Bad Experience With Claims Managers

[BigJohn]

Washington state.

I have very bad experience with claims managers and L&IME doctors (sociopaths). L&IME doctors will say anything to deny and/or close claims.

I injured my low back on job. Chiropractic adjustments for 8-9 months, with some relief but obviously no fix. Claim is closed by chiropractor (he said I now have private insurance, sad). Within a month I had my first bout of extreme right leg pain that required medication to alleviate. Claim was automatically re-opened because the pain happened within a couple months of claim closing. Chiropractor wanted an MRI. Claim manager said I had to see an orthopedist for evaluation first.

I went to exam. At end of exam I asked doctor what he thought. He said he didn't need an MRI to know I had herniated disc and that surgery was not indicated. Diagnosed herniated disc without MRI. Right? Wrong! This doctor only reported no need for MRI and no surgery indicated, without mention of herniated disc. I called the office to ask Dr. to correct this. No response. Claim closed and I appealed. Told judge this story and he told me to write this doctor. I did and again no response. Back in front of judge and told him still no response. Judge called Dr and told office to send fax in 10 minutes whether or not I had herniated disc. Here comes fax that I have herniated disc. Still Judge says no claim re-open.

I was getting some unrelated surgeries on hands and arms at the time and let claim close. Bad as back was hurting I figured no way I could last 7 years and that I would able to re-open claim for full benefits. Sure enough just short of 7 years and I had the identical severe right leg pain that re-opened claim once before.

I tried to re-open claim. I was sent for MRI and it showed degenerative issues. I went to L&IME and this doctor contradicted my injury claim re-opening saying the degeneration was not related to injury.

OK, I have history of heavy/very heavy work, including fire/rescue. So I went to another Doctor with my work history and degenerative disease diagnosis. This doctor thought more probablyy than not that my low back degeneration was work related and we filed a degenerative disease claim. I was sent for another L&IME. This time the Doctor said no this is not related to heavy/very heavy work, that it was due to the back injury claim. So I have L&IME Doctors so intent on denying me help with my low back (doctors gotta keep them big bucks coming from claim managers), that they not only contradict me, but they contradict each other. OK, so back to re-opening the injury claim, but now it is outside the 7 year limit and L&I finally approves re-opening my back injury claim, but only for medical, not full benefits.

Well I have been trying to get help with this for over three years as described here. I have both the degenerative claim and the injury claim alive, under appeal. I haven't been able to work in 9 months. My low back hurts like hell, I have leg pains, sometimes my legs buckle and for the last two months my feet are numb.

These claim mangers and L&IME doctors make their living screwing over injured workers. Helluva a way to make a living if you ask me.

I do not have a lawyer yet, but will if I have too. I had a bad experience with L&I WC on some wrist and elbow surgeries too. I am convinced that part of the reason L&I WC denies claim. is to make you have to pay a lawyer. A little extra penalty.

Get this. I had wrist and elbow surgeries. After the surgeries and healing time I asked surgeon if I needed Voc Rehab, because my hands and elbows were still hurting bad. The surgeon asked if I was a spiritual counselor. Well I have friends who would describe me that way. So I said yes, but that I didn't make a living at it. Surgeon started me on Voc Rehab. Then a month later the surgeon cancels voc rehab without seeing me or telling me. I found out a few months later in a newspaper article that a certain church uses that spiritual counselor question to see if you are a member of their church, without asking directly. The surgeon thought I was a member of his church, then must have found out I was not. Claim closed. Sad huh?

So my hands and arms were hurting so bad that I couldn't work. I got with another doctor. Then I got with a lawyer. After a 16 month starve out by L&I workers comp my attorney sent a letter to L&I workers comp telling them to send me for psychiatric exam or send me for physical capacity evaluation and nerve studies. L&I workers comp chose to do the latter. The reults cam back just as I had said, worse than before the surgeries. I was paid the back time loss, short a big chunk to the lawyer. But before this payment came I had lost everything, including the family home. Bankrupt and homeless for 5 months.

So I go in for second set of elbow surgeries and new surgeon says ulnar nerve lesions are so bad at my elbows that my prognosis should be guarded. He was right. Still numbness and aching on the little finger sides of my hands. Backs of arms below the elbows are numb. I went for final physical capacity evalation including 3 months physical therapy (extended phys cap eval). It was determined that I was basically restricted sedentary, that I would not be able to use my hands and arms frequently, forward or forcefully. So I went from the top of the heap physically to the bottom. From heavy/very heavy to restricted sedentary. My scores for all my hand arm tests were in the 10th percentile as compared with healthy industrial males. I am 6 foot five inches, 280 lbs and hand/arm strength had never been an issue for me before. Guess what I got for a permanent partial disability award. Go ahead guess. A big fat zero.

This system is not properly named in my opinion. This workers comp system has nothing to do with worker compensation due to injury or illnesss. The system should be renamed the employer liability reduction system. If truth in advertising applied here. But hell you can't even sue this indemnified system.

What a scam on workers.

[BigJohn]

If I was going to give some advice on this Washington L&I workers comp it would be as follows.

That L&I does a decent job of being fair on lesser injuries and illnesses requiring a few months or less to complete treatment and heal up With no lingering long term disability issues as a result. For instance, if a worker breaks an arm on the job. You need a cast and some pain meds with time off work for a week or two. Then with the cast on you can work light duty until the cast is removed, you rebuild strength in the arm and then you are released by your doctor full duty without restriction and no permanent partial disability. Everybody is happy, including the worker who has been cared for, including some lost wage money and light duty work while healing. All is good.

Now you have a worker who was lifting a large object when the workers foot slipped, the worker went down to the ground, with heavy object on top. Worker has excruciating back pain and with diagnostic imaging it shows that the worker has herniated 3 discs in the low back. Worker is in pain all the time, taking pain meds and can barely walk and take care of daily needs.

Now this worker is looking forward to months of treatment and not being able to work at all, possibly even needs surgery and the outcome is not going to be near 100% where the worker was physically before the accident. This worker will need vocational rehab to find a job the worker can do or find a job the worker can be trained to do. Time loss paid the whole time until the worker's Doctor signs off on a job the worker can do or be trained to do. Your L&I claim manager will bend over backwards with the help of their voc rehab counselors, physical therapists and Independent medical evaluation doctors to get the worker released to job that does NOT require costly re-training.

Then there is a permanent partial disability award that can run into the low tens of thousand of dollars easy enough. All this don't come cheap. And L&I claim managers will be on a mission to save as much of that treatment, time loss money, voc rehab and ppd money you deserve away from you by any means necessary. Especially time loss, voc rehab and ppd award money. L&I claim managers usually accomplish this through the liberal use of vocational rehab counselors (rehab closers), Independent medical evaluations (not independent) by L&I doctors and physical capacity evaluations by L&I physical therapists, that all have a huge bearing on the level of work L&I says you can do.

L&I will close your claim any way it can. If you miss an appointment and claim closes. Get a lawyer. If L&I gets a job analysis done through their voc rehab closer and your doctor signs off on this release your claim is closed. If you disagree with the L&I job analysis or L&I physical capacity evaluation; Get a lawyer. But the fight will be on. You may very well have to pay to see a specialist doctor of your own and a physical therapist of your own for another physical capacity evaluation. The worker will have to pay for these. Then if it goes to a hearing you will have to pay for all witnesses you call including your specialist doctor and your physical therapists. Spendy stuff. Your lawyer will take 10% of your time loss money you are collecting and 30% of all back awarded timeloss and permanent partial disability award.

If your doctor refuses to sign off on a job analysis for release. The L&I claim manager will just set you up an L&IME required evaluation with one of their L&I doctors who will sign the job release. Then you get a lawyer, go to court, as described above.

Oh yeah and once a claim has closed and your time to appeal has passed (60 days), good luck on re-opening that claim ever. L&I law says you can. But it is easier said than done.

Whatever you do as a worker do not ever fake any problems. Just be honest and don't overembelish, just tell it like it is.

Whenever going to an L&I ordered anything I just stay cool calm and collected. Totally cooperative. I like to write up a current letter on my injury/illness basics, how it has affected/is affecting my life and a description of my problem, especially issues of pain and what makes it hurt worse. That sort of thing. That way I make sure whoever L&I has meeting with me I have made clear how I am feeling. I also give a copy to my doctor at the same time. In evaluations don't exagerate your problem at all. Just be honest. There are even evaluation tricks that can be used to catch a worker making things up.

Any questions just ask.

[Aidenbear3]

OK, I see that this was over a year ago. But maybe you can offer a shred of advice.
My husband was in almost the exact situation as you discribed. Shelving unit with a bunch heavy boxes on it came off the wall, fell on his back. Was given physical therapy and occ therapy with no improvement. Dr requested MRI 3 times, L&I denied. After PT ended (because of lack of improvement), an IME requested MRI and results showed a herniated disc. IME says no need for further treatment, though his AP says cortisone shot. L&I says no, no need for Voca Therapy, says he can be a Parking Lot Cashier (yeah right!?) and stops payments. Then the employer designated FMLA runs out the same day they stop time-loss payments. So since his AP wouldnt release him back to full duty, his employer laid him off.

My Question is did you apply for unemployment, did you get it, and if so, can we appeal L&I decision (with the help of a lawyer) while collecting unemployment? Is there anything that would prevent him from getting unemployment? Were getting an attorney, but we need something while decisions are being made.

Thanks much, and Im really sorry you had to go through these punks for help too.

[BvIA]

Yes...you can appeal a L&I determination... go ahead and get the atty to help... there is no fee unless you have recovery/payment of benefits due.

FMLA can run concurrently with a WC leave... the ER is not required to continue job status past the 12 weeks under FMLA. FMLA is unpaid leave for qualifying medical necessity to you or a family member.

Yes...go ahead and file for UI... only they can make a decision for approve/deny UI benefits.

You should really begin a new thread of your own... even though your situation may sound similar to the OP here.

[drago81]

I agree this state is definitely on the side of the employer!! They want people to work supposedly to pay all the taxes they dish out, yet don't get hurt.. If you are unable to work they don't care because they are still getting paid and going home to their wealth.. I love how they make law after stupid law screwing the workers even more.. Laws about doing surveillance and investigations on a injured worker to prevent fraud.. Where is the law to investigate and do surveillance on your employer when they don't allow you to take breaks, don't modify duties requested by the doctor, etc and the list could go on and on. It's all a joke and it's pretty sad that people have to fight for everything these days even stuff like getting injured at work.. Sure people commit fraud in the L&I system but lets punish everyone now.. Let's just say "what is" if L&I approved all ligitament claims there would be no injury lawyers for this field of work.. Pathetic and this State should be ashamed...

[originald1]

OK, I see that this was over a year ago. But maybe you can offer a shred of advice.
My husband was in almost the exact situation as you discribed. Shelving unit with a bunch heavy boxes on it came off the wall, fell on his back. Was given physical therapy and occ therapy with no improvement. Dr requested MRI 3 times, L&I denied. After PT ended (because of lack of improvement), an IME requested MRI and results showed a herniated disc. IME says no need for further treatment, though his AP says cortisone shot. L&I says no, no need for Voca Therapy, says he can be a Parking Lot Cashier (yeah right!?) and stops payments. Then the employer designated FMLA runs out the same day they stop time-loss payments. So since his AP wouldnt release him back to full duty, his employer laid him off.

My Question is did you apply for unemployment, did you get it, and if so, can we appeal L&I decision (with the help of a lawyer) while collecting unemployment? Is there anything that would prevent him from getting unemployment? Were getting an attorney, but we need something while decisions are being made.

Thanks much, and Im really sorry you had to go through these punks for help too.

I too suffered a low injury back sprain strain, and DDD, spinal stenosis, nerve damage running down my leg into my three toes on right foot. And yes, this is a scam against patients who have major injuries. I was put through all the hoops and tricks...lying IME Doctors, Doctors who contradicted each other, and closings of my case without warrant. Yes we are forced to get a lawyer...a lawyer who basically does nothing but shuffle paperwork back and forth between L&I and the patient, and for that they get a hefty third of your money, plus "fees". In my case I had child support payments, which I had been paying faithfully until I had to fight L&I for back payment for a year...then the Courts came after me for contempt, and when I finally received my years back pay, child support took 50% of the TOTAL, the Lawyer took 33% of the TOTAL, (which is only 55% of your total pay anyway...and they went according to my pay from the original year of injury so it was $20 an hour instead of the current $27) leaving me a little over 5 grand for the years pay. This comes to $240 a month! Our system is pathetic in every way possible. The Doctors and Lawyers are all in this game, and the game is definitely rigged against the patients. The one commenter was correct, if you have a small injury that they can get you back to work quickly, everything goes smooth. But don't break your back in this state...you'll be treated worse then a leper with syphilis. By the ay, I was just released back to work...I was a lead carpenter for the last 20 years, built many multi-million dollar homes, the richest man in the country's home as a matter of fact, one of a kind homes, made $27 an hour plus great bene's, paid a lot of taxes...then I was denied returning to work as a carpenter EVER again, but they said no retraining for me, as I could be a...(wait for it)...PARKING LOT ATTENDANT!!! Gee, there sure is going to be a lot of talent sitting in parking lot attendant boxes across this country! Grown men in their 50's with the knowledge to build some of the finest homes in the country, thrown in a ditch by Washington State L&I claims managers...for what? Working hard, in a dangerous field, and getting injured? YEP...Labor and Industries cares SOOO much for the workers! Pathetic is what it is. Now I have to do a job search for "Parking Lot Attendant"...oh wait, I already did that at 7 am. It took me all of 45 minutes to learn there are no Parking Lots to attend within 60 miles of my house, and 4 people have been hired in the last YEAR across the entire state. And now child support is going to lock me up when they don't get their next payment. AMERICA...what a country!!! Work hard your whole life, end up broken, discarded, and imprisoned. Thanks L&I...

[lvnlife662]

Bad experiences with claim managers....I have had a couple. But the most memorable one is when I called about my PCE results. I initially saw a doctor for my injury, and it became clear real fast he did not know what he was doing, or even how to do it. So with the help of my employer got authorization to see a specialist. Well my attending physician did not agree with the PCE but did not give a medical reason (I have no clue why that was, so don't ask, lol). They sent over a copy of this PCE to my original doctor who had not seen in in over 9 mo. and he agreed with it! So L&I was set to go forward on his word, and I called to get the record straight on who was treating me and ask why this doctor was given the opportunity to have a say so in my case.

She couldn't answer that question, but rather complained that the attending physician wasn't co-operating so they only could go on the information they had. The signed PCE is still in my file, my doctor never gave a medical reason, other than he says so, and an IME was scheduled..again with the help of my company. (Yes this is a lucky thing for me, but my suspicion is that they want a legal resolution so they can move on, and not incur a legal leg for me to stand on later)

I have reported inaccuracies in my file of charges that were made, and paid for, for services never rendered, and nothing happens. They don't care, in the end it's just let get this over with and move on to the next case. I stopped talking to them, they don't really hear me anyway. I got a lawyer and he doesn't really listen either. So ever onward we go, and I'm thinking in the end this is not going to work in my favor. I will have to just take it and run with it.

originald1 is right "Work hard your whole life, end up broken, discarded, and imprisoned. (in a broken body.) Thanks L&I...for empowering me

[Bosbom95]

What a minefield this is we are walking blindly through.

I agree with a previous poster that being honest and working in good faith is the best approach, however....

When you're past the point where your case manager will work fairly with you and you've reached the point that you can't afford your housing or food... Why play by their rules anymore? There is a freedom in having nothing left to lose.

Call your case manager as many times in a day as you can get your fingers to dial. Make it impossible for them to get anything done unless they fairly work with you. Don't get angry or make threats. Just don't take no for an answer.

Send repeated letters in the same manner.

If you've been let go from your job, picket their place of business until they get sick of it and start demanding action as well.

Be an annoying tick that just won't go away and start affecting your case manager's mental health. Make them beg you to stop.

Who can add to this list? **************** propaganda********************

[tony]

Bosbom95

Call your case manager as many times in a day as you can get your fingers to dial.

That's the perfect way to lose your job, destroy your claim and end up in jail - The goal is to have zero contact with that agent and not give the employer a reason to fire you.
The best weapon against a case manager is an attorney.
You need an attorney to act as a buffer between you and this agent otherwise they'll terrorize your life.

That case managers' job is to close your claim by any means necessary, they have no intention of "working fairly with you" - If they did, the carrier would fire them.
Whenever a case manager is assigned to your claim, it's time to hire a lawyer - do anything different and you'll destroy your claim.

Be an annoying tick that just won't go away and start affecting your case manager's mental health. Make them beg you to stop.

They don't have to beg you for anything - They'd simply call the cops, have you arrested for Malicious Use of a Telephone and close your claim.
For the record, I removed the terroristic propaganda (gorilla warfare reference) in your last sentence - I strongly advise you to seek professional help before you do something stupid or incite others to do so.
This is the type of propaganda Trump's been promoting that leads to mass shootings and other acts of domestic terrorism - It may be allowed in this country by our president, it won't be allowed in this forum by me.

Don't be in my forum misleading people and inciting stupidity (like our president) Have a nice life, you're banned.

RCW 9.61.230
Telephone harassment.
(1) Every person who, with intent to harass, intimidate, torment or embarrass any other person, shall make a telephone call to such other person:
(a) Using any lewd, lascivious, profane, indecent, or obscene words or language, or suggesting the commission of any lewd or lascivious act; or
(b) Anonymously or repeatedly or at an extremely inconvenient hour, whether or not conversation ensues; or
(c) Threatening to inflict injury on the person or property of the person called or any member of his or her family or household;
is guilty of a gross misdemeanor, except as provided in subsection (2) of this section.
(2) The person is guilty of a class C felony punishable according to chapter 9A.20 RCW if either of the following applies:
(a) That person has previously been convicted of any crime of harassment, as defined in RCW 9A.46.060, with the same victim or member of the victim's family or household or any person specifically named in a no-contact or no-harassment order in this or any other state; or
(b) That person harasses another person under subsection (1)(c) of this section by threatening to kill the person threatened or any other person.
[ 2003 c 53 § 39; 1992 c 186 § 6; 1985 c 288 § 11; 1967 c 16 § 1.]
https://app.leg.wa.gov/rcw/default.aspx?cite=9.61.230

How to Deal With Telephone Harassment (Legally)
Obscene or harassing phone calls are an unwelcome intrusion on your privacy. They can ruin dinner with your family or a quiet afternoon. They can be a frightening experience. The Federal Communications Act, specifically 47 U.S. Code § 223, as well as many state laws, prohibit telephone harassment and create legal remedies and enforcement mechanisms.
https://www.lawyers.com/legal-info/p...arassment.html

Tony