Pre-existing condition claim by WC - Printable Version
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Pre-existing condition claim by WC - wt1949 - 05-01-2008 06:55 PM
Hi all, and God bless,
It has been awhile since I posted anything. I have just been doing the waiting game and trying get pain meds regulated to something I can live with.
My question, has any one faced the WC or job attorney trying to say that your injury is as bad as it is due to pre-existing conditions??
I fell at work Feb. 2, 2007 and injured my back and have been in pain eversince. When I finally got Dr. to run a discogram it showed 3 severely torn disc. The Dr. did not believe fusion would be successful so I am left trying to exist on pain med. My job had nothing I could do due to restrictions and pain and taking norcodic meds. Now they are trying to say because I had back problems in past and some signs of wear and arthritis my fall did more damage. ( In early 90's, I had a ruptred disc and had surgery. They only trimed it , no fusion, and I have done great. I had no major problems untill July 06 when I had a small herniation of the same disc and had 3 shots and was back at work doing fine form then until Feb. 07 when I fell on a steel rail car floor.)
Forgive me for being so long, but I wanted all to have enough info to know where I am coming from. The main point is , I was at work, doing my job and doing fine. After the fall the pain in low back has been constent. I have never had this kind of pain. All of my pain in the past has been in my left . Help if you can..
RE: Pre-existing condition claim by WC - 1171 - 05-01-2008 08:33 PM
yes this issue is common in workers comp because comp is different then health insurance-- it is event based.
you had an event that was work related so you had work injury. there maybe events before and after that are a factor in the extent of the injury
when there has been a prior injury or condition workers comp needs to separate out the employment component which is not covered. the carrier is not going to leave it up to the injured or the employer to make that call. they need to raise the issue and get some medical confirmation.
RE: Pre-existing condition claim by WC - sparkey - 05-02-2008 05:38 AM
I also would be considered pre-existing because I had carpal surgery in 98 on my dominant hand and after working harder, more pts. etc. my wrist swelled up one day and could not hold a needle anymore without dropping it.
The insurance co. is right now reviewing my IME from April 3rd and considering it as a pre-existing condition that was aggrivated. So, yes you can still claim it as a work injury and they will take that into consideration. You were working when the injury occured.
RE: Pre-existing condition claim by WC - capricorn - 05-02-2008 08:32 AM
I am also one of the "pre-existing" people here. My injuries now are cervical (stenosis, bone spurs, bulged disks( which are all basically wear and tear. Would I have them if not for the amount of overhead lifting I did at work especially in a freezer? Probably not, at least not at my age. Next is a shoulder injury, 1st time. Lumbar injury, all 3 are work related. Healed totally from the first 2 and returned to work without restriction. Knee.... 2nd work related injury. Healed first time and I returned to work no restrictions. Ankle.... 2nd work related. Healed totally and returned to work after the first one. So you can see right now I am suffering from 5 injured body parts. Some have been previous work related injuries, only my neck and shoulder are the first claims. The Judge has decided in my favor for all 5 body parts being work related because he also believed through medical documentation that my necks deterioration is work related. Hope this helped a little.
RE: Pre-existing condition claim by WC - Still in Limbo - 05-02-2008 09:22 AM
I have 4 Bulging and Dried Out Discs above the L5/S1 Area were I was Injured, and they still Accepted My Claim. I am not Covered for the 4 Discs, but I am for the Work Related One. They need to Separate Fairly the Injured Area as Opposed to the Normal Wear and Tear Areas, and Treat You! As 1171 has Stated, they have to Supply You with Medical Evidence Separating Normal Wear, and Your Injury. Pre-Existing is Usually their First Line of Defense, You need to get this Separated! Best of Luck, and Please Keep Us Informed!
RE: Pre-existing condition claim by WC - Bummer Knees - 05-02-2008 09:52 AM
I was injured 2005, left and right knee. I had had meniscus surgery on both knees and pica surgery on the right. My knees were unstable after the surgeries and I need bilateral total knee replacements.
The insurance company denied futher treatment of my knee as they were saying the need for knee replacements are due to a pre-existing condition. The wc doctor told me I have osterarthritis.
I had no problems with my knees before my injury and never received medical treatment. I did my job everyday working as a teacher with young children for ten years, my job duties were; bending, kneeling, and lifting years.
Yet, I had to fight for 2 1/2 years in court for medical treatment and recently received the judge's decision awarding medical treatment.
Not receiving medical treatment has lead to problems with my back and left hip.
My attorney tells me that aggervation to a pre-existing condition is covered under work comp.
RE: Pre-existing condition claim by WC - Lilly - 05-02-2008 09:59 AM
Claiming pre existing is the first thing WC says as Still has said.
This is their way of trying to "get out of it". Name me one person that doesn't have some pre-existing problem with their back or joints...this is due to wear & tear as one ages.
If you don't have a lawyer, you may need the assistance of one, so WC doesn't try to run over you.
take care & good luck, Lilly
RE: Pre-existing condition claim by WC - wt1949 - 05-02-2008 01:11 PM
Greetings All, and God bless,
Thanks to all who replied to my question. I do have a Lawyer and he is getting all my past records together. As I stated, I have never had this kind of pain before, pain has always been in left leg, bulging disc.
This is new kind of pain and it doesn't stop, just controlled by meds.I don't know how long this will go on. My lawyer wants me to ask for $150 -200,000.00 to see if WC will settle. My case if carried out by months. (estimated lenght of life 22 yrs) would come to $400,000. He does not think they will pay above $150,000 due to their claim of pre-existing. If I go to court and the Judge finds me any thing less than 100% disabled, WC will only have to pay me $57,000 with med. Does any one have any input about these amounts??
My WC payments stopped in Oct. 07 when Dr. put me at MMI (from a surgical stand point) but due to my restrictions and meds, my job could not offer me anything. I am terminated May 3rd (tomarrow) as this ends my one year furlough will end.
Thanks for all the input and God bless you all
RE: Pre-existing condition claim by WC - Bad Boy Bad Boy - 05-03-2008 12:42 PM
Doctor states surgery (may not help)? Have you seen a specialist yet, or had any 2nd opinions?
Strange that a Attorney would toss out such dollar amounts at this early stage.
RE: Pre-existing condition claim by WC - Still in Limbo - 05-03-2008 05:38 PM
Just a Suggestion, this is My opinion Only, but I would Never Talk Settlement until ALL Medical Options to Heal Me are Exhausted. If You Settle before any Surgeries, and Close Out Your Medicals, You will have to Pay to Try and Get Yourself Better. Plus, God Forbid there be any Complications with Your Surgery, they will be Off the Hook for that also. Even if You keep Your Medicals Open, You May still find Yourself in Hearing after Hearing trying to get Your Meds. and Medical Care. Please be Careful with Your Case at this Stage, as I said My Opinion Only, but this is Way too soon to be Talking Settlement!!