Fighting For Worker's Compensation Rights

The following letter was sent to many Ohio officials and politicians:

Dear:

I am writing this letter as a petition asking you and your good offices to seek a remedy to a process that unfairly and negatively impacts thousands of Ohioans and millions of hard working U.S. citizens in the course of their daily employment. An employee covered by Workers Compensation, who has an injury arising from his employment, must be subjected before his claim is adjudicated and settled through the process. I have come to believe that this process is inherently corrupt, and is designed to discourage an injured employee from seeking important benefits that are provided by law, and/or the collective bargaining process, and which were meant by legislative intent, to provide a necessary “safety net “ to workers who have suffered bona fide injuries arising from their occupation.

I am certain that there are employees who submit questionable or even fraudulent claims to Workers Compensation. I also believe that there must be important safeguards in place to discourage these claims. But, I also believe that legitimate claims are “tarred with the same brush” that is meant to discourage fraudulent ones, and that the safeguards in place to discourage those claims are so stringently applied in the everyday claim settlement process, that, in effect, all claims are considered to be fraudulent unless a covered employee submits to a claims adjudication process that rivals the trials of Hercules.

I am an employee of UPS, a multinational company, with hundreds of thousand of employees. I drive one of the delivery vans (a “package car”) that are seen daily on virtually every street in the United States. I have been continuously employed in this capacity since November 1984. My job calls for me to lift and carry packages that weight up to 150 pounds, and to work mandatory overtime daily. I have never suffered a negative review of my work performance, but perhaps inevitably, I have been involved in a number of accidents while driving for UPS, and have seen firsthand how the Workers Compensation claims process works.

In June of 1989, I was seriously injured in an accident while driving my “package car”. I did not cause the accident and was not cited. After consulting with the appropriate UPS Human Resource Management personnel in Cleveland, Ohio, I was referred to Dr. Frank then a UPS employed physician. I underwent a rigorous course of treatment that culminated in his recommendation that I undergo cervical spinal surgery in February of 1990. Dr. Sailor referred me to an appropriately trained orthopedic surgeon for this procedure, Dr. Matt, at MetroHealth Medical Center. I underwent this surgery, and after a lengthy post-op rehabilitation process, returned to work in August of 1990. I was informed by b! oth attending physicians that although the surgery alleviated some of my short-term discomfort, injuries of this nature are ultimately degenerative in nature, and there existed a strong likelihood that I would continue to experience pain and discomfort as a result of the injury. It was also suggested that future treatments including surgery where likely. Obtaining Workers Compensation benefits for this accident in a timely fashion was next to impossible despite the facts of the injury, which were undisputed. During the adjudication of Workers Comp claim, no wages are paid to the covered employee. Short and Long term disability benefits, part of labor negotiated wage and benefit guarantees, are suspended due to the work related nature of the injury. Thus at ! a time when the employee needs the vital income replacement benefits he is relying on as a promise from the employer, the union, and the government, he is forced into an arena where lawyers, company paid doctors, and a huge bureaucracy, all of which consider the Employer’s legal rights above his, operate daily. This is an arena, for which he has almost no experience and training, one that almost forces him to seek legal counsel, or more typically, settle his claim for much less than should have been rightfully his, and without due consideration to what the impact of future health issues arising out of the same incident might bring to bear on future claims.

In June 1992, the brakes in my “package car” failed causing my vehicle to be airborne over the expressway. The impact caused three bulged discs in my back, requiring further spinal treatment from the same physicians who treated my injuries three years earlier. As in the earlier case, the facts of the accident were indisputable, and I was not cited for the mishap. Once again I was forced to go through the ordeal of receiving the Workers Compensation I was rightfully entitle to, a process I regarded as just as painful and frustrating as the accident itself. This new disability lasted for several months before I could once again return to work.

In September 1999, my problems with Workers Compensation escalated. I suffered a setback my doctors, (the same physician referred to me by my employer 10 years earlier) considered a re-aggravation of the two earlier injuries. Shockingly, UPS denied this claim, and it took me a year to receive the benefits I was entitled. More importantly, the economic impact of the original denial was so devastating, that I was forced to return to work, before a full battery of test could be completed, including MRIs that would have conclusively shown the nature of the injury. This diagnostic tool would have been routinely ordered by any attending physician seeking appropriate diagnostic aids for his patient, where it not a work related injury. Howev! er, in the world of Workers Compensation such procedures have to be approved by the claims department before they can be ordered. In essence, they control the test available to a physician for his use in determining the extent of an injury, and its subsequent treatment…. a process not unlike the fox guarding the hen house. The attitude of my employer was remarkably confrontational and was marked by a total lack of empathy or cooperation, a posture forced on them by the system itself.

On December 30, 1999, my “package car” was hit by a car traveling at 50 mph while I was in the process of making a legal left hand turn. Once again, I was not cited for this accident, by either the State police or the company, as it was clearly the fault of the other driver. The car hit the drivers side of the “package car” flush. Immediately after the incident, I did not think I was seriously injured. However, shortly after the New Year, I began experiencing serious pain and discomfort. I told my superiors at UPS that I was experiencing the negative effects of the accident on numerous occasions, but I was little “gun shy” to press this issue because of the negative vibes I got from my issue of a few months earlier. Finally, I asked the company to allow me to shorten my workday from 10 to 9 hours per day, so that I could go for treatments after work. By February 2, facts were clear: My condition was worsening, and my request for reduction in workload was falling on deaf ears. As I had already been denied benefits in the fall of 1999, I properly asked my attending physician (of ten years) to submit a treatment plan for pre-approval. While awaiting the treatment approval from Workers Comp, I underwent treatment at a local Chiropractor Dr. Misty several times a week, and paid for these treatments out of my own pocket. I continued to wait for approval, which never came. Finally, a year later, in December 2001, the doctor resubmitted the pre-approval ! request and it was denied shortly thereafter. I hired legal counsel and he arranged for a hearing in March 2002. As soon as the company was notified of the hearing date, I was approved for 10 treatments.

More importantly, my relationship with UPS changed markedly over this period of time. As my request for a reduced workload remained unresolved, I petitioned the Division Manager for help in March of 2001. Three days after I met with her, I was accused of running more miles than necessary to perform the job. I was forced to account for every minute I spent in the course of my daily deliveries, and was followed by local management. I am now forced to carry a tape recorder, camera and a daily journal to record my daily work activities. The stress of the injuries and lack of trust after so many years of hard work was becoming unbearable. I had to use unpaid time to undergo the treatments as approved under the plan of care, and had to for! go a number of these treatments simply because I couldn’t take the time off the job. The medications the doctor was able to proscribe were limited because I must remain alert behind the wheel. On May 7, 2002, I had to come off the road to be driven to the doctor.

CC: All of the State Representatives have been sent the medical history, given that only three have responded to this letter I am not sending any medical reports at this time. I would be more than happy to forward you the undisputable evidence of the personal experience, which brings me to writing this letter. Perhaps, reorganizing a much need process that can benefit all working citizens of this country. A process that has been on going since early 2000. While waiting for a trail date to once again be subjected to the adjudicate process before the claim can be settled.

I have attached a detailed history of my medical history for your review. I can not conceive of how any of these injuries and the complications arising from them can not be considered as work related, even given the most stringent definition of that term. I have concluded that Workers Comp has adopted a completely adversarial posture in dealing with legitimate claimants. It forces employees who are not well versed in its policies and procedures to come to them under the most disadvantageous and stressful circumstances and, in effect, colludes with the employer to discourage even the most rightful petition for benefits. There is no voice within the process that advocates for the claimant, and the process of appealing the almost automatic declinations, requires litigation, or its threat. The claim process, even if a claim is approved, takes an inordinate amount of time, and creates harsh economic pressure for the claimant whose economic existence had been threatened by a work related injury for which he is blameless. How is it that such treatment of injured worker can be countenanced by those who have oversight in this process? My case is far from unique or even unusual. There are thousands of workers who have had the same result when trying to work through a process in which the cards are so arrogantly stacked against them, and for which there is so little help.

There are many employment scenarios where the probability of an injury or accident is likely, perhaps even inherent to the work itself. My employment is not atypical in this regard. It seems to me that the inherent problem with Workers Comp is that the employer has far too much self-interest to be involved in any part of the claims process. Withholding wages and other insurance benefits should not be used as a sword of Damocles against a worker who has suffered a legitimate injury. The process must allow an uninformed worker to learn what his rights are, and how his health can be restored without fear of employer related reprisals, and without regard to how the process of restoring that health will impact the employer’s insurance rates. He should be treated fairly, with civility, and under the presumption that his claim may in fact be legitimate. Certainly you would expect no less if you suffered an injury on the job.

I would welcome the opportunity to discuss theses issues with you, or to participate in any hearings that would help you shed much needed light on this important issue.

Injuries:

  • T11 Disc Herniation
  • Disc Bulge at L1,L3,L4
  • C4 Disc Herniation
  • C5 Osteophyte
  • Fibrosis at C4
  • Internal injury closed NOS sprain of neck
  • Fractured up end humerus closed
  • Fracture cervical Vertebrae Closed
  • Bulging Disc C5-6 Causing Radiculopathy
  • Concussion
  • Post-concussion syndrome
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All State Rep. Never responded to letter, forced back on the job or I would lose my position, now facing a civil suit, added expense to the past 4years I have been paying medical bills out of my pocket, no weekly benefits for the 7 months I was off, and now 10,000 to fight this claims process to protect my medical rights and loss wages.



Important Notice

These stories represent the experiences and opinions of individual workers, and do not necessarily represent the views of Worker's Compensation Insurance . com, its owners or administrators. There can be great value in learining from the experiences of others, but nothing on this site constitutes legal or medical advice. If you require legal or medical assistance, please consult a licensed legal or medical professional in your state.