join Date
    Apr 2007
    Posts
    32

    Default Re: Herniated Disks, SAIF and Settling

    SAIF isn't going to offer a settlement. You'll have to fight them tooth and nail just for simple benefits. You're going to need a reeeeallly good attorney when dealing with SAIF Corp. They are vicious and corrupt. In the last 19 years my husband has been the victim of every single mean trick in their book.

    Your lawyer should have filed for a hearing the minute that condition was denied. If it's rightfully part of the claim. Typical SAIF! Oh this is bringing back horrible memories! I may need to go put my head down between my legs.
    Last edited by Nirvy; 10-15-2007 at 12:36 AM.

  7. #7
    Join Date
    Apr 2007
    Location
    cincinnati,ohio
    Posts
    768

    Default Re: Herniated Disks, SAIF and Settling

    do not EVER stop fighting. so many do tho. appeal, get new attorney, and plead that the old one was not doing proper job for you. i have found that any decision made by them can be over turned with a good attorney. good luck, take care of yourselves, my prayers are with all.

  8. #8
    Join Date
    May 2008
    Posts
    1

    Default Re: Herniated Disks, SAIF and Settling

    I'm going through an aggravation claim fight myself. Herniated Nucleus Pulposis at L5-S1 and lumbar strain (should be sprain).

    It sounds like you've filed for worker's comp., seen the so-called "unbiased" IME (Oregon IME's are paid by the insurance company you are fighting. There has much talk about unfairness in this matter. I saw 2 IME's this year (2008) and the bill that the insurance co. (your insurer is SAIF, mine Sedgwick CMS) was $12,300. One doctor charged $7,600 for his 30 min dictation, 7 min examination and to have worker's comp. questionaire filled out and returned.

    IME doctor's charge's are unfair to the system. $800. per half hour. So he must have reported it took him about 8 hours to file out the report.

    SAIF is the worst. SAIF is also Oregon's owned worker's comp. insurance company. The SAIF ceo is the highest paid Oregon employee. SAIF help draft the re-structured Worker's comp. law 656. SAIF has done more damage to Oregon citizen's by looking at the $$$ instead of the injuried worker who pays their taxes and stimulates the economy.

    I'm fighting the system too. I'm working on a web site that will help injuried workers. But at the moment, I'm working on my claim case.

    You should have been told, I say "should have been told", because no one ever seems to tell the injuried person anything, that during the time after SAIF got notice of your filing for Worker's comp., all the medical appts., MRI, x-rays, etc should be paid by SAIF until they send you a denial letter. You see SAIF and most of these insurance companies are smart. The faster they get you that denial letter, the less they have to pay upfront and the borden of proof of your claim becomes your expense.

    I see that the last post was 10/2007. I'd like to know how this turned out.



    I'll be collecting denied claim, aggravation denials "stories" of Oregon injuried workers to post on my site. Oregon has a Senator, Vicki Walker, that has been fighting SAIF for a while now. The Gov.K, has also set up the MLAC (a group of SAIF and workers) to help. But I don't they're doing such a great job, because all I ever read is horror stories.

    I had retained an attorney (Hollander, Lebenbaum & Gannicott but they must have thought my case too much work. They declined to help me.)

    Be careful on yor attorney choice. You might even have them sign a contract to commit to service. It's their job to fight for you.
    OR lawyers http://www.osbar.org/public/ris/ris.html#referral

    Helpful sites
    http://www.oregon.gov/DCBS/OIW/index.shtml
    http://www.oregon.gov/BOLI/TA/T_FAQ_Tainjwkr.shtml
    http://www.injuredworker.org/
    http://wcd.oregon.gov/policy/bulletins/formsbyno.html
    http://www.impairment.com/PDFFiles/M...the_Guides.pdf

    Some law info to get you started.
    ORS 656 http://www.leg.state.or.us/ors/656.html
    OAR 436 http://arcweb.sos.state.or.us/rules/.../436_tofc.html

  9. #9
    Join Date
    Apr 2008
    Location
    In A House
    Posts
    308

    Default Re: Herniated Disks, SAIF and Settling

    Thanks to many doctors mine to started as only contusions and abrasions. and when it was finally allowed it went to aggrivated DDD (degenerative disc diesease) now herniated. So dont give up Fight a lawyer who is in it to help and get you fixed!!! The money they can keep as long as my medical continues to get paid and i can someday be closer to the way i was before it happened... Unfortunately or fortunatly it really depends on how good of a lawyer you have.

    I hope you get what you need soon

  10. #10
    Join Date
    Mar 2011
    Location
    hillsboro
    Posts
    4

    Default Re: Husband's herniated disks, SAIF and settling??

    Quote Quoting NuestraFamilia View Post
    Every doctor he has been to has clearly stated that they believe the disks to be herniated due to the injury. EXCEPT, of course the "independent" evaluation done by a doctor my husband was sent to by SAIF, who he only saw for half an hour, EVER, this "independent" doctor stated that he believed the disks were not related to the injury, only a coincendence and that a certain percent of people have herniated disks and dont know it right away, and that he believes my husbands disks were already herniated?! my husband has not had any previous injuries that would cause this.
    His current attending physician disagreed with the "independent" evaluation but that did not change Saif's decision.
    Saif accepted the claim for a lumbar strain, but not for the disks. Now my husband cannot get treatment for his pain because it is related to his disks.
    Hi there,
    I hurt my back on jan 1st and same as your husband, the IME dr said it was from a previous injury.BUT i have the old MRI and there was a bulge but no herniation and my jan MRI shows herniated disc with nerve damage!!! Saif accepted the lumbar strain but not the herniation. They also refused 2 dr's who requested me getting epidural shots. And they lied and said my dr released me to light duty,i went back one day and was in sooooo much pain.I called my dr and she never released me...How can they do these things???

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