Texas Worker's Compensation - Help For Injured Texas Workers

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  1. #1
    Join Date
    Sep 2010
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    4

    Default Old Work Injury. New Job. New Insurance. Who Pays

    I reached MMI 20 years ago. They told me that I was "not awarded" lifetime medical and was given 10% disability. Well, I made it thru college, got a job, and have been dealing with my injury myself using my own medical insurance.

    Recently, I have been having MAJOR issues with this old injury. So much so that I am losing work, going to see 3 different types of doctors (PCP, Chiropractor, Ortho), and am not doing very well at all.

    Going to a specialist on Monday that is going to do an MRI and probably an injection. There is even talk of surgery. But this leads me here to ask these questions.

    1. If this is from the same disk injury (will be be proven by the MRI), will they deny me for a pre existing condition?

    2. Do I contact the old Workers Comp OMSBUDSMAN? Or insurance company? Or get a lawyer?

    3. What do I do if I am totally disabled from this now? Which is what it is looking like.

    I am very scared at this point. Don't want to lose my job. Don't want to be disabled. And don't want to be told that I am pre existing and not be able to have the treatment I need.

    Any and all opinions will be appreciated.

  2. #2
    Join Date
    Oct 1971
    Posts
    3,361

    Default Re: Old Work Injury. New Job. New Insurance. Who Pays

    What state?
    Have you had any medical treatment for this injury in the past ten years?
    Did you inform your current employer of this condition when you hired in?

    Recently, I have been having MAJOR issues with this old injury.
    don't want to be told that I am pre existing
    These two statement are contradicting.
    You admit that it's pre existing.


    And don't want to be told that I am pre existing and not be able to have the treatment I need.
    You said "have been dealing with my injury myself using my own medical insurance."
    The worse case scenario you could just continue doing so.

    I would say to contact a lawyer asp, my money says you'll need one.

    Take Care
    Tony
    Last edited by tony; 09-25-2010 at 10:02 PM.
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  3. #3
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,021

    Default Re: Old Work Injury. New Job. New Insurance. Who Pays

    A new hire would be taken by the ER ''as is'', there are no pre existing condition with industrial injury/illness. The only time a prior injury might be considered in the resolution of a claim would be apportionment to cause of any PD/WPI. The rating from the prior claim would reduce any rating/impairment due to this claim, and the amount of money in award/settlement.
    You can only be 100% 'disabled', the current ER would be liable for the impairment to this injury/claim only.

    As you were not awarded future medical in the first claim, that ER/IC carried no liablity for future medical care.

    The only way you'll determine the current situation is to file a first report of injury/claim for WC benefits with your current ER. A investigation will be made into the claim, and determination to accept/deny liability.

    If the comp Dr opine to industrial causation, you'd have a case to litigate a denial.
    Don't think in TX you need an atty until you experience those delays/denials. Though it never hurts to consult a few.

  4. #4
    Join Date
    Oct 1971
    Posts
    3,361

    Default Re: Old Work Injury. New Job. New Insurance. Who Pays

    BvIA
    A new hire would be taken by the ER ''as is'', there are no pre existing condition
    They have a right to know if you have any condition or disability that may affect how you perform your job.
    Failure to disclose could be cause for dismissal.
    If what you where saying where true, every cripple and pending comp claim in the nation could find a job, lie and claim their illnesses and injuries on the current employer.
    There are many claims denied under the basis of pre existing, (not work related)
    In order to qualify for comp, you must be injured during the course of employment.
    A 20 year old injury hardly falls under that guideline.
    So explain how an employer would be liable for a 20 year old injury, long before this employee hired in.
    You dead wrong on that one..

    It would be nice if you would talk English so everybody would know what you're saying.
    Most people don't have a clue as to what you're talking about, which limits participation and confuses the topic.
    Tony
    Last edited by tony; 09-26-2010 at 06:41 AM.
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  5. #5
    Join Date
    Feb 2007
    Location
    Calif
    Posts
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    Default Re: Old Work Injury. New Job. New Insurance. Who Pays

    They have a right to know if you have any condition or disability that may affect how you perform your job.
    If a potential ER wants to require a 'fit for work' or drug screening prior to employment at their cost, that is their right.
    There are many claims denied under the basis of pre existing, (not work related)
    In WC aggreviation to a pre existing condition is almost always compensable/accepted.
    An ER cannot deny employment based on disability, even if due to a pre existing industrial injury.
    Nor can an ER request information about a prior or current WC claim prior to an offer of employment.
    So explain how an employer would be liable for a 20 year old injury, long before this employee hired in.
    I didn't say the current ER would be liable for a prior injury...I said the current ER is only liable for the % of impairment/disability due to THIS injury. The prior industrial injury rating, and/or non industrial injury that contributes to impairment, IE DDD, would be considered in apportionment to cause of any PD % as a result of this injury.
    If what you where saying where true, every cripple and pending comp claim in the nation could find a job, lie and claim their illnesses and injuries on the current employer.
    Even with all the "ifs", once the EE is hired, "as is condition"... if injured AOE/COE, the ER is liable.

  6. #6
    Join Date
    Oct 1971
    Posts
    3,361

    Default Re: Old Work Injury. New Job. New Insurance. Who Pays

    BvIA
    In WC aggreviation to a pre existing condition is almost always compensable/accepted.
    Now you added a new word "aggrevation" a whole different topic than what we're discussing
    Originally you said "the current ER would be liable for the impairment to this injury"


    You have to be injured during the course of employment, that's worker comp 101.
    I'd love you to show me one case where the employers insurance paid for a pre existing, non work related injury.

    BvIA
    I didn't say the current ER would be liable for a prior injury...
    Then tell me what this means "a pre existing condition is almost always compensable/accepted."

    BvIA
    I said the current ER is only liable for the % of impairment/disability due to THIS injury. The prior industrial injury rating, and/or non industrial injury that contributes to impairment, IE DDD, would be considered in apportionment to cause of any PD % as a result of this injury.
    There is no "THIS INJURY" the poster admitted that it's a pre existing condition.
    Only one injury here, a pre existing.
    See here's the quote "Recently, I have been having MAJOR issues with this old injury."

    You went off topic and changed it to a case where a pre existing condition was aggravated, I finally deciphered your legal mumbo.

    Tony
    Last edited by tony; 09-26-2010 at 08:45 AM.
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  7. #7
    Join Date
    Sep 2010
    Posts
    4

    Default Re: Old Work Injury. New Job. New Insurance. Who Pays

    This is not a new work injury. Re injured a 20 year old injury when I got sick and threw up. But, now it is effecting my current job.

    If my best bet is to just go with my medical insurance I will continue to do so. Have not had many issues in the past 10 years. Just pain needing medication. But now the pain is going down the leg again, I can' lift my arms over my head, can't sit, stand, or lay down for long periods of time without pain.

    Read that on medical insurance two years is considered pre existing. If you have not received treatment in those two years you are covered. Hope that is right.

    Have not told my current employer about this old injury because it did not effect the performance of my job... at the time. I have been in this profession for 15 years and at this current job for 5 with no lost time due to my back. Until now.

    Maybe I should just go into this treatment as if it is a new injury and not worry about the old insurance/stuff.

    Then if I am disabled again due to this I will file for Social Security.

  8. #8
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,021

    Default Re: Old Work Injury. New Job. New Insurance. Who Pays

    Re injured a 20 year old injury when I got sick and threw up. But, now it is effecting my current job.
    Was what caused the aggreviation to the old injury DUE to performing your job duties...Were you AT WORK when this happened...?

    If not...then this is NOT a new injury due to your employment, and would not be your ER liability for medical care.
    As you were NOT provided future medical in the prior claim, you are not covered for anything now. Use your own health coverage.

  9. #9
    Join Date
    Oct 1971
    Posts
    3,361

    Default Re: Old Work Injury. New Job. New Insurance. Who Pays

    Tricksy
    Maybe I should just go into this treatment as if it is a new injury and not worry about the old insurance/stuff.
    Don't lie, it'll catch up to you fast.
    In my opinion, you'll have a hard time selling the story that you suffered your injuries from throwing up.
    They'll smell something funny (no punt intended, kinda cool the way that fell in there)
    I would tell the truth and let the chips fall where they may (I did it again)
    You never know, maybe your employer will help you out, all you can do is try.
    Again, what ever you do - DON"T LIE!!!
    Take Care
    Tony
    Moderator
    We reserve the right to forbid any user from participating in this forum, and to close any user account, at any time, for any reason. In the interest of the community, this may be done without prior notice or warning.
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  10. #10
    Join Date
    Sep 2010
    Posts
    4

    Default Re: Old Work Injury. New Job. New Insurance. Who Pays

    I never intended to lie. Just did not know which insurance to try to get to pay for it. When asked I will tell that it is an existing injury that was aggrivated by an illness and go from there.

    Since my old claim will not cover it I will depend on my health insurance and if needed disability from Uncle Sam.

    I chose the profession I have now because it allows me to stand and sit when needed, but as the years went on the requirements have changed and I am now in a more physical role. I primarily stand and walk around all day in the classroom (I am an Elementary teacher).

    May need to go back to HS though. Not as many shoes to tie there...

    Thanks for the input.

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