Have questions and need help. Not sure what to do. - Printable Version
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Have questions and need help. Not sure what to do. - Durant - 02-09-2012 04:32 AM
I injured my knee while on the job here in Texas in August. After pt it wasn't getting any better and dr and I decided surgery was best option. It was approved so mid nov I had the surgery. Recovery time that I have found is anywhere from 3 to 9 months. I have been going to pt twice a week since the surgery and improving. My job paid me for the first two months I was out until January then they had the insurance people take over my payments and I started getting weekly checks. First 3 checks were for $889 then they started only being for $743 without notice I don't know why they dropped. The $889 is equal monthly to what my job was paying me while I was out. I have been off of work this whole time since nov. I had a follow up in december with my dr with nothing new happening then I had a follow up at the beginning of January and I was still not able to bend my knee all the way and still have pain and swelling and quad was still dead. My work does not offer light duty due to it being industrial lifting heavy equipment and usually around a slippery floor. Dr put me on light duty knowing I wouldnt have to go back to work because as she put it it makes "them happy to see your status change from out to desk duty" didn't matter to. Me cause I wasn't going to have to go back to work either way.
The Adjuster is a very rude and Mean lady. I haven't dealt with her in a while. At the beginning of jan I got a call from guy who works with the same insurance company of the adjuster who is a medical case worker??? He was nice at the beginning giving encouragement then said he wanted to go to my check up dr apt on feb 1st. I. Didn't care because I have nothing to hide. I went to the apt last week and he also showed up and was in the exam room with me and the dr. He took notes. I told the dr I still am unable to fully flex my knee and have pain whe putting pressure on it. I am unable to go up stairs with out holding onto the rail and unable to go down period only using my good knee one step at a time if I try walking down stairs normal I will fall the second my bad knee hits the step. I also let the dr know i am still having the constant aching and swelling and having to take the vicodin daily because the i 20 Advil pain pills just aren't cutting it. Dr said she only wants me taking the vicodine once every 2 weeks and that ain't happening cause my knee feels like its about to explode while just sitting on the couch not to mention the pain when and after I do my pt.
During the exam the dr lady said I should be almost ready to go back to work and the case worker guy from. The insurance company spoke up and said that he would expect me to go back to work around feb 20 so they set up another dr appointment on the 19th I guess to try to clear me.
After the exam the medical case worker guy talked to me and did the usually " you gotta get back to work by the 20th cause they will be expecting you and that's the day expect you to get cleared." I told the case worker that the qaulificatio s for my job are squatting, bending, stooping, lying down lifting and moving 75lbs and all this usually on a slippery floor. He said well you should just try to go back and stoop and squat a diffent way or use a pillow or just find a way to work around your injured knee when you go back". He then told me that my medical for my knee injury was covered for the rest of my life no matter what, like of I needed pain shots 19 years from now or whatever it didn't matter it was covered.
The medical case worker guy also told me he expects me to go back to work on the 20th and that after about a month back at work I will have to go take a mmi test and that it will be graded on a percent point system and each pint is worth 3 paychecks?????? I told him ok and left the dr office. Well this week I get a letter in the mail that I have an mmi exam with a different dr next week on feb 15th. I am not sure how I can do this exam when I am still out and why it is happening a week after my last exam and after he said it would happen until I theoretically got back to work for a month.
I got a call from the medical case worker today and he wanted to check in on me and how I was doing. I told him getting better but still having issues with strength and pain and he basically blew that off and said well you only have two more weeks to get your Knee better because they are expecting you to be cleared on the 20th. I told him also what excersies I was doing at pt and at home. I told him I used a lit 2lbs weight at the pt and he suggested I needed to use a phone book as a weight at home since I didn't have any. That just seems obserd to me cause first a phone book is more than two pounds and how is that safe.
My questions are
Why did my paycheck drop after the first 3 weeks.
What am I having the mmi exam right now instead of the month after I get back to work.
What happens when I go back to the dr a week after the mmi and I still know that I am unable to do my job safely?
Last thing I just don't know what to do or how to respond because I fell like he is pressuring me to go back before I am physically ready and would unable to perform my job.
Please help with any info or suggestions or if you have any other questions please ask me. Thanks for any help.
RE: Have questions and need help. Not sure what to do. - lucky - 02-09-2012 08:59 AM
(02-09-2012 04:32 AM)Durant Wrote: I injured my knee while on the job here in Texas in August. After pt it wasn't getting any better and dr and I decided surgery was best option. It was approved so mid nov I had the surgery. Recovery time that I have found is anywhere from 3 to 9 months. I have been going to pt twice a week since the surgery and improving. My job paid me for the first two months I was out until January then they had the insurance people take over my payments and I started getting weekly checks. First 3 checks were for $889 then they started only being for $743 without notice I don't know why they dropped. The $889 is equal monthly to what my job was paying me while I was out. I have been off of work this whole time since nov. I had a follow up in december with my dr with nothing new happening then I had a follow up at the beginning of January and I was still not able to bend my knee all the way and still have pain and swelling and quad was still dead. My work does not offer light duty due to it being industrial lifting heavy equipment and usually around a slippery floor. Dr put me on light duty knowing I wouldnt have to go back to work because as she put it it makes "them happy to see your status change from out to desk duty" didn't matter to. Me cause I wasn't going to have to go back to work either way.
RE: Have questions and need help. Not sure what to do. - jayne - 02-09-2012 10:20 AM
get a lawyer now....or you will be railroaded into going to work before that knee is ready.That nurse case worker who went to that appt with you her/his job is to get that Dr to release you back to work ASAP ready or not. Start interviewing lawyers now.Pick the one you are most comfortable with.And protect yourself.Are you union? if so ask them if not ask friends or neighbors for a recomendation.DO NOT take one off the TV....check on here for one at the top of the page.Ask them how soon they gety back to you when you call with a question,email a question,what do they charge if you settle out of court,if you go to court ect get your fanny covered now.They have a team of lawyers you can bet.
RE: Have questions and need help. Not sure what to do. - heynow - 02-09-2012 12:56 PM
I agree with the others. The nurse case manager is "for your benefit" and that is total BS. Their job is to get you back to work with minimal money risk to the insurance company. Do you have your own doctor? Where I live after 90 days you can go see any doctor of your choice. Like the other said, LAWYER UP ASAP.
RE: Have questions and need help. Not sure what to do. - bodybuilder1958 - 02-09-2012 01:09 PM
I agree, lawyer up. Let your lawyer handle these people. If they continue to call them refer them ASAP to your lawyer, you don't have to answer their questions. Make sure your lawyer is aware of all of your concerns that you mentioned here, don't leave anything out.
Only your doctor can release you to work. If your doctor says continued light work after February 20th then they are the ones who have to comply, not you. MMI is also determined by your doctor, not respondent or your case manager.
If you don't think your knee is getting better then ask for a second opinion. Knees are tough to deal with, sorry to say I know this from personal experience. It's hard when they send you back to work way too soon and you feel like your job is in jeopardy. It's hard, I remember those days all too well.
RE: Have questions and need help. Not sure what to do. - Durant - 02-09-2012 05:17 PM
Than y'all for the responses it means a lot.
Other quick questions.
Anyone have and idea why the medical case worker would say they'd have me do the mmi about a month after I went back to work only to have a surprise letter show up demanding I go to this new dr for a mmi exam next week?
What does this mmi exam include? I can't do much weight bearing when my bad repaired knee is bent. Walking down stairs is impossiable let alone while carrying weight like I would have to do at work.
Why would I take a test when my own dr that I've seen this whole time hasn't even cleared me yet.
The main thing is I know my knee is getting better and it seems it makes more strides week after week and I am thinking I will be back better than when I left soon but I know it isn't gonna happen in 2 weeks like they think. I just need more time. If my actual dr says yeah you're ready for work can I tell him wrong and that I am not ready? He only has be bend my knee to see how far it flexes when he sees me not do any actual excesses so he sees that I can't do lots of things and also have pain still.
On the lawyer part. What does a lawyer cost for something like this? I don't think I am getting any money from this. All I want is to make sure my knee is always covered for the rest of my life just in case. Still don't know what case worker meant when he said that each percentage point on mmi equals 3 disability paychecks??? So since I think that this knee will heal complete over time once I get the strength back all around but the pain might never leave from what I have read I don't think I would get any money. Is that right??? And would I have to pay the lawyer out of pocket then?
RE: Have questions and need help. Not sure what to do. - jayne - 02-09-2012 06:24 PM
a lawyer is paid a % of your award from WC.
RE: Have questions and need help. Not sure what to do. - lucky - 02-09-2012 06:35 PM
(02-09-2012 05:17 PM)Durant Wrote: Than y'all for the responses it means a lot.
Your questions need legal counsel IMO. I believe a Texas Lawyer receives up to 25% of your recovery +office fees etc. Most WC cases are taken on a contingency basis meaning your Attorney gets paid if you win your settlement. If you lose, There could still owe offices fees; My offices fees was approx $1000.
As far as the MMI goes; That means maximum medical improvement. This should be done BEFORE you go back to work so you can possibly be released.
WC is not trying to get you back to pre injury status; All they have to do is get you released with the ability to do some type of work.
Do you need a Attorney? If you want to challenge the Doctors I would say yes. Remember what MMI means; Just some level of work. If you are still injured and cannot work, your WC Pay (TTD) should continue and this is where your Attorney gets his 25%.
Be smart and get educated in Texas WC; All states are different so you must educate yourself. It is not easy but you have to believe in yourself.
RE: Have questions and need help. Not sure what to do. - bodybuilder1958 - 02-09-2012 06:36 PM
(02-09-2012 05:17 PM)Durant Wrote: Than y'all for the responses it means a lot.
Durant you pay nothing upfront for a WC lawyer. If you're getting TTD checks your lawyer will get a percentage from that check. They also get a percentage of your settlement and other fees like mileage, postage, etc. To get medical for your knee for the rest of your life that's a fight, you have to ask for that, they have to agree to that or you're just stuck. Don't settle without future medical, your own insurance won't cover it.
Take a look at the lawyer list for your area of TX, ask around, interview more than one lawyer.
RE: Have questions and need help. Not sure what to do. - UndercovrAngel - 02-09-2012 10:47 PM
Here in TX, lawyer fees are generally capped at 20% of awarded amount plus misc. fees. If you are already receiving TDD and anything for mileage, attorney won't get a cent of it. Only what s/he helps you get monetarily. And there is no fee for consults. If there are no TIBs = temporary indemnity benefits (TX is different in their abbreviations and what they stand for than other states) awarded at the end of your claim, you will be responsible for any of the misc. charges incurred by the lawyer.
Still don't know what case worker meant when he said that each percentage point on mmi equals 3 disability paychecks??? If/when you are found MMI, you will undergo an IME (independent medical exam). If there is any percentage of disability found, you will receive 3 checks equal to your TTD for each percent of disability. So if there were a 10% disability found, you would receive 30 more weeks of ttd, which would now become TIBs.
The big thing about TX.. medical is a lifetime benefit for all injuries on the job, so you don't have to worry about that.
As for you being MMI... they are going to be sending you to a Dr that is probably in their pocket and will state that you are ready to go back to work with no restrictions. It sounds like the case worker is trying to railroad your Dr into sending you back to work before you are ready/able. This is where a good lawyer will earn his fees. If your Dr feels you aren't ready .. and believe me, the dr is watching every move you make from the moment you step into his office, so don't think he is only checking the flexion in your knee.. and the WC MMI Dr says you are, your lawyer can file for a mediation hearing to see which one is more believable. Even if your Dr says you are ready for light duty, if your employer is unable to provide such, you will still be paid ttd until such a time as you can safely go back and do your job per your employer.
Now, from here on out, DO NOT let the case worker into your appointments with you. Let him/her talk to the Dr after you have been seen. Most of the time, this means that they have to make an appointment of their own. And if/when you find a lawyer, tell him/her that you don't want a case worker. They will deal with the issue, as well as start handling all correspondence with the IC. Your job will then become to relax and heal.
So quit fretting and get busy finding the lawyer that is going to represent your claim.