Workers' Compensation Discussion Forums

I am an RN in WV that was injured back in June 2008 while pulling up a 350 pound patient two other nurses. I was also 10 weeks pregnant when I was hurt...Ventral and Umbilical Hernias. I was placed on light duty in education until I delivered the baby on Christmas Eve. I was on maternity leave until March 18, 2009, but I started the corporate health and surgery process on January 28, 2009 because I wanted to get fixed ASAP and back to my normal life. I cannot lift more than 20 pounds and my hernias effect my digestion, elimination, posture and they can be painful. I was seen by my my surgeon who said that I needed both hernias repaired. I also have diastasis recti, which is the separation of my stomach muscles(typically caused my obesity or preganacy), and since I have this condition it could compromise my hernia repair and increase my risk for re-occurrence. My surgeon referred me to see a plastic surgeon, so that they could fix my stomach muscles while her fixes the hernias, but I was denied. My surgeon also tried to add the condition on my claim via a Diagnosis Update Form, but that too was denied. Diastasis Recti is concidered cosmetic surgery except in RARE circumstances where it is present in conjunction with a hernia. I did not have DR after the birth of my first child and did not have the DR before I was injured, so who is to say the chicken came before the egg? I also did not have any diagnostic studies, i.e. CT Scan or MRI.

There has been issues since the beginning of my claim...the person at Corporate Health did not process the request for surgery until the middle of May and the paperwork was requested to be completed by my surgeon on February 25, 2009. I would call and try to follow-up and this person never called me back. I did designate my surgeon to be my specialist since I was having the run around. I did go back to work on Light Duty on March 18, 2009.

About four weeks ago was confronted my my HR Dept and they were not friendly and in one meeting the manager yelled at me and told me that I was "talking out of both sides of my mouth and that I did not know what end is up"! They stated that the Diagnosis Update Form did not exist and acted like I was trying to milk the system...when I have not missed any days of work and I have been honest and upfront. They did eat crow after they made a couple of phone calls and found out that the form does exist and that it was being processed. They said that light duty is temporary and not permanent and that, if I did not get my surgery scheduled in the next week or so that they did not know what they were going to do with me. Then on October 15 (2 days after I received my Denial Letter for the added DR condition) they said that if I do not get my surgery scheduled by Nov. 6, 2009 I would no longer have Light Duty available for me and I would not get paid for time off until I have the surgery. I requested that they give me this scenario in writing, but they refused. My employer has a job abandonment policy, but they do not have a policy on how long they can or will offer light duty. I am worried that if I do not show up the week of November 11 that they will try to push the job abandonment policy. I feel like I am being bullied and harassed into having my surgery and I cannot afford to be off without pay and I cannot find another job because I am still injured. I have seen re-occurrence hernias and they are not pretty and usually have infections and or poor wound healing. I just want fixed properly. I am 31, 5'6" and 140 pounds...I want fixed properly, but do not want to live in poverty and go into debt or risk losing my house. I also feel like this denial in light duty is a retaliation because I am in the process of appealing the denial and my employer was aware of my denial.

I know it has been a long process, but that is not my fault since I can only work one end of the spectrum. I feel that if there was not such a delay in the processing of all of the paperwork then I would have been able to appeal the denial and I would not have my Light Duty Status denied. Can they remove my light duty status when nothing has changed except the denial of diastasis recti and me getting an appeal letter set-up?

Sorry about the length of this post, but I have a years worth of info...
Thank you in advance for any feedback that you may have.

Hi, and welcome to the forum !

You ARE being jerked around and will most likely get screwed, IF you do not immediately hire a certified WC Lawyer! You can call around, or use word of mouth suggestions to get a good one. They usually work on a contingency basis...so you don't have to pay them, until YOU get paid!
Do NOT go for a lawyer that advertises on TV. (it's a rip off)
You'll need a lawyer to do all communications with them & your employer...this way they cannot lie to you, or jerk you around! You wil have less stress because you won't be allowed to talk to them, your lawyer will do this for you. Your lawyer can take them to court to have denials reversed, and to add extra injuries to claim.

If you have a doctor's written restrictions that states "Light duty only" this means light duty only. Your employer must abide by this. If you are "off work' for any reasons related by your injury...then you may possibly be canidate for loss of work pay...each state is different..ck out your state at top of page, where it says "State Info" then select your state, and read.

I feel really bad about your situation, but you need legal assistance badly, or you'll be taken advantage of....like they are doing now.
Hopefully , someone else on here more knowledgeable than me will answer you soon, but please be advised that weekends are slow...so please be patient for answers.

Take care and good luck, Lilly

Hi,
Nothing makes you feel better than being confronted by your CA's, manager, in the hallway why on duty. It happened to me at the hospital I worked for twice. The first time it almost left me in tears. I had been given via work-comp a un-loader brace and they didn't want me working with it on. Well, true it was an accommodation it didn't interfere with my doing my scrub tech job in LDR. But it did make my life easier and I was able to work 12 hr shifts with it on. It also make it less likely for my knee to buckle with it on so I wouldn't be a danger to myself or when moving the patients in the OR (since most term patients outweighed me by 100lbs or more). Like you I won, I could wear it, it helped me with my job and there wasn't a thing they could do about it.

I consulted with my attorney after the encounter and this is what I was instructed to say. (In my state once you hire a lawyer HR, managers, cannot talk to you about your case). "My lawyer has advised me to inform you that any questions about my care, case, forms, etc need to be directed to him only." That ended that.

As per you surgical needs to properly fix your hernia to prevent re-ocurrance I think part of problem the is the wording of the surgical procedure submitted. Or perhaps you need a multi-specialty surgeon who can do the abdominal wall properly.

I think it's a matter of your attorney submitting the proper documentation to a judge. Having a second doctor's opinion also state that both surgeries need done and then let the courts decide.

Bottom line here as an RN your job is hard enough.. You're a dedicated medical professional who's trying to do her job. You don't need HR, management, or your clinical advisers talking to you about your case. It's none of their business, it stresses you out. They're trying to make you quit and you can make it stop quite easily. One of the LPN's I worked with had several work comp injuries, management was trying to get her to quit. She had one complaint that she wasn't complimentary enough. She was told to carry around a clip board with paper on it and every time she gave a compliment to a staff member they were to write down what she had said, date and sign it. She needed 8 signatures a week to keep her job. She was a mess after 2 days, I consoled her in a back room and told her to call her attorney. The next day she was called into the manager's office and told there had been a mis-understanding. She didn't need to get any signatures, nothing. She still has her job at this hospital. The manager was dismissed not to long after that.

Take care, hope this helps,
BB

Thank you everyone...I talked to a lawyer and I feel that I found a good one. I have a meeting with one of the VP's of the hospital to talk about the way I have been treated. She seems to care...I am waiting on "hiring" this lawyer until I have this meeting. I will let you guys know how it goes!

Thanks for all the advice!!! It means a lot to me.

that could be a huge mistake.....

I'd be very careful about discussing your W/C case with management. My. former manager was very supportative initially but later in court my words used in her office was repeated in court.

Management is not evil but they're working for the company. Their job, the hospital is their first and frankly their only agenda. Nearly every member of this forum can tell you stories of how their management has turned against them.

I would hire that lawyer regardless of what the VP says. You need a specific surgery to heal properly, it's been denied. The proper surgery needs to be presented and argued in court.

Take care, good luck,
BB

I would NOT talk with the VP of the hospital either till you speak with the lawyer. Like others have said or at least the way I feel they can use your words you said against you. You need to find legal help before this goes any further.

I did not have a lawyer for my case which was a big mistake. I took on my case by myself and did receive a 10% award but could have probably got more that I do not know about. I am having trouble today with denial of my workers comp. now because of a pain clinic doctor wanting me to get a spinal cord stimualtor and WC sent me to a IME and it came back with the doctor saying this is NOT a work injury and now my WC is being denied.

Now how can they do this after saying my case was a work injury and paying me the award??? I really should get a lawyer and still thinking about this. I do see you are having trouble in the beginning of your case and YOU really need help right away before it gets way out of hand. Interview a few of them before you decide on one. Good luck.

I am an RN also and going through similar issues but different injuries. First of all termination for abandonment is only if you leave an assignment and leave your patient in jeopardy ie no relief arrives to replace you, etc. You have to be primary nurse providing direct care...
Do no meet with HR or administrators without legal representation. Get yourself a good work comp specialist attorney, as a nurse you know if you want something done right go to someone who specializes in that.
I didn't want to get an attorney either but now am very glad I did. Get one ASAP