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  1. #1
    bill Guest

    Default Torn Rotator Cuff

    i tore my l/rotator cuff back in 6-05...had to get a lawyer 4mo. later due to work comp comp doc said there was more wrong than rotator cuff, but my doctor didnt do anything about that, wether he knew or not, now 1.5 yrs later and after just rotator cuff surgery, they say i also have nerve damage in the arm and maybe torn muscle, the same work comp doc agrees...and i have chosen the work comp doc to do the surgery, but work comp ins. wil not allow him to scope the arm to see if there is more damage, will only let him do the nerve damage, is this fair? also i was on work comp for 6mo. from 05-06, and the ins, is wanting to adjust my weekly check to show that estimated amount, is that fair? and does anyone have an idea of what a fair settlement is? one doc said the arm and shoulder will prob. hurt for life..? thanks alot

  2. #2
    Join Date
    Oct 2006

    Default Re: work comp

    fairness has nothing to do with it; everyone who gets told "no" thinks the system is unfair to them.
    Settlement is not automatic but if one is offered it'll be based on a medical report outlining your work restrictions or an impairment rating. They are only going settle on what benefits you are entitled to not on what you think is fair. Generally it's a lot lower then what you want.

  3. #3
    Unregistered Guest

    Default Re: work comp

    ok, i understand work comp tries to benefit themself, but what i am asking is since for about 7mo's last year i was on this year since the arm hasnt gotten any better and am due for another surgery, they are wanting to give me TTD based on what i made this year when 7mo. of my earnings was on TTD, and it wold have been more if i was never injured to begin with, is it LEGAL i should ask for them to do this. I never wanted anything from comp. except for them to fix the arm, until they screwed around and didnt pay the TTD for 4mo. when i was told there was no light duty...thats when i was told by the employer to get a lawyer...

  4. #4

    Default Re: work comp

    Do you have a new injury or accident ? Or are the problems related to the old accident that were never dealt with. If the old accident, and you did NOT settle out your rights, then what ever your lawyer is doing for you on that case would apply to this injury. Make sure he or she is up todate on your medical status. If the current problems are due to a new injury, and the prior case is still unsettled, then I would suggest you retain the same lawyer for the new injury, for continuity purposes. If this injury relates to a new accident and the other case is resolved, you can pick and choose lawyers, but again, your old lawyer has all the old records.

    As to the TTD rate, if this matter relates to the original accident, then that rate should apply, even if there have been promotions or raises that have taken place in the interim. If the injury relates to a new accident, the insurer cannot take the TTD paid when calculating Average Weekly Wage. They can only use wages earned since off TTD.

    As to the 'estimated rate', I have never heard of anyone paying TTD on an estimated amount, other than in on interim basis. Average Weekly Wage is simple to figure out and the formula is precise. They pay 2/3rds of what your gross average weekly preinjury was (including overtime and bonuses). That's why its called Average Weekly Wage in Illinois, not Estimated Weekly Wage.

    With regard to workers' comp not authorizing 'their doctor' to scope the arm to see if there is more damage, this isn't a question of being fair, its a question of them being stupid. Your attorney can push this issue now for presurgical authority, or you can just go ahead and have it done without preapproval. The insurer will look real stupid saying they do not approve treatment and care when "their doctor" says it's needed. The surgeon, although your treating doctor is also 'their doctor' in the eyes of the Industrial Commission. So if they dispute him, what are they going to do ? Hire him to rebut himself ? Go IME Dr. shopping ? I say schedule the surgery and have the doctor do the arthroscopy. You can always put the arthroscopy under group health and then stick it to the insurer when and if something is found. Or go to trial and just let them look stupid.

    As yo your employers advise "...get a lawyer" ...Great advise...Get one now!!! Good luck.

  5. #5
    Unregistered Guest

    Default Re: work comp

    Thank You Very Much For Your Input, This All Makes Sence. I Just Wish I Read It B4 I Had The Surgery, So I Did Not Get The Arm Scoped.
    So What Now? My Own Doctor Said This Was A New Case, But He Also Said He Did Not Want To Get Involved, Because He Is Closing Up Practice, For Retirement. If You Look Up In The Records That My Lawyer Has Though, From Both Doctors, Its All From The Same Injury, Just Not Dealt Wiyh Then, So Now I Just Let The Work Comp Do The Elbow And Wrist Surgery, But Again He Said They Would Not Let Him Scope. Do I Leave This Open? Just Incase There Is Something Still Wrong?

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