Workers' Compensation Discussion Forums

I am posting this for my friend in N.J. I am writing from memory so I may have some of the facts wrong. She had a fall at work and at the time was seen by her works nurse. She filed a report, but didn't actually file a w/c claim at the time. She wasn't sure that the pain she was getting was normal so just kept going along. Then a few months later she tried to lift her grandson and wasn't able to...she got severe pain and had to go to emergency. She never actually went to a doctor on the original accident. Just took over the counter meds to try to help.

She has a history of non symptomatic Tarlovs cysts. But the Mylogram she had recently showed that they are now causing problems. She never had pain prior to the date of the accident. She has filed w/c claim, but it has been denied. She has been using her own insurance to deal with her needs. She does have an attorney....but they now have to prove that the pain is directly related to the accident at work. Her surgeon has said that it is. Any ideas?

She is due for surgery in this month for the Tarlovs...but obviously it would be good if w/c accepted this.

time limit defenses are weak;

did they accept the fall at work? if not, why was it denied?
what reason was given for the denial of the current condition?

I suspect they are denying a connection between the fall and her current condition or that her underlying non-industrial cyst was aggravated by the fall at work.

liability issues can be settled or the evidence can be presented to a judge for a decision.
Her atty will be the best judge as to which option is best for her situation.
Her current health provider will likely be filing a lein to recover its costs should the claim eventually be found to be industrial.

This is the reply I just had from N.J. She states as follows:

I just viewed the reply from 1171. They accepted the fall at work which was documented with the nurse. i think they are questioning the time frame from 1/15/2008 until jan/2009 when school insurer was notified. They said the pain i'm having must have occured with some other issue.

yes that's the most obvious difficulty- establishing a causal link especially over such a long time period. the quality of her doctor's opinion is what the case will turn on.
looks like they will have to take their evidence and she hers to the comp court for a determination.