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  1. #1
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    Jul 2009
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    Default How to Prove a Pre-Existing Condition

    I am an RN in a busy Labor and delivery unit in a philadelphia hospital. I injured my back at work in 1994 (herniated L4 & L5 discs), which caused me to be out of work for approximately 8 months in physical therapy before being allowed to go back to work. Again in August of 1996 I reinjured the same area from bending over to pick up sponges in a c-section. When I went to employee health... and told them my pain was in my buttocks area... they sent me for an x-ray and stated I could have a fractured coccyx.. and was told there is nothing they could do about it. Instead of them thinking I reinjured the same area... they sent me home with pain meds. After two weeks I was in such pain... I couldn't walk... had numbness down the back of my left leg... couldn't stand on my toes... etc... after them finally sending me for an MRI it was shown that I had the same herniated L4/L5 which was worse... it was pushing on my dural sac and the nerve that innervates my left leg (hence the numbness)... this time the physical therapy was much more intensive, etc. I had to rehab for almost a year before being placed back to work. Now.. this past May... while I was doing home chores... I bent over... and "whack" the pain was unbearable... unable to stand up... walk, etc. I went to the ER and they said I had a pulled muscle and sent me home with painkillers. I informed the ER doc about my extensive history with my back injuries...and he said to go see my family doctor if the pain didn't go away in a week. I then went to my family doctor (who never treated me for this back injury) who also said I probably pulled a muscle. After two more weeks and missing work for this time... I finally got an MRI per my family doctor... Guess what... its the same injury which has been reaggravated. Now my issue is... isn't this a preexisting workman's comp injury? Currently I am being paid all of my sick time and vacation time... because the injury occurreed at home... but since the MRI states its the same injury... Can I utilize workman's compensation?

    I am sorry for such a lengthy story... but was unsure how to condense it. Also... from the 1996 injury... I never regained feeling in the back of my left leg (its still numb)... i had my first Physical theraphy yesterday... and the therapist stated that my reflexes are very weak in that leg and my muscles are weak. He is afraid that this weakness will get worse and potentially interfere with my ability to walk. Help.

    Thank you for any advice.

    Melissa W.

  2. #2
    Join Date
    Oct 2006
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    9,078

    Default Re: How to Prove a Pre-Existing Condition

    not the same injury.
    under work comp terms an injury is an event.
    it may be similar part of body. it may be similar mechanism of injury. it may respond to similar treament. it may result in similar symptoms.
    it probably is/was a non-industrial aggravation of a previous work injury.
    under workers comp law an aggravation is considered a new injury.
    the event happen while performing non-work related activities in a non- work setting.

    had the 2 prior injuries happened at home and the recent one happened at work it would be an aggravation and covered.
    it doesn't work both ways.
    Last edited by .SH; 07-07-2009 at 06:28 AM.

  3. #3
    Join Date
    Oct 1971
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    5,008

    Default Re: How to Prove a Pre-Existing Condition

    xena060870
    I injured my back at work in 1994 (herniated L4 & L5 discs), which caused me to be out of work for approximately 8 months in physical therapy before being allowed to go back to work.
    Again in August of 1996 I reinjured the same area from bending over to pick up sponges in a c-section. When I went to employee health...
    Now.. this past May... while I was doing home chores... I bent over... and "whack" the pain was unbearable...
    I went to the ER and they said I had a pulled muscle and sent me home with painkillers. I informed the ER doc about my extensive history with my back injuries...and he said to go see my family doctor if the pain didn't go away
    Why would you go to your doc if it was an on going work related injury?
    The problem here is how you presented your injury to the ER doc.
    You should've went to the emergency room and complained about the pain you've been experiencing for the past years over your WORK RELATED INJURY and inform them it has become unbearable.
    The fact that you where home doing chores or whatever is irrelevant, you where already
    experiencing problems, you had a documented history that it was work related.
    Talk to an attorney, maybe he can find a way to put your case back into perspective.
    You are suffering from a ongoing, work related injury which exhibited itelf while you where at home.
    Tony
    Moderator Responses are based on my personal bias, experience and research - They do not represent the views of the admin nor may be accepted in the legal community, always consult an attorney.

  4. #4
    Join Date
    Dec 2007
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    Tunkhannock, PA
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    1,266

    Default Re: How to Prove a Pre-Existing Condition

    Quote Quoting xena060870 View Post
    I finally got an MRI per my family doctor... Guess what... its the same injury which has been reaggravated.

    Melissa W.
    This part concerns me. Are there new findings on the MRI? If so, are they acute or degenerative? If you injured yourself at home then documented the at home injury in medical records and have a new MRI consistent with the at home injury causing a substantial worsening of your condition, this would be a tough sell.

    I would also be interested to know whether you ever returned regular duty after the 1996 injury or if you were working a modified duty position.
    Timothy D. Belt, Esquire
    Helping injured workers in Northeast Pennsylvania.
    belt-law@belt-law.com
    www.belt-law.com

    DISCLAIMER: This post is intended as general information applicable only to the state of Pennsylvania. The information given is based strictly upon the facts provided. This post is not intended to create an attorney client relationship, or to provide any specific guarantee of confidentiality.

  5. #5
    Join Date
    Jul 2009
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    4

    Default Re: How to Prove a Pre-Existing Condition

    Tony - I did return to work in August of 1997 to my old position. I have a dual job... 24 hours desk work and 12 hours nursing. I had to go to a lawyer, who sent me to a doctor to get back to work. They placed me in a job... answering phones sitting at a desk for 40 hours a week (which the lawyer said they could send you to work anywhere, as long as they give you a job)... so I fought to get back to my old job. Every single day I have some kind of pain... but learned to live with it with pain killers and rest. Never pain free and the numbness and weakness of the left extremity never went away. When I saw a neurosurgeon (sent by workman's comp doctor in november 1996) he said that if the numbness didn't resolve within six months... that it probably wasn't ever going to go away. I wonder if living without feeling in the back of your entire leg is not related to the injury... when it never went away.

    Also... i went to the ER because I could hardly stand up. I was home with my 12 year old son and drove myself to the only place I knew to get treatment... the ER. Where else should I have went? I am, unfortunately, not too saavy with this entire process. The workman's comp people don't really want you to know the laws... they want you to think you are crazy.

    As per the new MRI... it showed the same injury as 1996 (herniated l4/l5 with dural sac compression), yadda yadda yadda. Actually there was slight improvement from the 1996 MRI... but not significant enough.

    Melissa

  6. #6
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    Oct 1971
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    Default Re: How to Prove a Pre-Existing Condition

    I'm saying you did the right thing by going to the E.R, but....you shouldn't have mentioned that you where doing chores at home.
    It gives the impression that you hurt yourself while doing chores.
    You could've had the same symptoms while sneezing, coughing or sleeping in the wrong position.
    In my opinion, what you where doing is irrelevant, you where already injured.
    You should've stated that you are experiencing pain from an ongoing work related injury (give them the dates, doctors seen, ect).
    You then should have requested a referral back to the last comp doc you seen.
    You're not being deceptive, you're keeping things in perspective, it would've made your case alot less complicated.
    Consult a lawyer pronto...
    Tony
    Last edited by tony; 07-07-2009 at 01:36 PM.
    Moderator Responses are based on my personal bias, experience and research - They do not represent the views of the admin nor may be accepted in the legal community, always consult an attorney.

  7. #7
    Join Date
    Jul 2009
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    4

    Default Re: How to Prove a Pre-Existing Condition

    Tony... when I went to the ER... I kept telling the physician that I had this prior injury, etc. I stated that I had these injuries from work in 2004 and 2006-2007. He kept saying this was not related to my disc herniation. He said it was definitely musculoskeletal. I was sent home with narcotics and ibuprofen (to decrease the swelling of this supposed 'pulled muscle'). If anybody has any medical background here... the treatment for a pulled muscle is heat/cold and to increase movement. The treatment for a herniated disc is to not bend, lift, turn, etc. So, the ER doctor, in my opinion, sould hold some liability too. I swear he didn't listen to one word I said. He also asked if I had any pain down my leg... I said... I have no feeling down my leg... because of my prior work injury. I said... I could cut myself shaving (cut my leg off) and I wouldn't feel it. So..,. considerng this.. how could I feel pain down my leg? I know this is a lot of b.s. = and to be quite honest... im tired of dealing with it.

    I contacted a lawyer yesterday (Krasno) and he said that it will be hard to prove a preexisting condition... because I was sent back to work able to perform my job. He did say to come in for an appointment and he would see what he could do.

    I am sooo confused...

    Melissa

  8. #8
    Join Date
    Dec 2007
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    Tunkhannock, PA
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    Default Re: How to Prove a Pre-Existing Condition

    Jason Krasno is a good lawyer. We were in the same class in law school. If there is anything that can be done with your case, he will find it.
    Timothy D. Belt, Esquire
    Helping injured workers in Northeast Pennsylvania.
    belt-law@belt-law.com
    www.belt-law.com

    DISCLAIMER: This post is intended as general information applicable only to the state of Pennsylvania. The information given is based strictly upon the facts provided. This post is not intended to create an attorney client relationship, or to provide any specific guarantee of confidentiality.

  9. #9
    Join Date
    Oct 1971
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    5,008

    Default Re: How to Prove a Pre-Existing Condition

    xena060870
    He kept saying this was not related to my disc herniation. He said it was definitely musculoskeletal.
    Must be one hell of a doc to make that determination in a couple of hours without an mri or an xray.
    He's a quack, period.


    I finally got an MRI per my family doctor... Guess what... its the same injury which has been reaggravated.
    Who said that, your family doc? If so this could be used to contradict the quacks opinion.

    I love how the system works.
    If you had a set aside fund set up, the quack would've said it was definetly related to your previous injury.
    Hell if you had a cold or a broken thumb he would swear it was related in some way.

    If it's a on going comp case, it's impossible to be related, no way, it's just a pulled muscle.

    Business as usual, the interest of the IC and doc comes first, the patient's welfare is irrelevant.

    Hopefully Krasno can put your case back into perspective.
    Good Luck!
    Tony
    Moderator Responses are based on my personal bias, experience and research - They do not represent the views of the admin nor may be accepted in the legal community, always consult an attorney.

  10. #10
    Join Date
    Jul 2009
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    4

    Default Re: How to Prove a Pre-Existing Condition

    Well... the negative part of this is... when I presented to my family doctor after one week of following the ER doctors advice... my family doctor initially agreed with the ER doctor, stating that I could go back to work in one week... which I did. I followed their advice... and after going back for three days... that saturday... the pain was worse... so I went back to family doctor... who then ordered the MRI (after complaining about my pain and difficulty walking). So... the family doctor followed the quacks advice initially.

    the only caveat I can give to the family doctor... is that he has NEVER treated my back injuries (they were always treated by workman's comp)

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