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  1. #1
    Join Date
    Nov 2011

    Default Appealing WC Denial for Occupational Injury

    Thanks for reading this huge post. This is my entire story and I could use any help you can offer.

    I am waiting for my appointment with a lawyer and I am one of those people that likes to be as prepared as possible and do leg work. Any help or advice is much appreciated.

    I worked at my last job for 12 years with no injuries or WC whatsoever. I have never filed a WC claim before this one. Prevous job was standing 99% of the day.

    Started this job performing desk work as well as additional duties that reuired me to stand and move about. It was about 50/50 sitting and moving. Several months back my duties changed to just doing desk work. After a few weeks I started feeling a strong ache and soreness in my butt while I was sitting. It would come and go and was never THAT much pain, just an ache that was relieved when standing. I believed it was just a normal ache, like your feet if you stand all day.

    I had never sat for that amount of time so didn't know if it was normal or not. I asked for a new chair as well as my supervisor asked for a new chair about five separate times during the time before my injury "occured". Fast forward 2 or so months and I was told to begin 10 hour days, still sitting virtually the entire day except for my breaks and lunch. The chairs we had available to us were the general 60 dollar chairs, but they had been handed down from office to office until they arrived to us. Beaten and abused with very poor padding. Fine for sitting sporadically, but not 10 hours nearly non stop. I found another chair at work that wasn't used, so I cleaned it and used it. It was also in terrible shape, but was a little better than what I had.

    Had no pain for a few weeks, then had intense pain when I sat at work one day. I stood up and told my manager that I couldn't sit down. With this pain, it only really hurt when I was sitting. I filed an initial injury report saying it was from sitting long hours on a poorly padded chair. We decided I would give it a little time to see if it would go away on it's own if I didn't sit for a while. I stood up the entire month and on the 30 day mark told them that it didn't go away and I was going to the doctor.

    I went with the manager in to the HR managers office and told the HR manager that I was still having pain and couldn't sit and was going to the doctor. They then had me take a UA (weeks after the injury report).

    The manager cam up to me the next day before my appointment and told me he had talked to the HR manager and said "It's ok, I told the HR manager that it wasn't work related". I said what are you talking about, I have said since the beginning it was work caused as well as telling the HR manager directly and writing it on the injury report.

    I went to my office and told my supervisor what the Manager had said and he just shook his head, as well as the other worker at the time, because they knew it was caused by work.

    I went to the doctor and was diagnosed with nerve damage from the prolonged sitting (similar to carpel tunnel in the pelvic where you sit). The causes of this injury are caused by pelvic surgery, accidents (car, etc.) and prolonged sitting. I have dozens of documents from leading professionals and experts on this injury that agree with me. At the doctors, I filled out the 801 form for WC.

    When I arrived at work the next day, I gave them my release to work saying no restrictions except "limited sitting is ok at the patients discretion". The manager then told me I had to fill out an injury report. I told the manager that I had filled one out already. I asked the HR manager for copies of the documents including the initial report I had filled out and the HR manager told me that it had been disposed of because I didn't think it was work related.

    I emailed the HR manager directly back and said that I have never said it was not related, that I was shocked when the manager told me that the manager had told the HR manager that and that I set the manager straight. I also told the HR manager that the cause of injury on the initial report I filled out, that was thrown away, was from prolonged sitting on a poorly padded seat.

    The HR manager replied saying thank for the input.

    I went to the IME exam and the result was lies and un truths. He said he had checked in vital spots where the injury is, but wasn't within inches of it. He told me that they were trying to find an IME for quite a while because it's complicated location and noone else wanted it so he volunteered. He spent 90 percent of the time checking areas that were not affected by the injury and trying to catch me in lies by jumping back and forth in time over an injury that took months to progress to noticable pain.

    The results were he said it wasn't work related and that it was all in my head most likely. Even though he found numb spots in my genital area and all my symptoms are related exactly to this injury.

    I sent my letter of appeal and within a couple days was "perminantly eliminated" from the company.

    I know that was a lot of reading and I appreciate you looking over my case.

    Where I am now is, like i mentioned, I am getting a lawyer. I am on meds that have reduced most of the nerve pain and have gotten somewhat better. I still cannot sit. I have several witnesses that will testify that I told them right after it hurt that it was work related from the sitting for 10+ hours a day. I also have my direct supervisor that I had been mentioning my butt ache and he tried several times to get me a new chair because of the poor quality. He can also testify that I told him it was work related, testify that I came in the office in disbelief after the manager told me that the HR manager was told "I didn't think it was work related". Also he'll testify that I was great at my job and that I got fired because of my injury/appeal, in his opinion.

    I also have 50+ emails from the leading (best in world) professionals on this injury saying that my work conditions not only could have caused it, but it is likely that it did. I will also see a physical therapist to rule out other reasons that aren't work related. I am also going to see another local PT that can check thoroughly check me and also diagnose my injury in more detail. This PT has also said that my work is most likely what caused the injury. The IME also found numb areas which show there was nerve damage. I also have proof that everything the Manager said he "knew for sure" was actually lies or made up. Can disprove that 100%, so hope it shows that the manager is a liar.

    I took pictures of the chairs I used and the work area. They also hired a new PT employee (before I was laid off) and on this employees first day the employee complained about how uncomfortable the chair was. It was the same chair I had my injury sitting in. This employee was given a brand new 150 dollar office chair within a short time. The supervisor was also given a new chair. This shows me they know the chairs were horrible and unusable. The WC sent me my appeal documents saying that the IME was a neurologist, which is fitting for my injury, but he in reality was a physiatrist/rehabilitation doctor. Nothing to do with neurology although they can perform some electro nerve testing. He didn't use anything on me, but my flexibility was fine so I was good to go apparantly.

    Any other info I should gather or prepare before my meeting? I am laid off and have tons of time.

    Thanks so much and again sorry for the WHOLE story.

  2. #2
    Join Date
    Nov 2011

    Default Re: Appealing WC Denial for Occupational Injury

    Just an update. I went to see a specialist in Pudendal Nerve Entrapment and was fully examined and diagnosed. Then, as a result, SAIF had me examined by yet another IME. This time the IME was a qualified urologist and agreed with the specialist that my PNE was caused by the job. SAIF then dropped the denial and accepted the injury as work caused and will cover the costs.

  3. #3
    Join Date
    May 2011

    Thumbs down Re: Appealing WC Denial for Occupational Injury

    Quote Quoting butthurt View Post
    Just an update. I went to see a specialist in Pudendal Nerve Entrapment and was fully examined and diagnosed. Then, as a result, SAIF had me examined by yet another IME. This time the IME was a qualified urologist and agreed with the specialist that my PNE was caused by the job. SAIF then dropped the denial and accepted the injury as work caused and will cover the costs.
    Pardon the Pun..................................... Reads like a pain in the ASS !

  4. #4
    Join Date
    Nov 2011

    Default Re: Appealing WC Denial for Occupational Injury

    Yeah, the specialist was a 10 hour drive to and from, luckily the wife did the 20 hours of driving. a year of not being anle to rock my baby or sit and watch the kids play sports. It is a pain in the ass lol.

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