California Worker's Compensation - Help For Injured California Workers

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  1. #1
    Join Date
    May 2008
    Location
    CA
    Posts
    3

    Unhappy Injured 2 Years Ago... Losing My Mind

    I was injured on the job 2 years ago. It was a fall at work and the company was at first very supportive of me. Doing whatever they could to make me comfortable at work. Was only off work for a week at first. 17 months after injury I had surgery on my hand and wrist which was unsuccessful and actually caused more pain then before. 3 1/2 months after the surgery my company fired me with a very lame excuse. I retained an attorney after that. The attorney helped me change my doctor who ordered a cervical MRI which showed a damaged cervical disk at c5-6. His recommendation is surgery and I was told that the problems with my arms are most likely due to that. The pain is getting worse everyday and I am at the point where I can hardly wash my hair even. I am still marked as TTD so am receiving benefits. The problem I am having is that WC is denying surgery because I never said anything about my neck before. Sorry but it doesn't hurt! When I went to the ER after the fall with a head injury and arm pain (they did a CT scan of my head to check for bleeding) I was never given a cervical exam. So even though for more than a year of telling the doctors about having fallen and hitting my head (hard enough that I don't remember the whole fall, just the sound of my head hitting the rocks) they always ignored me. And now they don't want to cover anything dealing with cervical pain. What can I do? My attorney seems a bit slow to take care of things. Also my company has already called and offered me money "to make this all go away".

  2. #2
    Join Date
    Aug 2007
    Posts
    179

    Default Re: Injured 2 Years Ago... Losing My Mind

    The ins co will send you for an IME and of course expect thier doctor to say it wasn't due to your fall but if your doctor was as good as mine was when we went to court his records will show how this is related to your fall.
    My fall was 19 months ago and just today I was notified that my surgery will be scheduled.
    We had to go to court to get this far because even though I broke my arm and shoulder the ins co said my neck had nothing to do with the other injury.
    Because of them delaying all treatments from the beginning it took 10 months to find my neck injury.
    Dr office told me ins is really mad I got the court order and I have not gotten a check for two weeks so I assume they are playing games.
    I have notified my attorney but that doesn't mean anything.

    Good luck and hang in there

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

    Default Re: Injured 2 Years Ago... Losing My Mind

    appeal the denial to the work comp court.

  4. #4
    Join Date
    May 2008
    Location
    CA
    Posts
    3

    Default Re: Injured 2 Years Ago... Losing My Mind

    The attorney says she is doing that, appealing the denial, (or the secretary says she is, I never get to talk with the attorney) I have been waiting a month to get into pain management (doctor ordered cause he won't give me anything) It took 3 months to get the EMG(thats on 6/3) I'm fed up with everything. So much pain, not being able to do anything anymore and fighting with all the red tape. I don't even know what to do when the pain gets severe like today. I haven't been able to turn my head and my left arm is so bad I almost can't lift it (thats the good side) Can I even go to the ER if it gets any worse? I can't get ahold of my doctor or attorney.

  5. #5
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,018

    Default Re: Injured 2 Years Ago... Losing My Mind

    Maybe a few questions/answers will help to get you move a little forward here..

    1) what was the injury reported on the "First Report of Injury'' you filled out and gave to your ER...?

    2) Are you being treated within the ER/IC MPN...that is a "Medical Provider Network'' the ER/IC use to control your medical treatment....?

    3)
    The attorney says she is doing that, appealing the denial,
    Do you know exactly what is being done as far as an ''appeal'' is concerned..?
    There are specifics here, and a hearing may or may not be the right course at this point...

    4)
    I have been waiting a month to get into pain management (doctor ordered cause he won't give me anything) It took 3 months to get the EMG(thats on 6/3)
    There are also specifics on requesting treatment as well...how is the pain management doctor referal being handled ?
    Who is making this request...? a month is WAY too long for an authorization on a referal...of any kind.


    The problem I am having is that WC is denying surgery because I never said anything about my neck before.
    It will take some time to get a surgery approved. First the cervical injury/condition will have to be dealt with in getting the ER/IC to accept this as an ''injury/compensable consequence''...your PTP must be able to show an association to your orginial injury as reported (see question 1 above)

    3 1/2 months after the surgery my company fired me with a very lame excuse.
    That isn't something you should be worrying about just yet. The labor code provides for this, and there can be penalties of up to $10K for terminating an IW due to a work related injury... but it will depend on the actual date of your termination on whether a 132(a) can be filed now.

    Even at that, your job is still somewhat protected..while it may not be the same job, the ER is mandated to make reasonable attempt to bring you back to work is some capacity.

    My attorney seems a bit slow to take care of things. Also my company has already called and offered me money "to make this all go away".
    Though it may appear your AA is 'slow', she probably isn't...the whole system is slow, and is a great source of aggrevation to all IW's.

    Can you clear up what you mean by ''your company'' ...? Is your ER 'self insured' and has an in-house claims administrator, or is there an IC involved ?
    Whatever the case, your ER/IC should NOT be contacting YOU with any offer to 'go away'...ALL communication should/must be through your attorney. Just forward any calls/letters to your AA office and don't be concerned with any offer to settle this yet.
    It's more important to concentrate on your recovery...

    BUT...as you said you are TTD at this point, and receiving TTD/wage loss benefits...You ARE capped at 104 weeks paid within a 2 year period...gaps in TTD still count toward that cap. So, depending on your first payment of TTD, it looks like you are approaching that cap...
    Did you apply for SDI/state disability when you were first injured...?
    If not you should contact EDD/SDI now to see if you are still entitled to those benefits...you will need some sort of 'income' after the TTD ends.

    Can I even go to the ER if it gets any worse? I can't get ahold of my doctor or attorney.
    Of course you can go to the ER...just present there and give them your WC information/claim # and the name of the ER/IC handling your case.

    WHY can't you 'get ahold' of your doctor/PTP...all doctors have somone available to take a call at nearly any time of day/night...if it's not 'your' doctor, there is one ''on call''...

    What you are describing here..
    I'm fed up with everything. So much pain, not being able to do anything anymore and fighting with all the red tape. I don't even know what to do when the pain gets severe like today. I haven't been able to turn my head and my left arm is so bad I almost can't lift it (thats the good side)
    is called ''depression'', and is treatable...ask your PTP for a referal to the pain management facility again..you will receive a comprehensive evaluation on how to handle your pain.

    As your PTP treats industrial/occupational injuries, he should be aware of the process involved in getting a request for treatment approved. It would be submitte to the CA and sent to UR for review to ACOEM guidelines...that UR process cannot take longer than 21 days...max.
    It would be almost impossible for there to be a denial as a pain management doctor is per the ACOEM guides in chapter 6 "Chronic Pain" and there are specific guides to treat pain.

    Don't discuss your feelings of being ''fed up'', and the ''red tape'' of the system...that is the ''litigation process'' and would not be a 'compensable consequence' to your injury, but the ''pain'' associated IS.

    The IC won't send you to an IME or 'one of their doctors' on this.
    There could be a PQME or AME used to settle a medical dispute..we'll talk more on that later...if you can answer the questions it will help us in helping you...

  6. #6
    Join Date
    Oct 2006
    Posts
    9,109

    Default Re: Injured 2 Years Ago... Losing My Mind

    you can provide treatment at your own expense and if you win your appeal you can ask the judge to order reimbursement. Some doctors will treat and file a lien for their services against the claim.
    if workers comp has denied benefits usually a health carrier can then pick up benefits.

  7. #7
    Join Date
    Dec 2006
    Posts
    2,165

    Default Re: Injured 2 Years Ago... Losing My Mind

    Katz, from the symptoms you are describing, you MUST read the information, particularly the LIST OF SYMPTOMS in the the Link I am provideing you:

    www.rsds.org

    IF these symtoms are "familiar" with what you are currently experiencing, then you MUST DISCUSS THE POSSIBILITY OF RSD/CRPS WITH YOUR PTP, ASAP. If diagnosed and treated EARLY, then chances of improvement are GREATLY INCREASED. IF left UNTREATED however, RSD/CRPS can be EXTREMELY difficult to manage, and can actually spread.

    PLEASE read the information, and keep us posted....

  8. #8
    Join Date
    May 2008
    Location
    CA
    Posts
    3

    Default Re: Injured 2 Years Ago... Losing My Mind

    Thank you for the responses. I will try to answer what I can. I am a little confused on some of the terms but am getting them figured out.
    1. When I first went to the ER I was given a CT scan to check my brain for bleeding and had apparent wounds on my face and forehead. The injuries also included arm and wrist pain which I got x rays for. They never checked my neck.
    2.I was seen at the ER and then sent to a workers comp dr. I was seen by them for 3 months at which time I was told by an ortho dr to "learn how to deal with the pain". At that time they told me I was done and could be back at work. (I had been back at work since after the first week) I appealed the decision and was seen by a QME 2 months later who said I still needed treatment.It took 4 months to get to another DR. 6 months no treatment. Got into the 2nd Dr and was seen by him for 1 year. He did some slight treatment for the first 9 months (injections, braces and exercise) then did surgery on my hand and wrist. At 1 yr is when I lost my job and got the attorney. She switched my doctor to another within the network. He is the one that said I needed to have my cervical spine checked which showed damage. That was this past Jan. I have had MRI's and been seen by the DR every 4-6 weeks. I am given a pain shot at each appt and then told we are waiting for the authorization for the surgery.
    3. According to the secretary the attorney is requesting a hearing for the denial of the surgery. Thats all I know.
    4. I had been approved to go to pain management when I was seeing the previous Dr, but couldn't go because that was when the attorney switched my DR. (It took my WC Adj 2 1/2 months to get that approval.) This Dr. just asked for Pain management the start of May. I spoke with the att secretary yesterday who said she would try to make me an appt.
    5. The company I worked for is a very large Corporation. The VP called and offered me cash last month. I had told the attorney that she was calling me and she was going to notify them not to contact me. It wasn't the fist call from her.
    I hope this info helps. I'm lost in all of this....all I know is that I worked about 98% of all of the time since I fell and did everything I was told, never asked for any pain management until I really couldn't take it anymore andam getting scared that this injury is getting worse and worrying that some of this could be permanant nerve damage.

    Thanks again.

  9. #9
    Join Date
    Dec 2006
    Posts
    2,165

    Default Re: Injured 2 Years Ago... Losing My Mind

    Katz, the "hang-up" here could be that UNTIL it is determined that the cervical spine surgery is either finally DENIED or APPROVED, the IC may NOT be authorizing pain management if it is the Multidisciplinary pain management program referred to in Chapter 6 of the ACOEM treatment guidelines....that SHOULD be approved IF it is determined that you will NOT be having cervical surgery...

    Now, under the WC Labor Code, WHENEVER spinal surgery has been recommended, and the IC outright denies it, THEN you are REQUIRED to go through the "Second Opinion Spinal Surgery" process...

    This Second Opinion Spinal Surgery Doctor is THE Doctor who will make the FINAL determination whether to approve or deny the spinal surgery....IF you go ahead and have the surgery BEFORE GOING TO THE SECOND OPINION PROCESS, you will NOT BE ENTITLED TO REIMBURSEMENT FOR THE COSTS OF SPINAL SURGERY....

    SO, the bottom line here is, UNTIL your spine surgery status is RESOLVED, AND your spinal surgery is DENIED, it is UNLIKELY that the IC WILL approve a Multidisciplinary Pain Management Program...

    Find out what TYPE of pain management has been requested....

  10. #10
    Join Date
    Oct 2006
    Posts
    9,109

    Default Re: Injured 2 Years Ago... Losing My Mind

    yes you can go to the emergency room for treatment. they can also deny payment if it's not an emergency.

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