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Second Surgery (Cervical Spine)
#1
Injury occurred in Phoenix, AZ in / or about 2002. I currently reside in the State of Arizona. I had an injury to my neck in 2002 resulting in a cervical fusion surgery. I was discharged from my job after I filed for work comp. The employer was uncooperative. I hired a well known attorney to represent my case. I had a fusion surgery in 2003. The surgery helped, however, I could no longer work in my former job capacity. After I was released by my neurosurgeon, I had no income and I moved (out of state) into my family's home where I had no living expenses. I helped out in the family business in order to contribute. Working for my father, I was able to work temporary- part time (contract labor) in order to have some spending money . I was granted disability in 2005. Due to the fact that my disability benefits were garnished by 65% by the State of Washington due to back child support I qualified for "Extra Help" and medicare paid my medical expenses. In / or about 2005 the insurance company offered me a lump sum settlement. I declined the offer as it too, was to be garnished by 65% and did not appear to be in my best interest. After my refusal to sign the agreement for the lump sum I began receiving a check each month from my attorney for $30.07. After about five years (2009) I clearly had to seek professional help as I endured increasing pain and limitation. Because it was a work comp injury I contacted my neurosurgeon to seek advice as to what course of action to treat my problems. He reviewed new films. He explained that although the fusion plate had "two broken screws," he believed the fusion was still holding. He sent me to a pain management clinic here in Arizona. I lived with family here in Arizona and relied on their help in order to afford my expenses. At that time I began a regimen of medication and epidurals for my neck pain. My condition continued a steady decline as I was increasingly restricted by my injury. I made the effort to seek advice from my attorney's office and tried to understand how I would ever get compensated for my related expenses. I had realized that by declining the lump sum settlement, it interfered with the procedure for them to be fairly compensated for work they provided in my behalf. I was advised that the work comp carrier would always be liable for my medical expenses regarding my neck injury. This is the year 2017. The only expense that the carrier has ever paid is my first fusion surgery and, after I declined the lump sum in 2005, they pay a monthly benefit of which I realize $30.07. When I moved back to Arizona in 2014 I lost my "Extra Help" from Medicare. I have exhausted my resources. My prescription costs for my neck run about $350.00 a month. My attorney now explains that the carrier won't pay because I am above the guideline for
opioid medication by about 30mg. a day. The carrier never paid any money "ever" for any of my prescriptions! The attorney is aware of my expense since 2009 but has never asked me to supply any receipts for anything. However, he
assures me that the carrier will always be liable for expenses stemming from my injury? That is it...

Now, after I pursued another evaluation from my neurosurgeon (the same surgeon that I have always had, the same surgeon who was paid by the work comp insurance carrier back in 2003), my neurosurgeon recommends that in view of my continued debilitation, neuropathy in both arms and hands, continued neck pain, etc., it is manifest to him that a second surgery be performed. He explains in his written evaluation report that this is a continuation of my care- back to the initial surgery and therefore, in his opinion, no question as to the responsibility of expense to the work comp insurance carrier.

My attorney is now much more attentive.

We have been methodically working through the procedure to satisfy the demands set forth by the Industrial Commission for the State of Arizona, etc.

If I am granted a second surgery to extend the plate in my neck up one more level then what kind of benefit amount could I conceivably be expecting?
Obviously, I am beyond the point whereby I automatically expect anyone to fulfill their responsibility to me, personally. I do not know how to understand
if I am being treated fairly?

What advice can someone provide me as to how to understand if I am, "within the realm" of being treated fairly?

Through this adversity remain grateful to God! I can appreciate the fact that I must try to make informed decisions

Who should I seek advice?

Thank you,
smith.daniel
--
 
Reply
#2
workers compensation is "no fault". Both the employer and the employee are expected to bear the expense of the injury; the employer/carrier is not required to make you whole as in tort law.
workers compensation is not health insurance; it not you that is covered. by providing mandated benefits, the employer is immune from civil suit. fairness has to be understood from both the employer and employee perspective; under the law the burdened of the injury is to be shared.
the extent of future permanent impairment cannot be accurately predicted. how well your recovery goes will determine the amount of additional disability, if any, is
awarded.
if you have complaints about the effectiveness of your legal representation, you can seek other counsel; the fee will be shared.
you can also seek help from the state bar
http://www.azbar.org/legalhelpandeducati...ithlawyers
Reminder :
........Each state has their own comp system; POST YOUR STATE to get accurate information. Use the search feature to find information from similar questions.
THANKS FOR POSTING.
 
Reply
#3
(07-20-2017, 06:55 PM)1171 Wrote: workers compensation is "no fault". Both the employer and the employee are expected to bear the expense of the injury; the employer/carrier is not required to make you whole as in tort law.
workers compensation is not health insurance; it not you that is covered. by providing mandated benefits, the employer is immune from civil suit. fairness has to be understood from both the employer and employee perspective; under the law the burdened of the injury is to be shared.
the extent of future permanent impairment cannot be accurately predicted. how well your recovery goes will determine the amount of additional disability, if any, is
awarded.
if you have complaints about the effectiveness of your legal representation, you can seek other counsel; the fee will be shared.
you can also seek help from the state bar
http://www.azbar.org/legalhelpandeducati...ithlawyers
 
Reply
#4
(07-20-2017, 06:55 PM)1171 Wrote: workers compensation is "no fault". Both the employer and the employee are expected to bear the expense of the injury; the employer/carrier is not required to make you whole as in tort law.
workers compensation is not health insurance; it not you that is covered. by providing mandated benefits, the employer is immune from civil suit. fairness has to be understood from both the employer and employee perspective; under the law the burdened of the injury is to be shared.
the extent of future permanent impairment cannot be accurately predicted. how well your recovery goes will determine the amount of additional disability, if any, is
awarded.
if you have complaints about the effectiveness of your legal representation, you can seek other counsel; the fee will be shared.
you can also seek help from the state bar
http://www.azbar.org/legalhelpandeducati...ithlawyers
 
Reply
#5
I understand the points which you have illuminated. What I do not understand is, my attorney has led me to
believe and what he still professes, is that the work comp insurance carrier is always, and always will be, liable for the real expenses (which I have and do incur each month) for the rest of my life. In your opinion, is
he misrepresenting my case to me?

I am 65 years old, I have been on disability since 2005. I have not had any taxable income since 2003. I look
forward to being rehabilitated so I can rejoin the work force in any manner.

It is his opinion that I will have to proceed with a second surgery in order to receive any meaningful benefit amount. My situation has deteriorated over the years since my first surgery. I am in much worse shape now than I was in 2005. It would seem to me that in all fairness to the insurance industry that I should not be made homeless because I can't afford the therapy that the neurosurgeon who they agreed was proficient to
perform my surgery in 2003 continues to support at this time.

If I decline to have the second surgery and I get worse is that my end of the cost. If we are only talking about a benefit amount, lump sum or monthly then how come that criteria also be relevant for my increased actual cost of my injury? Do I have to have a second surgery in order to get any compensation that will cover my injury to date?

There is something here that I do not understand? I'm not educated in workman compensation. What am I
missing that makes this arrangement equitable.

I do not want anything more than my medical expenses that are directly due from the accident?

Thank you for your patience.
 
Reply
#6
yes, he is over simplifying. laws change and are not for "always".
when dealing with just one claim you are probably missing or under appreciating the bigger picture and the pressure by employers to reduce the cost of the coverage. politically, workers comp insurance has to be affordable for the state's employers. the legislature is constantly altering the benefits to make it so and carriers/employers continue to narrow the day-to-day-limits and definition of coverage and their costs.
for example, Arizona uses the ODG to determine acceptable treatment under it's comp laws. the ODG is regularly updated.
https://www.azica.gov/official-disability-guidelines
and here
https://www.azica.gov/divisions/medical-...office-mro

generally with major surgical treatment there is some residual permanent impairment for which there could be additional disability awarded.
in the legal world "fairness" is determined by the court.
a past medical opinion is not a future guarentee of acceptance or persuasiveness to the court.
any change in medical condition would have to be caused by the original injury event as determined by the comp court.
you would have to have an increase in permanent impairment - whether there is surgery or not, to be eligible for additional permanent disability benefits.
of course, the issue of continuing liability for your future medical care can be settled.
more information here
https://www.azica.gov/alj-faqs-final-set...benefits-0
Reminder :
........Each state has their own comp system; POST YOUR STATE to get accurate information. Use the search feature to find information from similar questions.
THANKS FOR POSTING.
 
Reply
#7
(07-20-2017, 04:33 PM)smith.daniel@centurylink.net Wrote: Injury occurred in Phoenix, AZ in / or about 2002. I currently reside in the State of Arizona.  I had an injury to my neck in 2002 resulting in a cervical fusion surgery.  I was discharged from my job after I filed for work comp. The employer was uncooperative.  I hired a well known attorney to represent my case. I had a fusion surgery in 2003. The surgery helped, however, I could no longer work in my former job capacity. After I was released by my  neurosurgeon, I had no income and I moved (out of state) into my family's home where I had no living expenses.  I helped out in the family business in order to contribute.  Working for my father, I was able to work temporary- part time (contract labor) in order to have some spending money .  I was granted disability in 2005. Due to the fact that my disability benefits were garnished by 65% by the State of Washington due to back child support I qualified for "Extra Help" and medicare paid my medical expenses. In / or about 2005 the insurance company offered me a lump sum settlement. I declined the offer as it too, was to be garnished by 65% and did not appear to be in my best interest.  After my refusal to sign the agreement for the lump sum I began receiving a check each month from my attorney for $30.07. After about five years (2009) I clearly had to seek professional help as I endured increasing pain and limitation.  Because it was a work comp injury I contacted my neurosurgeon to seek advice as to what course of action to treat my problems.  He reviewed new films. He explained that although the fusion plate had "two broken screws,"  he believed the fusion was still holding. He sent me to a pain management clinic here in Arizona.  I lived with family here in Arizona and relied on their help in order to afford my expenses.  At that time I began a regimen of medication and epidurals for my neck pain.  My condition continued a steady decline as I was increasingly restricted by my injury.  I made the effort to seek advice from my attorney's office and tried to understand how I would ever get compensated for my related expenses. I had realized that by declining the lump sum settlement, it interfered with the procedure for them to be fairly compensated for work they provided in my behalf.  I was advised that the work comp carrier would always be liable for my medical expenses regarding my neck injury.  This is the year 2017.  The only expense that the carrier has ever paid is my first fusion surgery and, after I declined the lump sum in 2005, they pay a monthly benefit of which I realize $30.07. When I moved back to Arizona in 2014 I lost my  "Extra Help" from Medicare.  I have exhausted my resources. My prescription costs for my neck run about $350.00 a month.  My attorney now explains that the carrier won't pay because I am above the guideline for
opioid medication by about 30mg. a day. The carrier never paid any money "ever" for any of my prescriptions!  The attorney is aware of my expense since 2009 but has never asked me to supply any receipts for anything. However, he
assures me that the carrier will always be liable for expenses stemming from my injury?  That is it...

Now, after I pursued another evaluation from my neurosurgeon (the same surgeon that I have always had, the same surgeon who was paid by the work comp insurance carrier back in 2003), my neurosurgeon recommends that in view of my continued debilitation, neuropathy in both arms and hands, continued neck pain, etc.,  it is manifest to him that a second surgery be performed.  He explains in his written evaluation report that this is a continuation of my care- back to the initial surgery and therefore, in his opinion,  no question as to the responsibility of expense to the work comp insurance carrier.  

My attorney is now much more attentive.

We have been methodically working through the procedure to satisfy the demands set forth by the Industrial Commission for the State of Arizona, etc.

If I am granted a second surgery to extend the plate in my neck up one more level then what kind of benefit amount could I conceivably be expecting?  
Obviously, I am beyond the point whereby I automatically expect anyone to fulfill their responsibility to me, personally.  I do not know how to understand
if I am being treated fairly?  

What advice can someone provide me as to how to understand if I am, "within the realm" of being treated fairly?

Through this adversity remain grateful to God!  I can appreciate the fact that I must try to make informed decisions

Who should I seek advice?

Thank you,
smith.daniel
--

CAN ANYONE PLEASE HELP ME FIGURE OUT HOW TO POST A QUESTION IN HERE. I NEED STEP BY STEP. I'M REALLY FRUSTRATED. PLEASE AND THANK YOU.
 
Reply
#8
At the bottom right of the injured forum is a link to a new thread
http://www.workerscompensation.com/forum....php?fid=4
Also there is a HELP link at the top of every page and in The Navigation section at the bottom of every page on how to use this site.
Reminder :
........Each state has their own comp system; POST YOUR STATE to get accurate information. Use the search feature to find information from similar questions.
THANKS FOR POSTING.
 
Reply
  


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