Live in MA. I am a 100% commission salesperson. 1040, not 1099
Try to keep brief. On sales call last winter. Leaving clients office, slipped in snow and heard 2 pops. Knee and back. Sudden knee pain and then a little swelling. Severe back pain. Called boss immediately, told me to get to urgent care and then come in to fill out WC papers.
Urgent care stated xray neg for back. Just a sprain that I have a couple times/yr. Healed in a month. Noticed issue in knee xray and told I would need MRI. I did not contact lawyer as I like my job and want to get back asap. Injury happened around holidays and it took 6 weeks to get to a DR. Local ortho booked out, people on vacation etc. WC case worker found me a Dr. 60 miles away and I agreed to see him. Had MRI. He stated it was unclear but on physical said I had a lot of play in the knee plus loose bodies, arthritis, which we knew was pre-existing. He thought small tear in meniscus and he would suggest surgery but said WC will go with PT. WC approved PT for 6-8 weeks. Completed that and back to work. Knee got worse over time and started to give out every now and then. Back 2nd ortho, MRI,, this one showed a tear and he recommended surgery.
Fitted me for a brace and I wear that. Have been out of work for 5 months. WC has changed my case worker 4 times. Cannot get any communication. I am getting weekly checks and they are paying benefits. Case worker calls says I have to see IME. Went and saw him, (no clue that these work for Insurance Companies). Felt uneasy with DR. as he was very negative, your fine, less than 10 minutes with him. 15 second physical of knee, pulls, pushes, I tell him "yeah that hurts". End of physical and he states he will have answer in 1-2 weeks.
2 weeks go by. I call lawyer and ask questions regarding time frame, explain case. He tells me that as long as WC is paying benefits, nothing you can do. Call me back when they stop. 6 weeks go by. Local ortho calls me the other day saying they also have been leaving messages with WC for over a month with no response. She called back (Dr. Asst) yesterday. Finally heard from WC. They switched case mgr. again 8 weeks ago and we have been leaving VM to someone no longer there.
Nutshell- New caseworker tells my Dr. that IME denied surgery. Asked why no letter or communication. She has been busy and will send one out. Knee getting worse. She will send letter to my Dr. Stated in general terms that my tear was not serious enough YET for surgery.
I get 60% of pay which is 1/3rd of my average weekly pay. Not sure what to do. Dr. asst. says wait till letter comes and we will appeal. Now, I like the company and want to get back asap but will not without surgery as I carry heavy samples and when knee gives out I could be in some trouble.
Will they just stop sending checks now? Depending on letter/reason for denial then I will get with the Lawyer.
Sorry for the novel. Just losing my mind over here and did not know this forum existed. One other piece of info. that I did not mention. My company changed WC companies when I was back to work after first PT. New comp. refused and old company had to open new case which took 6 weeks but they back payed me. Also, after initial PT they told me I had to have DR. sign off that I could return to work. They would not as WC company refused to pay their fee so WC case worker said he signed me off.