Hi,
I have been reading over these boards for days and I am just sick about the hurdles that must be jumped through just to get what is already deserved. I am here in NY and new to all this workers comp stuff. I have some questions and I hope someone can help me.
My son fell two stories from a roof on January 29,2009 and landed on his feet. His whole body was sore. At the hospital they thought he had a heel fracture. He was sent to an Orthopedic - put in a boot - on crutches - a MRI ordered. He filed a WC case stating injuries as left heel, left wrist, ribs, neck and back. After some days passed of just laying around his wrist and ribs felt better but he was having daily headaches and back pain. I suggested he see a doctor and just get it checked to be safe. He had x rays which found a traumatic herniation of the back and a vertebrae was messed up in his neck. Started seeing a doctor. After a month he started receiving Comp checks. Then he had his MRI on his foot and the doctor said on March 5,2009 he found nothing and he could return to work with no restrictions. His checks stopped - they say he owes money back for over payment- they are denying all bills from back and neck doctor. He has a lawyer but does nothing for him. So I called his insurance carrier to inquire. I was told first he never claimed a neck and back injury - then he waited to long to claim a back and neck injury. (13 days)
He was ordered to go to IME on April 27,2008. And now we are waiting.
Can anyone help me with what he should do and how long this will take?
Did he wait too long to be seen (13 days ) for his back? Any information will be great! Sorry this is so long.
ramsay0
Hurdles, oh yes. All the time.
His Attorney will have to have a medical report, to show the relations of the other injured body parts. This might take place in a Hearing, or the Insurance carrier just might accept it. One just never knows.
If he got a letter of Denial, he shows that to his Health Insurance Carrier, and they should then help him out.
he needs to take the comp denials to his health care provider and get treatment outside of comp until the comp court can make a decision.
Thank you for your responses!
He has no health insurance since he was fired a few days after this fall.
He has continued seeing his Chiropractor twice a week. He has never seen any other doctor for his back or neck other than this Chiropractor. That is one of the things we don't understand - the insurance carrier says an Orthopedic trumps a Chiropractor. He has never seen a Orthopedic for his back and neck. What I understand from the last letter he received from the workers comp board is they were requesting information from the insurance carrier and something about Facilitator.
If I understand correctly the workers comp board is going to make the decision.
His Chiropractor doesn't think he has anything to worry about but I am nervous because my son doesn't want to fight anymore. I also know from reading this board that IME are not our friends. I just hate to see him give up and spend the rest of his life in pain.
Not all IMEs are the enemy. Mine was great, he actually made my injury to be worse than my own Dr. did. Hopefully you will get a good one.
Please tell your son not to give up. If he gives up he may be forfitting his rights to future medical care. One never knows what problems may develop down the road. He will win in court with his drs diagnosis and opinion. He who has the last drs report wins the hearing. He should always file an updated report & opinion from his dr before any of the hearings requested by the insurance company. The insurance company plays games thru out so they dont have to pay until the judge orders it and so the injured will give up.His dr should show how the neck & back injuries are related to his other injuries. If he doesnt have a neurosurgeon or orthopedic dr he should contact his primary care physician and make an appt ASAP.
Neurosurgeon trumps Orthopedic, Orthopedic trumps a Chiropractor
I would agree;
Thank you for all your responses. I am going to have my son read this thread because I am also worried about his future medical. He is only 22 years old. I don't want him to give up until he is better.
Bad Boy - I also agree an Orthro would trump a Chiro Our problem is the Orthro only treated his foot and said he could return to work with no restrictions with his foot. Money was cut that day. The Chiro was for his back and neck. The Orthro he had for his foot will not see him for back or neck.
The IME was a MD
He saw the IME on April 27,2009 and if I understand correctly he is to have an answer from workers comp board by May 11,2009.
Ramsay,
I am from NH and when I went for my IME exam they had 30 days to get the result to the IC and then the IC to me. The IC pays for it so of course they get to see it first and then I had to call to pretty much beg for it and say I know they only had 30 days and I would like a copy of it etc.
As far as what Oblivious said, it does not always work as " he who gets the report last wins". It is who the court finds more credible. Unfortunatly I feel differently. My Occ Med. doctor knew me and treated me and did my exam and it took him over 1 1/2 hours using every instrument the guideline book asked him to use. He came up with a 32% whole body. Of course the IC did not like that result so they sent me to a doctor that saw me for 10 mins. and did not use one piece of eqipment and could not even remember what state he saw me in when he wrote my report and they found him more credible because his name was very common in the court I went to. So he was the more credible doctor.
After I got the result from their IME doctor and disagreed with his 10% I had my pain doctor write a note which was very well written and said I had RSD and needed my medications and also had my primary doctor agree and so that is 3 doctors to 1 and they still found the other doctor more credible. I still cannot figure that one out when even when I read his credentials it never said anything about him ever doing any AMA guideline exams. All it ever talked about was him going to seminars and doing sport injuries. This was recurring carpal tunnel that I was diagnosed with at the time.
I do recommend your son to get as many diagnosis as possible before any hearing he may have to go to. Also I never had a lawyer and the court officer pulled me aside and whispered for me to get a lawyer. He knew what was going to happen without one. I should have listened but I just wanted my medical which I still have with no problems. I wish your son well.
Thank you for all the great responses!
The process that my son is going through now is -conciliation process.
The letter was requesting information from the Insurance Carrier. Nothing from my son. He has been almost two months with no payments and denying all medical for back and neck injuries. The insurance Carrier is claiming unrelated injury. He has documents (C-4) when he first applied for Workers Comp stating injuries as left foot, left wrist, ribs, back and neck.
Insurance Carrier only says he claimed left foot.
Can anyone explain what he can expect?? Anyone ever went through a conciliation process?
Thank you