California Worker's Compensation - Help For Injured California Workers

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  1. #1
    Join Date
    Nov 2007
    Location
    Cali
    Posts
    5

    Exclamation RSD/CRPS and Work Comp

    I had a work injury in April 07, it turned out i had a torn ACL, surgery followed Oct 07 and Jan 08, knee is stable but still in pain and getting worse. My ortho send me to Pain Management clinic and they diagnosed RSD/CRPS. Here is my question to all of you. I called a lawyer today because i have the feeling that workmans comp will deny the RSD, does anybody have any clue about this? The pain from the initial injury is still the same, and i guess got more aggravated with the surgeries. Can work comp deny that part of the injury? The lawyer said if it came because of the surgery work comp does not have to pay, i need some serious help i am lost

  2. #2
    Join Date
    Oct 2006
    Posts
    9,108

    Default Re: RSD/CRPS and Work Comp

    I think you misunderstood the lawyer. if the RSD condition is due to surgery workers comp authorized and paid for then the employer and the carrier are responsible. side effects and consequence of approved treatment are a compensible part of the original claim.

  3. #3
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,011

    Default Re: RSD/CRPS and Work Comp

    Can work comp deny that part of the injury? The lawyer said if it came because of the surgery work comp does not have to pay, i need some serious help i am lost
    SH is correct here, I would only add for you that...
    Your biggest difficulty now is going to get the ER/IC to accept the RSD as a compensable consequence to the orginial...the treatment for RSD is expensive and on going...

    The illness/diagnosis will be disputed, and a PQME/AME will be the next step here...if still denied, a DOR for expediated hearing is then appropriate, if you have the medical evidence to back up the diagnosis and treatment plan.

  4. #4
    Join Date
    Nov 2007
    Location
    Cali
    Posts
    5

    Default Re: RSD/CRPS and Work Comp

    thanks for the replies,
    no, i did not misunderstand the lawyer he flat out told me that no matter what work comp will not pay is not responsible, i guess time to look around and get some more info from another lawyer.

    What do you mean by medical proof and etc. how do i go about that??

    All your guys help is really appreciated cause i feel like i am drowning in all of this and my live is falling apart and i will be left with pain and no future.

  5. #5
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,011

    Default Re: RSD/CRPS and Work Comp

    Well, your AA is wrong on this...

    If you have a disputed medical diagnosis by the CA, you request an evaluation by an AME or PQME as the case demands...and get that doctor to provide a diagnosis...if there is still a dispute to the issue, you file a DOR for expediated hearing and let the judge decide the compensability...

    Many AA's just don't like going to exped hearing unless it's really necessary...there isn't any extra fee for this, and most times disputed issues are negotiating items in a stipulation...or C&R>..but that aside, you need to get the RSD diagnosis accepted as a 'compensable consequence' to your orginial injury...you begin that documentation through your PTP...

  6. #6
    Join Date
    Sep 2008
    Posts
    132

    Default Re: RSD/CRPS and Work Comp

    If the IC authorized the referral to pain management, then if the doctor states you have RSD, and requests treatment, the IC has to refer to UR for review. If there is a good causal relationship established by the doctor, UR will authorize the treatment. RSD is a diagnosis that develops out the original injury, so the IC should pay for it. The other issue is failing to treat the symptoms of RSD can be detrimental to your overall recovery and more costly for the IC. If UR doesn't authorize, then your doctor needs to appeal the decision.

  7. #7
    Join Date
    May 2008
    Posts
    329

    Default Re: RSD/CRPS and Work Comp

    If you have RSD/CRPS that sucks!!!!!

    I have it, and your in for a life of pain. I don't say this to scare you, but to INFORM you. Check out RSD.org.

    There are NO defined test that can prove rsd, you must get a DR. that is Trained in RSD, and let that DR. diagnose it. Preferably a Pain Management Anesthesiologist.

    Good luck, and keep us posted.

  8. #8
    Join Date
    May 2008
    Posts
    244

    Default Re: RSD/CRPS and Work Comp

    yes unfortunatly they don't pay at all for pain and suffering ! good luck

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