Employer and Insurance Company Refusing to Pay Benefits for 4.5 Months

[Sentinel106]

Got hurt at the latter end of November 2020. Lifting injury at work. Lifting procedures and shelving in my department was outside of OSHA/NIOSH standards. We had to lift 30 pounds over our heads onto a 6'+ multi-tiered shelf. Lifting hundreds of 30 pound packages all throughout the day and bending at the waist sometimes a couple of thousand times per day. Lifting practices above onto the shelf and down near the floor onto empty pallets with the 30 pounds both seem to be outside of the recommended NIOSH standards. Lots of complaints about the shelf, but employer never changed it. Even the manager would complain about back pain when helping out for just an hour or two.

I reported the injury to HR immediately and went to panel worker's comp doc the next available day. X-rays taken and doc claimed to have not seen any spinal spacing issues. Diagnosis was lumbar strain. After a month of physical therapy did not work, MRI was ordered. Doc ignored results on the MRI, gave me a couple of more weeks of physical therapy and discharged me with permanent ongoing >10lbs lifting and limited bending restrictions that I had been under for a couple of months prior while being accommodated in another department at work. I was told by the doc that there was nothing else that they could do for me. Before my work injury, my personal physician had been treating me for just under a year for a rather benign and unrelated condition. So the worker's comp doc barely knew anything about it and sent my employer a letter blaming that pre-existing condition for basically causing my back injury and pain, claiming that my initial injury had healed up already. WC doc also listed in the letter that they put me on restrictions for the pre-existing condition, not the back injury. Employer filed FMLA for a serious medical condition that I did not have because of that. I ended up going back for an emergency visit again and the WC doc again said that my condition is not a work injury after acknowledging in the same letter to my employer that I had a work injury. For months the insurer didn't want me to see a new treating doctor that they said I had the right to see because they were saying that because they didn't send me any weekly benefits checks, I can't see the new treating doctor. Their story kept changing.

Took several months to finally see a spine doc due to the first WC doc's false attribution. Spine doc said no visibly pinched nerves on the MRI, but Lumbar Radiculopathy aka sciatica down both legs to the toes was diagnosed after a straight raised leg test. That MRI ignored by the first WC doc shows the L4-5 disc nearly worn away and with a bulging disc. Sciatic list, pain, numbness and tingling in the legs and certain parts of my legs have been numb for over half of a year now, consistent with dermatome maps of the L4-5 that link to the nerves of those areas in the legs. There was some degeneration, but spine doc says the work injury/lifting exacerbated the degeneration. My understanding is that in Georgia, this is treated as a full-on work injury regardless. Spine doc stated that my personal condition is completely unrelated to my back injury. My primary physician also wrote his own letter stating that my pre-existing condition has no relation to my back injury, either.

Employer/insurer hasn't paid any worker's comp checks in 4.5 months that I have been out of work. Insurer/employer's lawyer has kept saying that they "think the employer has light duty" and they have not said either way. It's a warehouse. I'm under continued >10lbs lifting, limited bending and 15 mins alternating sitting/standing by the spine doc. Insurance is about $7K behind on weekly benefits and won't even start current benefits. My WC lawyer for whatever reason feels that they may not pay any benefits until the hearing in a couple of months. I've had a double L4-5 epidural that lasted all of 3 days and the pain returned. Got another round coming up in a couple of weeks.

What's the general reasoning behind this lack of benefits on behalf of the employer/insurer?

[airdale]

Its what insurance companies do...........Deny as many claims as possible hoping you will give up.
Being in a Red state they dont care about workers and give more power to the employer and insurance comapanies.
I glad you have an attorney because that is the only way you will get anywhere with a situation like this!

[Sentinel106]

Yeah, that seems to be the common thing. When the staff at my spine doc found out that the insurance company was denying benefits and also had denied my visit with the spine doc for several months beforehand, their reply was "Of course they did!" So I gathered that they probably hear that all day long.

I'm surprised that the employer/insurance company doesn't seem to realize how bad that is going to look that they'll be 6+ months behind on payments when it goes before a judge. Do they really think the judge is going to just sweep that under the table?

I purposefully found an attorney that doesn't charge by the hour and instead gets 25% of the case settlement, instead. Fortunately, my attorney started out as a worker's comp attorney and then flipped to help the injured workers, so they have a lot of background that really helps with the case. They know the tricks and such. It makes me laugh every day that the insurance company is probably paying thousands for their big-name attorney who can't really refute much with my case.