Results 1 to 7 of 7
  1. #1
    Join Date
    Dec 2009
    Posts
    13

    Default Shoulder Injuries Requiring Surgery, Compensation for Lost Time

    My workers compensation claim was made in the State of: California
    Ok, so the last post I had here was in May of 2011. I was diagnosed with a compensatory injury to my right shoulder due to having 2 surgeries on my left shoulder, all work related. In October of 2010, the PTP put me through PT and said after 6 treatments that I needed to go back to the ortho who did my last surgery and have him look at my right shoulder.
    She then requested an M.R.I. Of course, the insurance company denied it.
    Won't go into more about that time frame since it was in my earlier posts.
    Ok the current situation is this: It took me from May of 2011 to NOW to finally see my original ortho doctor. This was due, I believe to an upcoming MSC. I had the MRI done on eb 7, 2012, with the results to my doctor the next day. The M.R.I showed a SLAP lesion to the right shoulder, along with impingement and edema swelling and tendinitis in the left shoulder. Now the doctor says I have to have 2 surgeries. A scope and clean out and repair of my right shoulder and a bicep tenodesis (which the AME recommended back in May of 2011) on my right. I am in so much pain right now, and no pain meds. Waiting for surgery date on the right. Also through all of this, my job laid me off in September, had to rehire me in December, due to labor union codes that were broken, and they just fired me again effective Jan 23rd, after trying in December to fire me for job abandonment! They are now saying that since the claim was denied in November of 2010, the chiro who put me on sedentary work only (which they could not provide) was not one of "Their" doctors, that my time off of work is not being attributed to W/C, and I cannot be compensated for time lost for the injury. Any suggestions? Yes I have an attorney, but he is hard to get ahold of sometimes, and we are too far in to change attorneys now.

  2. #2
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,021

    Default Re: 16 Months Later, and Finally an Appointment. Can They Do This

    They are now saying that since the claim was denied in November of 2010, the chiro who put me on sedentary work only (which they could not provide)...was not one of "Their" doctors, that my time off of work is not being attributed to W/C, and I cannot be compensated for time lost for the injury
    Your ER/IC doesn't make the determination when TTD is due... your PTP, and/or AME will do that. A judge has the final determination on benefits due.

  3. #3
    Join Date
    Mar 2012
    Posts
    6

    Default Re: Shoulder Injuries Requiring Surgery, Compensation for Lost Time

    what part of california are you in?

  4. #4
    Join Date
    Dec 2009
    Posts
    13

    Default Re: Shoulder Injuries Requiring Surgery, Compensation for Lost Time

    I currently live in the Sacramento area. I did have an arthroscopic debridement on the right shoulder on March 12, 2012, so I am currently a little over a month into healing and physical therapy. When I saw the doctor for a re-check on the 12th, he said he was going to recommend and see about scheduling the bicep tenodesis on the left shoulder (this will be the 3rd surgery on that shoulder). He based his recommendation on the AME's report from May of 2011. The AME said in his report that he recommended an MRI and further treatment. He also stated that due to the past 2 failed surgeries on the left shoulder, that he did not know if another surgery would help, but not having an MRI report made his examination difficult. My doctor did put in the request for surgery, because past treatments of cortizone only lasted 3 days and physical therapy did help, and the fact that I have been in pain for the past 18 months. He said his goal was to get me pain free. Now, the insurance company based on recommendations from the UR Board, denied the surgery. Can they do this? I thought that once the AME and doctors reports are in and surgery is requested as a further treatment, that it can not be denied. They have also stopped my TTD payments.

  5. #5
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,021

    Default Re: Shoulder Injuries Requiring Surgery, Compensation for Lost Time

    The AME said in his report that he recommended an MRI and further treatment

    My doctor did put in the request for surgery, because past treatments of cortizone only lasted 3 days and physical therapy did help, and the fact that I have been in pain for the past 18 months. He said his goal was to get me pain free. Now, the insurance company based on recommendations from the UR Board, denied the surgery. Can they do this?
    MRI should have been performed based on AME, and AME report wouldn't be final until those results were incorporated into a final report.

    AME didn't recommend surgery, but additional "treatment", if that's not spelled out... doesn't mean a thing.
    PTP submits a request for treatment...in this case surgery, with medical evidence to support the request. If UR denies...you go back t AME.
    They have also stopped my TTD payments.
    Based on what? You must be sent a NOPE letter...Notice Of Potenial Eligibility for benefits any time your benefits change/stop/begin. You didn't provide your actual DOI, or how many weeks of TTD you have been paid...but if you've rec'd 104 weeks of TTD, there won't be any more. You should apply for SDI if eligible.

  6. #6
    Join Date
    Dec 2009
    Posts
    13

    Default Re: Shoulder Injuries Requiring Surgery, Compensation for Lost Time

    Thank you for responding. I have only had 52 weeks of disability payments. Although the AME stated my injury was compensatory, the insurance company only paid me for the period of 10/14/2010 thu 03/12/2011. So for the past year, waiting for doctors appointments etc, I received nothing eventhough the insurance company said the accept the report from the AME.

  7. #7
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,021

    Default Re: Shoulder Injuries Requiring Surgery, Compensation for Lost Time

    Your attorney should be filing for a hearing in court on the back due TTD, including penalties/sanctions for unreasonable delay.
    Talk to your attorney.

Similar Threads

  1. Replies: 1
    Last Post: 11-04-2011, 09:09 AM
  2. Work Injury Requiring Shoulder Surgery
    By TimW23 in forum North Carolina
    Replies: 2
    Last Post: 09-07-2011, 09:59 AM
  3. Back Injury Requiring Surgery
    By Brokeninlimbo in forum New York
    Replies: 8
    Last Post: 07-29-2009, 08:36 PM
  4. Time Lost Compensation
    By ski54 in forum Disability Benefits
    Replies: 5
    Last Post: 02-16-2009, 06:52 AM
  5. Lost Time Compensation
    By ski54 in forum Nevada
    Replies: 1
    Last Post: 02-09-2009, 11:11 PM

Bookmarks

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
 


Find a Lawyer