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  1. #1
    Join Date
    Apr 2010
    Posts
    34

    Default Injured in Attack by a Patient

    hello everyone, let me first start out by trying to describe the events of my injury leading up to now. i worked at a local hospital as a nurses aide. i would also like to add that at the time of my injury i had obtained an application for the hospitals RN program and had three house supervisors willing to write me letters of recomendation. does me no good now, just adding to the point i guess... i was attacked my a patient and sustained injury to my upper back and right shoulder. i spent almost two years classified as TTD. as of my last MD appt, it was changed to a PPD of 75% with work restrictions:

    i am not supposed to do any work with my right arm(dominant arm) and can work with my left arm for 5 to 10 minutes before it causes pain in my upper back. i am able to stand for roughly 30 minutes(down to 15 minutes if involving hills or stairs). i am able to sit for about an hour(around an hour and a half if i am able to lay forward onto a desk or table). in between this times of sitting or standing i need to be able to lay down or at elast recline to less an a 45 degree angle untill the pain in my upper back subsides. my total time on my feet is about a maximum of 6 hours a day which is divided up among several session of either sitting and standing.

    those are my current restrictions, i am waiting for the IC's IME to be scheduled and apparently my own lawyer will set one up for me as well after their's is done. the IC is also demanding a FCE be done, the WCJ did order one to be done if approved by my own MD and it will be done by either vessid or the WCB's unit. wasn't really clear on this point. the FCE however brings up my first concern for this post.

    at first i had no problem with the FCE, i thought it would help me because it would prove that my restrictions are correct and it would help me. after doing some research though, i see that the test is 4 to 5 hours long. unless i can lay forward onto something the whole time, i wont even make it an hour and a half( that's assuming i lay down in my car both before and after the test so that i can get to and from home safely). now i am afraid of this test. what do i do? i don't want to be screwed by not being able to finish the test, and i also don't want to made even worse from the strain of trying to complete it. thankfully my wife is standing by me, but if i am hurt even further, and completely end all chances of being able to have a family she might not.... can my MD say i can't do the test on the grounds it violates my restrictions, and can the IC's IME over rule my MD on this issue? also, if my MD denies it, can i lose my benefits because of it? i already lost my home from being injured, i don't want to lose another one...

    the next issue i would like to address in this post is to due with my date of injury. i was injured on 04/05/08. that means i am stuck with the new laws. my own atty. states that i am higherable. while not agreeing with my atty, the IC's atty. did let slip at the meeting before the last hearing that he wouldn't higher me. putting it bluntly, at the current state of my injury, i doubt i will ever be able to work again. if that is the case, what do i do? it is my understanding that since i am not classified as 100% disabled i am capped at 10 years. how can i support my family after the ten year cap is up? i have heard there are ways around the cap, and i am sure my atty is working on them, but due to his poor communication skills, i don't know what they are(i would replace him due to this if it wasn't for the fact he keeps"winning" at ever hearing). do any of you know what these loopholes are that would allow me to still support my family after the 10 years are up? I want to be clear with this point that i am asking if there is a truthful way around the 10 year cap for my situation, i don't care about any shady ways around them because i have been honest from the start and do not intend to change that now...

    the third point for this post today is actually in regards to my wages and a possible future settlement. i am told that since i was 23 at the time of my injury, when my permenand wage is set i am eligable for minors expectancy. first, what is that, and what kind of a percentage of increase should i expect? let me also lay out some of the math at this point. my AWW at the point of injury is 509 and change. at 75% of the 2/3's of my AWW, i get 254 and change a week. if i am reading it right, if i were under the SLU at 75% it would be 400 weeks times the 509 with is just over 200,000. please correct me if i am wrong with that understanding. now, i am classified as PPD and not in a scheduled award as of right now(keep in mind all the actual %'s still need to be finalyzed). does that mean as a settlement i should expect to get more or less than the SLU settlement?(i know that i have not added the minor's expectancy or the possible section 32 at this point in my math) now to cosider them, lol. i don't fully understand the minors expectancy, so i can't address that, but am aware of what a section 32 settlement is. since the new healthcare law has passed, my wife's insurance wont be able to deny my back and arm, so i do not mind giving up the medical benefits as much now. but all i get from my atty is that with a section 32 the IC pays considerably more for the settlement. thus far i have been yet to find a dictionary that translates considerable into an actual percentage, lol. does anyone know at least like an average of what i could expect? i am also aware that if i am capped at 10 years, it will significantly lower what i will get, if anyone more experienced with these devils than i can address that with this answer as well, i would greatly appreciate it.

    thank you for your time in readying my insanely large post. i know i am a worryer, but i can't help it. my wife wants kinds and it's hard enough even to try with the pet, and that's not even including the terror at one day not people able to finacially care for them. i would think that alone would be enough to terrify anyone. any answers that anyone can give in regards to my three point would be great. thank you guys/gals, god bless.

    by the way, sorry for the long post, i just wanted to put it all in one to make it easier to reference. oh, and tony, if you could answer here, that would be great too, you have been the most helful so far from what i have read from other posts. thanks.

  2. #2
    Join Date
    Jul 2008
    Location
    California
    Posts
    1,856

    Default Re: Nervous About the Future

    Quote Quoting molara View Post
    hello everyone, let me first start out by trying to describe the events of my injury leading up to now. i worked at a local hospital as a nurses aide. i would also like to add that at the time of my injury i had obtained an application for the hospitals RN program and had three house supervisors willing to write me letters of recomendation. does me no good now, just adding to the point i guess... i was attacked my a patient and sustained injury to my upper back and right shoulder. i spent almost two years classified as TTD. as of my last MD appt, it was changed to a PPD of 75% with work restrictions:

    i am not supposed to do any work with my right arm(dominant arm) and can work with my left arm for 5 to 10 minutes before it causes pain in my upper back. i am able to stand for roughly 30 minutes(down to 15 minutes if involving hills or stairs). i am able to sit for about an hour(around an hour and a half if i am able to lay forward onto a desk or table). in between this times of sitting or standing i need to be able to lay down or at elast recline to less an a 45 degree angle untill the pain in my upper back subsides. my total time on my feet is about a maximum of 6 hours a day which is divided up among several session of either sitting and standing.

    those are my current restrictions, i am waiting for the IC's IME to be scheduled and apparently my own lawyer will set one up for me as well after their's is done. the IC is also demanding a FCE be done, the WCJ did order one to be done if approved by my own MD and it will be done by either vessid or the WCB's unit. wasn't really clear on this point. the FCE however brings up my first concern for this post.

    at first i had no problem with the FCE, i thought it would help me because it would prove that my restrictions are correct and it would help me. after doing some research though, i see that the test is 4 to 5 hours long. unless i can lay forward onto something the whole time, i wont even make it an hour and a half( that's assuming i lay down in my car both before and after the test so that i can get to and from home safely). now i am afraid of this test. what do i do? i don't want to be screwed by not being able to finish the test, and i also don't want to made even worse from the strain of trying to complete it. thankfully my wife is standing by me, but if i am hurt even further, and completely end all chances of being able to have a family she might not.... can my MD say i can't do the test on the grounds it violates my restrictions, and can the IC's IME over rule my MD on this issue? also, if my MD denies it, can i lose my benefits because of it? i already lost my home from being injured, i don't want to lose another one...

    the next issue i would like to address in this post is to due with my date of injury. i was injured on 04/05/08. that means i am stuck with the new laws. my own atty. states that i am higherable. while not agreeing with my atty, the IC's atty. did let slip at the meeting before the last hearing that he wouldn't higher me. putting it bluntly, at the current state of my injury, i doubt i will ever be able to work again. if that is the case, what do i do? it is my understanding that since i am not classified as 100% disabled i am capped at 10 years. how can i support my family after the ten year cap is up? i have heard there are ways around the cap, and i am sure my atty is working on them, but due to his poor communication skills, i don't know what they are(i would replace him due to this if it wasn't for the fact he keeps"winning" at ever hearing). do any of you know what these loopholes are that would allow me to still support my family after the 10 years are up? I want to be clear with this point that i am asking if there is a truthful way around the 10 year cap for my situation, i don't care about any shady ways around them because i have been honest from the start and do not intend to change that now...

    the third point for this post today is actually in regards to my wages and a possible future settlement. i am told that since i was 23 at the time of my injury, when my permenand wage is set i am eligable for minors expectancy. first, what is that, and what kind of a percentage of increase should i expect? let me also lay out some of the math at this point. my AWW at the point of injury is 509 and change. at 75% of the 2/3's of my AWW, i get 254 and change a week. if i am reading it right, if i were under the SLU at 75% it would be 400 weeks times the 509 with is just over 200,000. please correct me if i am wrong with that understanding. now, i am classified as PPD and not in a scheduled award as of right now(keep in mind all the actual %'s still need to be finalyzed). does that mean as a settlement i should expect to get more or less than the SLU settlement?(i know that i have not added the minor's expectancy or the possible section 32 at this point in my math) now to cosider them, lol. i don't fully understand the minors expectancy, so i can't address that, but am aware of what a section 32 settlement is.
    ] since the new healthcare law has passed, my wife's insurance wont be able to deny my back and arm, so i do not mind giving up the medical benefits as much now .


    Your wife's insurance will not be able to deny you insurance coverage, however they will not cover your work related injuries. This topic has been dicussed on a few other threads. I recommend you do not sign a C&R if you still need medical treatment for your work related injuries. The new health care laws do not cover work related injuries, after you sign a C&R.

    but all i get from my atty is that with a section 32 the IC pays considerably more for the settlement. thus far i have been yet to find a dictionary that translates considerable into an actual percentage, lol. does anyone know at least like an average of what i could expect? i am also aware that if i am capped at 10 years, it will significantly lower what i will get, if anyone more experienced with these devils than i can address that with this answer as well, i would greatly appreciate it.

    thank you for your time in readying my insanely large post. i know i am a worryer, but i can't help it. my wife wants kinds and it's hard enough even to try with the pet, and that's not even including the terror at one day not people able to finacially care for them. i would think that alone would be enough to terrify anyone. any answers that anyone can give in regards to my three point would be great. thank you guys/gals, god bless.

    by the way, sorry for the long post, i just wanted to put it all in one to make it easier to reference. oh, and tony, if you could answer here, that would be great too, you have been the most helful so far from what i have read from other posts. thanks.
    I am sorry I could not answer your other questions.

    Take care.
    Last edited by tony; 04-04-2010 at 08:08 AM.

  3. #3
    Join Date
    Apr 2010
    Posts
    34

    Default Re: Nervous About the Future

    have you read the actually 2,000 page law? i have. i think you may be mistaken on that. i believe they can only deny you if you have an open claim, besides, i was attacked, i have chronic back pain, plain and simple. although, i still bet a settlement is still a year or two off so i do have more time to clarify.

  4. #4
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    17,943

    Default Re: Nervous About the Future

    The reforms mandate a carrier providing a policy of coverage, does not mean you are covered for everything. Big difference there.

    Industrial injury/illness is the liability of your employer, not you/employee. As such, the ER must either pay out of pocket or buy a policy of coverage from a carrier in your state.
    WC is not "health coverage/insurance' for the employee/IW.
    That is why your private pay health coverage does not pay for work injuries/illness.

    When/IF you close out your comp claim by lump sum, accepting money for future medical care, you are agreeing to accpet all future liability for your injury/illness... you pay for that treatment out of your pocket, with the money provided by your ER/IC...not your own health coverage insurer. Again, big difference in where the liability lies.

    Closing a comp claim without money for FMC/Future Medical Care would mean there is no need for further treatment to the claimed body part... therefore, there would be no problem using your own health care coverage. The injury is "cured" and no longer considered a pre exsisting work related injury, for insurance/liability purposes.
    If you return to work, and aggreviate that injured body part, it would be a new injury/claim.
    since i am not classified as 100% disabled i am capped at 10 years. how can i support my family after the ten year cap is up?
    As to your future... you should be filing application for SSA/SSDI now. Not later on.
    WC benefits are limited to wage loss while you cannot work due to your injury, treatment to that injury, and indemnity based on the residual disability/impairment due to this injury with this employer.
    Unless you are declared 100% 'disabled" under NY state comp definition, it would be unlikely for you to see enough money to ''retire'' on. WC just doesn't pay those kind of benefits.
    Once you are declared MMI/max medical improvement has been reached... stabililty, you will be rated, and your claim move to some type of resolution.

    At MMI, it is expected you will return to some type of gainful employment. Even if not in your pre injury job, or employer. There may be VR benefits available to help you in identifying your current job skills, and/or job placement services.

    Comp just doesn't go on forever, only in the cases of 100% PD, and per the statutes. Any "loopholes" will be addressed on a case by case basis... not somthing you should provide here. Your atty is the best source of those answers.

    NY does permit a lump sum cash payment of the indemnity due, without commutation or reduction to todays dollars. But even at that, the money is not great or ''huge" by any standard compared to the potential earnings loss.

  5. #5
    Join Date
    Apr 2010
    Posts
    34

    Default Re: Nervous About the Future

    yeah... i am going to have to look into this more. i was able to get ahold of my atty, and he basically told me that i would be covered by my own insurance once everything takes place in 2014. you guys are saying no though.... i guess i just need to find out more.

    oh, this is only a small part of my total questions. please answer the others if any of you know anything.

  6. #6
    Join Date
    Apr 2010
    Posts
    34

    Default Re: Nervous About the Future

    hi folks, it's me again. i am sorry for bumping this by posting this reply, but i was just wondering if anyone had and thoughts on the questions that have not been answered thus far. i guess the FCE is also moot. the law judge ordered that i have an FCE after i get the approval of my treating physician. just had my appt. with my doc and he wrote that he feels the small amount of knowledge that "might" be gained with this test, does not come close to justifying the pain and suffering it will cause me. i am assuming that wont be considered consent of course. i just got through a two week peak in my back pain and will now be able to be online a little bit more and offer some help with things that i have already gone though. thanks for your time guys. i look forward to seeing any response here and also to helping whereever i can again.

  7. #7
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    17,943

    Default Re: Nervous About the Future

    You wanna single out a couple questions at a time?
    There is a lot of print there to read...though nicely formated....(thank you) lots of info that may/may not be relative to the answers to your questions....so, I admit I didn't read it word for word.

  8. #8
    Join Date
    Apr 2010
    Posts
    34

    Default Re: Nervous About the Future

    well, i guess the two big ones would be whether or not the ic's IME can overrule my own doc on the FCE issue, and the other question that still sticks out to me is the minor's expectancy and the 10 year rule. as it stands right now i am classified at 75% by my doc, but i am permenant and with my restrictions i will never be able to work again. what will i do at the 10 year mark? i still wont be able to work but the carrier is free and clear? i hate uncertainty, and this system is rife with it.....

  9. #9
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    17,943

    Default Re: Nervous About the Future

    FCE is a tool. Dr's use this to help in determining what you are capable of doing in your daily activities. Not necessarily just your job functions. And, a FCE is only valid for the day you are evaluated. Your condition could change significantly the next day or week. What good would the FCE results be if the report hasn't even issued by then ?

    It's not about one Dr vs IME and ''over rule'' on any given issue. Dr and IME only provide opinions, Those opinions should/must be based on substantial medical reasoning, not just ''I think..."

    How you are rated for PPD (the 75%) is what is used to calculate the indemnity due for your reduced earning capacity, or reduced ability to compete in the open labor market. Loss of earning capacity is much different than being ''disabled'' to that extent.

    i am permenant and with my restrictions i will never be able to work again.
    Under most state comp definitions, you would only be unable to work again if you were 100% PD. And even then, not all IW's fit that classification. I'm 100% PD, under comp definition, but only to the body part injured. So, under that rule, you/I would conceivably be able to perform some type of gainful employment. Sedentary it may be, but able to earn a "living wage".

    I'd have to read about the "10 year mark".... If you mean the max PPD payments are 525 weeks, then once those weeks are paid out. Your benefits stop. The number of weeks is determined by the PPD %. The medical coverage for the accepted body parts should remain available.
    i hate uncertainty, and this system is rife with it.....
    Just know that there is no certainty in WC...nor in life for that matter. You're gonna have to move on from that thought process. Whenever you have some other party paying the bill... there is going to be resistance, and disputes. The ER/IC doesn't want to pay for anything more than the law demands.
    WC is not like a personal injury claim, ie motor veh accident. There you would receive medical to return you to pre injury condition, not so in WC. Money for past/future lost wages...not so in WC. And money for pain and suffering, maybe punitive damages... certainly not the case in WC.

    Your third point there... section 32 is a C&R (from what I've read). And as I said before, NY permits a lump sum payment of the indemnity due. A 32 closes out the claim completely. Including medical.

    I think what you are looking for is if you are going to collect WC wage replacement benefits for life. (?), based on the info you provide here... that answer is "no". Your weekly benefits, if you let this pay out by the week, are going to end when the indemnity is satisfied.

    And your wifes GHP is not going to pay for your work related injury. IF you 32/cash out the claim, you would be accepting money for future medical care. So, IF you knowlingly allow another carrier to pay for treatment to your injury, it would be double dipping, and possibly fraud against that carrier.

    If you think the GHP is going to pick up the tab... get it in writing.

  10. #10
    Join Date
    Mar 2009
    Posts
    50

    Default Re: Nervous About the Future

    Great info everyone. My story is simular to yours. I was a nurse aide for 10 yrs. and was also hurt when working with a patient. I herniated 2 disc with tears, DDD, spinal stenosis, and major nerve damage in both legs. Did every coservative treatment out there and was told I could no longer work as a CNA and was sent back to school(which I payed for) to be retrained for a setatary job. Was doing well with only 1 to 2 episodes per year and was really in the best shape of my life losing 70 lbs and became a exercise freak.

    It all came crashing down one Sunday morning after walking my dog. Came home and picked up one of the kids toys of the lawn and down I went. My husband had to pick me up and carry me into the house. The next day I could barley walk and went to the back dr that I see on occation. He did lots of test and said that I exasterbated the injury and it was really bad this time. Went though several bouts of PT which made matters worse and was falling down all the time. Fell down is sons room and hit my head on dresser which left big bruise and rug burns on face. Dr said he had enough and that surgery was no longer an option but a necessity if I wanted to be walking for the rest of my life. I had a combo of ADR and fusion L4-S1 in May of 2009. I still have a lot of issues because of the nerve damage in my legs.

    I am 1yr out and have reached MMI with IME disability rating of PPD at a moderate level. My doc rates me at 70%. I go to court May 12 to see what happens now. IC wants to settle and I have thought about it because this has been going on for 7yrs and am sick of looking over my shoulder. Not that Im doing anything wrong (cant do anything anyways). Im going though the same stuff and its really cofusing because I want to make the decision thats best for me and my family in the long term. My lawyer is talking all the same stuff, SSDI, MSA, settlement issues. I was also told that my husband isurance would pick me up. Ill have to check again.

    Sorry this is so long but just wanted to let you know that I feel your pain. I also was planning to return to school for my RN and also plans to have another child. RN school was out but in my case, surgery squashed my chances of being able to carry a child. Life has been turned upside down and it is very hard to except your new life. Hard for me anyways. Good luck and will post my answers if I get any on May 12 for we seem to have a simular questions. Good Luck!!!
    Last edited by catgirl39; 04-30-2010 at 11:06 AM.

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