Hi everyone. this is my first post here and I hope those wiser than me can help. I am sorry it is a long story but I am grateful for anyone who muddles through.
I do have a lawyer, but unfortunately, even getting an email answered is rare. useless.
anyway..I tripped and fell sept 2013 at work. I broke my nose, cuts all over, and shattered my upper humerus. in January, I learned my rotator cuff was torn too.
I went to the nearest medical facility. After waiting 2 hours for insurance approval, xrays were taken and the doctor sent me to another facility for emergency surgery. So urgent she wanted to take me via ambulance- it must be done NOW.
Once there... it was surreal. Everyone acted as if they had no idea why I was there, even though I heard the Dr on the phone explaining it in advance, and I had xrays and reports in hand. 5 hours later, I got my first pain pill, an immobilizer, and 2 doctors who said only "your arm and your nose are broken. go on home"
I was so out of it I didn't care or understand until the next day when the first clinic called asking how my surgery went. I told them what happened, she was real mad. She called around to find an ortho doc who would see me BEFORE work comp approval, which explained it all.
By the time i saw an ortho, day 3. the new doc said no surgery for now. honestly, this doctor did not understand the complexity of the fracture. But this type of fracture does call for immediate surgery... and the very first doctors report suggested MRI too. it probably was dangerous not looking for vascular and nerve damage.
I treated with this doc from sept - dec. every visit he took xrays and gave me pain pills. He started me in pt for 12 visits. I was not improving so he ordered an MRI at the end of December.
I'd been off the whole time. I was getting ttd served up with the 'starve her back to work' games.
I couldn't sleep and I wasn't making enough to pay my bills. ttd checks were usually late. I live alone and could not do ADL's or care for my pets. My house was/is a disaster. Every day is a battle trying to keep utilities on, or pain, or something. everything I knew of my life is gone. I was so dependent I lost friends. I can't blame them- I was a mess in every way. I couldn't even live at home for the first two months.
I told every doctor and my adjuster, manager, HR guy... that I was becoming severely depressed and could not properly care for myself, before and after surgery. lack of sleep made me completely insane. I asked to see a Doctor for depression from the injury and lack of progress but was ignored. I begged for something to happen... tell me a plan- do something-anything. I wanted nothing more than the ability to be able to simply care for myself again.
When the adjuster heard the Doc wanted an MRI she was mad and set it up in a different facility. She told me to call my dr and make him lift my restrictions. I didn't, so more late checks.
I got the MRI at the end of Dec, then in early Jan I got a letter she was sending me to IME with her Doctor, in mid Jan. Nearly 5 months had passed and absolutely nothing had been done to fix me. I was tired of the pain, but more tired of the helplessness and I was very close to suicide. I again told that to everyone and still, no one cared except my manager. He got a message to me to get a lawyer which was hard too- an arm is not worth enough apparently.
Every part of my life was spinning in warp speed to depths of Hell I never imagined, and I was helpless to do a thing w/o insurance. I can't risk liens on my house with my future so uncertain.
I was cautiously optimistic about seeing the new doc, hoping for ANYTHING to happen or even to just hear what is going on. I'd been out of pain pills for 3 weeks when I first saw the new Dr. I had a lot of questions. He made it clear he was not treating me or answering questions, only giving his opinion. He said IF he was treating me, He thought a cortisone injection and 5 weeks of PT would be his plan. He told me multiple pieces of my bone had fused out of place and one was impinging up in my rotator cuff, which, btw, was torn. I hated his plan, but didn't worry thinking I would return to the other doc anyway. But 3 days later, adjuster calls me with 'good news- new doctor says I can go back to work, and he is taking over treatment'.
I was really mad. He hadn't even treated me- refused to hear a single comment and would not treat my pain, yet he returns me to work with a 5# restriction/ no overhead work. Keep in mind this is January and there is snowstorm after snowstorm through February. I just found a lawyer and hoped for some help. I got my termination of ttd and was shocked that my lawyer didn't dispute it- even though just digging my car out was violating my restrictions. my first appt as patient, I got the injection that was clearly useless and was not happy. in fact -I was hysterical, telling the doc I was losing it, and I didn't understand how the injection was going to fix all those misaligned bone fragments, and five more weeks of therapy was bull- I needed something to happen or not- just tell me or fix me. We yelled at each other.
I did as I was told, went without pay until March when surgery FINALLY happened. it was instant relief. I could feel it the day after surgery- it felt better. why did they drag it out for 6 months when they knew?
my ttd picked back up and I started PT again. I was immobilized yet again, and now had a case manager that could refuse me help on my ADL's, even after commenting that I would be unable to do them. I broke a piece of my FRONT tooth opening a package 2 days after surgery- trying to fix something to eat. My lawyer simply said "they don't have to provide you with help". apparently, they are not responsible for my tooth either, even though this was the only way to manage.
this lack of help CAUSED me to become so depressed. and with restrictions that said "sedentary" and "NO use of arm or hand" for 10 months, I ended up gaining 70# between January and May. I have never been but a few lbs over weight. I can't walk to the car without getting winded. and this makes me feel worse. I avoid everyone. I do nothing. I'm embarrassed and ashamed.
I was an outgoing, happy friendly SALES rep when I fell. That person is gone.
I did get 13 days in a work hardening program, but 30 more would be needed to undo 10 months of doing absolutely nothing.
yesterday, doc released me to return to work with no restrictions, said I was at MMI when asked by the case manager, yet scheduled me another appointment in 2 months?? He did not discuss PPI even though I do not have full ROM, as of now have no strength.
after I left my appointment, for 1st time in almost a year I can attempt to do things above shoulder height. Still no strength but MMI? Well I hope not, but its enough to stop my ttd.
If I am at MMI, why another appointment? how do I get the ppi? He said NOTHING about it. He knows I am not good as new. Plus my bone. No one wants to mention that. why is it considered and emergency surgery when you get a 3 part fracture if you can just ignore it then remove the problem areas? How can I get answers without insurance (and possibly no job)? Is it just okay that insurance would not authorize the emergency surgery and i eat the consequences of that decision regardless? It has never stopped hurting. All the therapists have been shocked by the fracture. None had ever seen anything like it. "it must have been like putting a jigsaw puzzle together". They all shut up when I tell them it was never put back together. I have no idea what my injuries were or are... just that it was serious and unusual.
I know ttd pays 66 2/3 of aww. I had just begun this job and was still learning, so my salary after exactly 60 days was low. But when I got my w2's in January, I could finally calculate my aww,and I believe I am being shorted about $44 a week. I asked my adjuster, she couldn't explain then was asking her supervisor when I got the lawyer. After numerous emails, my lawyer called and said THEY are right. She never explained how my calculations are wrong, and I am still confused. all wages I earned in the 60 days I worked should be included, right? My w2 showed my 60 days of wages at 3999.00. that, divided by 9 (weeks) = 444.33
I think that's my aww and don't understand what could be different. So 444.33 x .666 is 295.92- SHOULDN'T this be my ttd amount? I don't understand why it is 253.20 How? My pay is commission only and I earn the commission the day of the sale. no chargebacks or deductions. injured on day 64. I earned no money the day of or any day after the injury. Does it make a difference that I hadn't received all my pay as it is withheld a week as is normal? I don't know how to challenge it anymore since my lawyer just ignores me.
Is it possible to fire my lawyer and not owe since I can show they will not even answer URGENT emails?
I think this whole system is so inhumane. There is so much more hurt than what they will treat. If I ask the Dr why I can no longer turn my head even 90* on the injured side- it's not related.
thanks for any help...