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  1. #1
    Join Date
    Aug 2015

    Default Worker's Compensation Won't Provide Treatment for Chronic Pain

    Hello everyone,

    My dad had a sprain in the lumbar region several years ago. He was receiving treatment for a while, mainly physical therapy, and then it was okay. An independent medical exam didn't find any objective findings of impairment (and his pain isn't objective according to them) so they closed the case. Recently he started having pain again and went to his doctor who didn't find anything objective again. No idea how you can analyze the inside of his body just by touching it. They denied claim reopening. He wants to file an appeal, but I don't know what the reason might be? He believes his doctor isn't acting in his best interest so is it possible for him to go to a different doctor to be examined again? Thanks all, any help is appreciated.

  2. #2
    Join Date
    Oct 1971

    Default Re: Pain is Present, but the Dept is Going to Do Nothing About It

    To be brief.
    If the past claim was closed with no objective medical evidence - let it die, file a new claim.
    At this point he needs to follow the protocol for reporting an injury and filing a claim in your state.
    He needs to first, report this injury to his employer and afford them the opportunity to provide medical treatment.
    At the first sign of problems, consult and retain an attorney who specializes in Worker Compensation.

    Moderator Responses are based on my personal bias, experience and research - They do not represent the views of the admin nor may be accepted in the legal community, always consult an attorney.

  3. #3
    Join Date
    Feb 2007

    Default Re: Worker's Compensation Won't Provide Treatment for Chronic Pain


    You are right about not being able to fully diagnose by just touching and looking if it is a nerve or muscular problem. The Industrial Insurance Act (RCW 51) leaves the Dept. with the responsibility to get the worker to their maximum medical improvement (functioning of the body) without considering pain.

    At this point an Appeal by your Dad would not be beneficial. He needs to either get diagnostic studies (E-Xray, MRI...) to show what the physical problem is or there is nothing the Dept. will allow.

    If your Dad returned to work after the original claim was closed and there is a proximate cause of the condition (physical damage causing the pain) shown by diagnostic study then he could attempt to re-open the original (if it is the same condition) or the suggestion of attempting to open a new claim may be easier due to worsening of a pre-existing condition.

    Consulting with a workers comp attorney is advised also as they seem to be given more respect and consideration in their conversations with the administrators (claim managers) then the worker is given.

    Remember, the worker must show, through diagnostic studies that there is an injury otherwise it is viewed as something as simple as muscle soreness that is called pain.

    Hope this helps and good luck to you and your Dad.

  4. #4
    Join Date
    Aug 2015

    Default Re: Pain is Present, but the Dept is Going to Do Nothing About It

    Thank you everyone for your responses. He does work at a new place now and the type of work is different though he does have to do some things for prolonged amounts of time. So I'm not sure he can file a claim with his current employer? He certainly would be afraid of retaliation for that. He also has another condition which, according to Google, can also cause the symptoms in some people. According to your opinion, would it be worth a shot to appeal the decision on the basis that the doctor couldn't probably conclude based on the brief examination he provided? Would it be worth a shot to ask them to provide a more extensive examination with MRI, etc?

    Thank you very much.

  5. #5
    Join Date
    Feb 2007

    Default Re: Pain is Present, but the Dept is Going to Do Nothing About It

    I have heard of the Board (Industrial Insurance Board of Appeals) calling for an examination upon the agreement of the parties. If that is done the parties stipulate, agree that the determination of the Board Examination (an IME Dr agreed upon by the Parties) is final and binding in the hearing of the Appeal. You cannot go out and find another Dr trying to over-ride what has been determined by the Board Examiner.

    I would rather get another Dr myself that would be willing to take an X-Ray and if that shows nothing will then conduct an MRI.

    If you tell the Dr it is work related then thy cannot bill it to insurance and then if the Dept. rejects it they will bill the worker, patient. It is at that time the worker needs to Protest or Appeal. The worker needs to pay those medical bills until they receive a judgment that the Dept.'s determination is overturned at which time the worker can notify the medical offices asking them to rebill L&I and after they receive payment they then should issue reimbursement.

    Discussing this all with an Attorney will cost you nothing for the initial interview and then they can only collect if the worker is awarded an over-turning of the Dept.'s rejection.

  6. #6
    Join Date
    Oct 2015
    Tacoma WA

    Default Re: Pain is Present, but the Dept is Going to Do Nothing About It

    This post is going to sound callus but:

    Washington State overall is not treating chronic pain. They have laws keeping doctors at bay when it comes to pain prescriptions, The reasons for this change in our state medical community being cited the most is the amount of overdoses. Since changing some laws the amount of overdose deaths have gone down, addiction to these drugs have gone down, and the third reason is that pain is a subjective thing that is hard to measure. My pain level of 3 would put a hardened warrior to his knees and he be crying saying he was at a 10..or vica versa.

    With that said, even when it come to settling a claim, pain is not taken into affect. as long as you can perform an action..whether it hurts or not is good enough to move forward. Physical Therapy, work hardening therapy, etc. are methods they are implementing because it's believed the longer you wallow in your pain the worse your injury will get and the increased chance that you will become disabled.

    These things have had a positive effect for the system to some extent,(saved some money, saved some lives, etc.) but we are not all the same. Our injuries are not the same, even if the diagnosis is the same, it is possible to have multiple outcomes with the same treatment. This is where the system fails those of us who don't fit in the mold. It doesn't help when there is fraud out there, and we all get punished for the deeds of the few.

    I agree with kdgardiner, talk to a lawyer, then decide if it's all worth the time and trouble. If he doesn't see money at the end of the line, then know that an alternate plan of self sufficiency will need to be considered. The doctors will see you collect their fee, and in the end if it's monetarily worth it, might help you. No one out there really cares. They are just doing a job, and in the end the math is what is most important. Not the quality of life for each individual.

    *In any moment of decision, the best thing you can do is the right thing, the next best thing is the wrong thing, and the worst thing you can do is nothing.
    Theodore Roosevelt

    Good Luck to you!

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