Workers' Compensation Discussion Forums

I found what you posted on the thread titled "Disability" interesting.

I am not trying to get any garbage started. I am mearly looking for some clarrification.

Lets take the state of Texas for example. I injured my back and could not walk. The only thing that would change my condition would be surgery. I refuse surgery. By refuseing surgery, I would get a rating of 25%. That means that I would receive lifetime monitary benifits from WC.

Now if I have the surgery, I am able to walk again. I receive a 10% rating. WC pays my monitary benifits for the 10% and that is it.

In either case, I get approved for SSDI.

Are we saying that WC. has no way of protecting themselves from having to pay benifits based on the first scenerio????

Just curious.

AQA that is interesting.

I had a bilateral knee injury. After the surgery to repair the meniscus I was rated at 10%, 28 months later I won in court and had a total knee replacement.

The replacement surgery voided the 10% rating and gave me a 35% rating.

I have wondered something like that myself. In my case I had three surgeons look at me. Now all three didn't think the odds were in my favor of surgury helping me. Now if one would have said yes I'm not sure I would have said yes to having it done. If that would have been the case I have wondered what what would have happened to my claim.

here if you refuse your case is done unless Docs dont want to do it

Jayne, read the thread I referenced and you will see why I posted what I did.

PS. I just want to make sure the right info. is given, and I do not want to get anything statred. I mearly am trying to figure out what I do not know. Which is alot.

AQA- WHy would what you do now be influenced by what some unknown person on the internet says >.. ( LOL !!! )

I have no idea how your state works and was only answering on the issue of the determination of impairment as commonly understood. If you take the AMA Guides to the Evaluation of Impairment as source the determination of impairment is a functional assess. If the function improves after surgery then the impairment is obviously less that it had been prior to surgery.

For instance a fractured leg that never heals, called a non-union fracture, would have significant degree of functional impairment while a healed fracture generally is 100 % and has zero impairment.

Impairment is what is rated and then converted into disability. Impairment is a medical issue then while disability is a social issue, alteration of ability to engage in normal activities of daily living or ADL's as it's called.

So, in most states, but maybe not yours, the diagnosis is not particularly important but rather the functional response as a result of the diagnosis. Did that answer your question ?

Many states have a clause in their comp laws that allow suspension of benefits if there's a finding of interference with reasonable medical care.
In the states I'm familiar with this is rarely used and only in cases where a worker is intentionally prolonging their injuries/diability.
Otherwise your scenario is correct - there is no protection from higher impairment costs when a worker decides not to accept the risks of surgery.
what can be even more strange is that some states have a time limit for locking in the impairment rating.
after the time limit expires, the worker can change their mind and have the surgery without risk of getting another rating which would be lower.

Hi all,
Well, this is interesting for sure.....but i didn't know that a work injured person could deny surgery at all, if it was deemed helpful for their future recouping. I thought since it was a WC injury, that one must follow what they think would be beneficial to you to get you healed, and back to work asap??? I assumed that they could stop any benefits if you didn't seek the help the doctors & WC thought would help you?? That would seem to me to be intentionally prolonging an injury and any payments would cease, pronto.
Lilly