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  1. #1
    Join Date
    Jun 2010
    Posts
    1

    Default Misdiagnosed Workmens Comp. for 3 Years

    I was hoping someone may be able to help….

    Dates are approximate….

    In 2006 I was preparing an office for a new employee, I was reorganizing the office. While moving a heavy box I twisted my Knee and heard a “pop” sound I had pain but did not think much about it at the time until the pain started to increase and swelling started. The next day I reported to our employee health office to report the injury. The sent me to an Orthopedic specialist where I was diagnosed with a torn meniscus. I was told that many people with a torn meniscus that live with out a problem and he would recommend me not going though surgery unless the condition became a problem.

    I decided to take the doctors advice and hold off on surgery to correct the problem. The following year I had additional elevated pain and swelling in my knee, which I was told is a symptom of the torn meniscus and would occur on occasion. The pain and swelling as so sever that I decided to follow through with surgery.

    At that point I made another appointment with our Employee Health Center and they informed me the original Orthopedic specialist that evaluated me was no longer on contract and sent me to a new Orthopedic specialist where the did an additional MRI and the doctor said yes it was a torn meniscus and pointed it out to me on the MRI image in his office.

    They set me up for surgery but it was months out, in the meanwhile I improved greatly and again decided not to go through surgery.

    I asked the Employee Health doctor if this would effect my workmen’s comp status and he told me that no and that the “We own my knee now”.

    The following year again major pain and swelling in my knee and I came to the conclusion that I can not live with the debilitating pain even if it was just sporadic.

    I was again set up for surgery and in 2008 I had arthroscopic surgery on my left knee.
    After surgery I was informed by the surgeon that it was not a torn meniscus but a condition called “Pigmented villonodular synovitis”. To treat this condition they preformed the radical procedure of removing the lining of my knee. The lining of the knee is critical in lubricating the joint and I am now told it is inevitable I will get rheumatoid arthritis.

    My belief is once they determined that it was not a torn meniscus that they should have stopped the procedure and closed me up. Doing that would have giving options for treatment of the condition other than the radical procedure of removing my knee lining which causes debilitating symptoms later in life. I would have had the option of radiation therapy rather than this radical procedure is I was consulted before it was done.

    After surgery the Employee Health doctor sent me to physical therapy to help with recovery.

    I was told by my adjuster at the time any thing related to the surgery would be covered under workmen’s comp since the City is the one that sent me for surgery.
    Recently I have had complications with my knee to the point where I have had to miss a week of work and was unable to get out of bed for day being in such pain.

    I spoke with our Employee Health Center doctor and they told me they were not considering this a workmen’s comp. issue any longer and I would have to go through my private insurance to get treatment.

    I did go through my private insurance for treatment and had another MRI done. It is now determined that scar tissue from the surgery is to blame for my pain and swelling and I would need additional surgery to remove the scar tissue if it continued to be a problem.

    I paid for all my co pays as well as used personal vacation/sick leave time for the time I was off rather than using workmen’s comp time.


    Do I have a case against my employer to cover this under workmen’s comp?

    I do have FMLA paper work from the surgeon stating that this is going to be an on going problem for me.

    Thank you for your help,

  2. #2
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    17,941

    Default Re: Misdiagnosed Workmens Comp. for 3 Years

    Can you whittle this down.../
    All the details don't matter here... one, did your injury occur due to your employment... and two, did the injury occur in the course of performing your job duties.? Those are the AOE/COE standards for a compensable claim.
    \
    Do I have a case against my employer to cover this under workmen’s comp?
    You file a petition to reopen the org claim, and/or file a new claim and it will be investigated. It 's not about having a 'case' against anyone... it's about liability. Of course the HR people will tell you they are not considering your injury work related any longer, they don't want to pay. You should not be using your GHP/group health plan coverage...you are not the responsible party for the injury treatment. IF you had closed the claim by cash payment, you would not be able to use the GHP either... that would be double dipping and potential fraud.

    At this point, you should be discussing your options, and getting legal advice from an attorney. Message board is not a good substitute.

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