My claim was made in the state of : Texas.
First off, let me say hello to everyone and let you all know how happy I am to have found this site! Sorry for the "book" I am about to write, but it is a complicated situation that I'm, unfortunately, having to go through.
Back in 2008 I suffered a fall, while on duty, which resulted in a double year in my meniscus. Had surgery to repair the tear in 2009 and after some rehab, went back to work. A couple months later injured the same knee, from a wet bathroom floor, which resulted in a sprained MCL. In both cases everything was covered under Workman's Comp and I received TIB's.
On 3/17/2012, I was injured on the job. I was forced to fill out the injury report and claim form, before being allowed to get medical treatment. I went to my employers doctor, the first chance I got. By choice. They put me in a knee brace and on crutches, set restrictions and diagnosed me with a sprained LCL and patellar tendonitis. I didn't hear from my adjuster or employer for several days until the day I was scheduled for my followup with the treating doctor. That was on the 23rd of March. I gave my recorded statement to the adjuster, over the phone and was told that she was going to call my treating doctor and authorize an MRI. That was done and after the appointment I had the same restrictions. The MRI was done the following day, 24th. When the results came back I was told them by my treating doctor. He stated that in addition to the other injuries I had, that there was no mention of my LCL in the report. On the 3rd of April I received a call from my lady in payroll asking me if I had spoke with my adjuster lately. I said no, why? She said I needed to call them because they had denied my entire claim. I called and my adjuster states the reason for my denial was, "the mechanism of injury wasn't substantiated by the MRI findings and that the MRI report showed that I have a degenerative medial meniscus and that they consider that to be a natural disease of life". Interesting thing considering there was no mention of my LCL anywhere in that report!
I never received any TIB's, at any point during this whole ordeal. I had been approved for 6 sessions of physical therapy as of the 29th of March, but the denial was on the 30th of March. Kinda convenient, isn't it? I have contacted the state and a lawyer on the matter. I am still employed, but who knows for how long. My payroll department sent me FML paperwork and asked me when could I get a full duty release. How am I supposed to do this when #1 I am unable to work at this time, #2 have no TIB's coming in to afford the doctors visit to get the stupid release, which he wouldn't give me anyhow. Btw, before getting denied I was told in writing that my employer wouldn't be able to accommodate my restrictions.
I have been studying everything to do with the TWCC Laws and from what I understand, if my employer is unable to accommodate my restrictions then I'm entitled to TIB's. Never received any....from anyone.
Found out today from my Attorney that my employer is self insured but they used a third party administrator. So he said that actually works out in my favor.
I really hope these people rote in hell for this! I just had twins on the 4th and with no money coming in I'm being forced to pawn, sell and borrow to pay bills. Much less anything else. I am married have the twins as well as a 10 year old and a 7 year old.
Sorry for the long rant, but maybe there's something I'm missing here, ghat maybe one of you guys could point out for me.