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California: Prior injury private treatment / current injury WC
#1
Hello,

I apologize for the long post but I tried to cover the essential details up front. Please go to the => to cut to my question if you prefer.

About 2 years ago I developed a painful injury due to repetitive stress at work. I did not pursue workers comp and chose to deal with it through my personal medical insurance. This is a sustained condition rendering my left thumb wrist and elbow weakened and with varying degrees of pain. The treatment involved receiving a referral to a physical therapist from my private doctor. My doctor did not do more than listen and offer a referral. I did not have anything like an X-ray or MRI. The PT involved various exercises to strengthen and work around the weakness and pain.

During the past two weeks, I injured my left arm and shoulder when a van cargo door malfunctioned and required extra force to open and close. I have to open and close this cargo door throughout the day. The consequences did not take effect until after a few days of dealing with the door. I woke up during sleep all night because the pain was so intense. I worked for three days avoiding use of my left arm as much as possible. It has not improved over the weekend. At the least I need to miss one day or more to continue resting my arm so it can recover.

It should also be noted that I have received WC for a back injury in the past. (2 years ago). I only mention it in case it makes me a special candidate for scrutiny. The injury was due to heavy lifting and a prior fall at work. I thought I was fine after the fall and worked for a month until I was lifting something and it stressed out the very spot all of my weight had landed upon when I had fallen. That case was not disputed. The treatment has been successful and I have not had any problems related since but I was out for several weeks and had to have the time extended as the injury had not healed.

=> Question: How much of problem should I expect if this leads to a workers comp claim after having had the arm treated for stress though private insurance in the past? The past treatment was focused on the thumb, wrist and elbow. At one point the therapist suggested the source could have been the shoulder and the rest was compensation stress for it but that was speculation. I also never attempted to benefit by pointing out that the cause was work-related repetition. We were just trying to determine the activity to avoid or build strength against. . The therapist inquired about a sort of repetition survey or investigation to clearly define the environment but nothing like this was conducted as I did not attempt to have this treated as a work-related injury.

Thank you
 
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#2
the amount of the problem depends on the length of the delay in reporting. the employer is entitled to timely investigate any injury. failure to report a work injury makes it that much more difficult for them to make a determination. it also could allow other non-industrial factors to intervene and " muddy" the causality chain. trying to get benefits on an old injury months later usually leads to litigation.
"Make sure your supervisor is notified of your injury as soon as possible. If your injury or illness developed gradually, report it as soon as you learn or believe it was caused by your job. Reporting promptly helps avoid problems and delays in receiving benefits, including medical care. If you don’t report your injury within 30 days, you could lose your right to receive workers’ compensation benefits."
http://www.dir.ca.gov/dwc/injuredworker.htm

aggravations of a pre-existing condition are considered a new injury.
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.
 
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#3
Thank you.

I will notify management Monday when I call to notify them I must miss work.
 
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#4
Update:

Upon seeing the company approved doctor I discovered I have an age related bone condition. The activity at work aggravated a tendon because there was extra stress upon this area of the bone. It is a rough area at the end of a bone which can lead to things like this.

The doctor pointed out that the bone condition was not caused by the work situation. The aggravation was due to the extra stress on this area from overworking the arm (doing work activity). The doctor is not making the decision whether it is a work-related injury.

Although it is now a different context, does this still apply?: "aggravations of a preexisting condition are considered a new injury." Are there rules which render this eligible or ineligible as a WC situation because it involves something I could be classified as being uniquely susceptible to?

Thank you again
 
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#5
Yes.
During the period of aggravation the treatment and any disability are covered by workers comp.
You or the employer can go to a QME for another opinion.

In work comp law an injury is an event or series of events, not a body part or a medical condition.
The employer takes the employee as they find him. That includes all the conditions, suseptibilities, weaknesses , strengths, vulnerabilities, etc.
Many employers require medical exam or fitness for duty evaluation, medical history background, before hiring to avoid buying into aggravating injury situations.
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.
 
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#6
I am grateful for your assistance and knowledge.

You have been very helpful.
 
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#7
you are welcome.
comp is a "different animal" then health insurance or liability claims and can be confusing to those needing help.
there are many more who come to this site for general information and don't post so I often give a broader answer then just the one asked.
be well.
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.
 
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#8
Another update:

The company authorized physician had taken an X-Ray and was able to identify the age related condition in my shoulder while I was there for the examination. I was to return at the end of the week for an evaluation. When I returned on Friday it was a different doctor. This doctor thought he would be informing me of the X-Ray results but I said the previous doctor had mentioned it briefly. This doctor did not come right out and say it but I could tell he was considering this to be the whole situation. Rather than being something aggravated by activity at work he was considering the pain a symptom of a condition unrelated to work. The other doctor had said the condition was not caused by work activity but did not make a distinction whether work activity aggravated the condition.

The doctor I saw on Friday said he could refer me to physical therapy and gave me a prescription for different medicine, something that might work better which could be taken over a longer period because the initial medicine could cause problems if taken much longer. He also renewed the no work status for 2 more weeks. When I read the summary of the visit he had written in a brief description for the age related condition but there was nothing indicating strain or aggravation from work conditions.

The takeaway in my perception is that this doctor's office has switched from this being WC to an unrelated ailment. I don't believe it is the doctor's office making the call one way or another but their input will be a factor. I am expecting everything to be scrutinized by the department which handles WC claims at my employer's. I have read other online resources that align with what you have stated here about my situation, namely the pre-existing condition being aggravated by work activity is a valid candidate for WC, but these cases are frequently denied anyway. Either immediately or after a little consideration, they will probably deny the claim. I suspect I may have to get a lawyer involved.

Have I jumped to conclusions?
 
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#9
if the medical evidence is, " we don,t know", you'll have a tough time overcoming a denial.
Either side has a second chance to get supporting evidence/opinion thru the QME process.
How does the doctor explain why you are having symptoms now? "Spontaneous pain"!
Do the symptoms subside when you stop working? Why did you think it was an aggravation?
That,s not a very persuasive opinion.
No you are not jumping but you had no chance if you didn,t file. You have to give them a chance.
Employer/carrier approves and pays all your docs.
http://www.dir.ca.gov/dwc/medicalUnit/faqIW.html
If you want to litigate, get an atty specialist
Caaa.org
If you go back to work and the systems return file another claim, pick another doc.
There s no limit to the number of claims.
To be persuasive the doctors opinion has to be consistent with your history; they can't just make up a reason/opinion.
You can get private care while you appeal the decision.
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.
 
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#10
I am not sure if you are asking actual, rhetorical or hypothetical questions and so I am responding to them hoping to stimulate further discussion. I am writing this paragraph after having composed the following response. I hope this does not appear to be argumentative. I am just describing my concerns bounced off the ideas you have presented.

(09-03-2017, 12:17 AM)1171 Wrote: if the medical evidence is, " we don,t know", you'll have a tough time overcoming a denial.
How do they ever know when so many situations are not clear like an encounter with a dog or a fall witnessed by someone? Other than clear cut cases like a fall or a dog bite is it possible to say "we do know"? For example, a back injury from lifting, they could say "we don't know" because they just know there is an injury and only have the patient's word that it happened while lifting at work. That injury could have happened after work or could be from something months ago.

(09-03-2017, 12:17 AM)1171 Wrote: How does the doctor explain why you are having symptoms now? "Spontaneous pain"!
No one has addressed that and I did not ask because the situation did not arise. If I am correct and they have shifted their opinion towards being an unrelated ailment I imagine they would explain it as having hit the stage in development that it has started to become an obstacle to daily activity. Whether their explanation is valid or not the onset of pain coincided with the breakdown of the cargo door and my struggling with it. That shoulder gets the most stress operating that side door. The arm motion ties in with the pain I am experiencing.

(09-03-2017, 12:17 AM)1171 Wrote: Do the symptoms subside when you stop working?
They have not yet but that is not necessarily a barometer. A couple of years ago when I fell I was completely airborne and landed with all of my weight and the additional force of moving forward on my back. I immediately got up and continued working. I worked for a month. Then one day I lifted something and felt a strain in the exact spot in my back where I had landed. A couple of days later the pain was so bad I could not work. When I first reported the back injury I did not remember falling a month earlier. I did not remember the fall until weeks after I was out of work. Generally, I work whether I feel ill or not. The prior 5-year period I had only taken one sick day. I can cite that because I had the records to review. But the rest of my time has been similar. I only requested time off work because I could not work due to this pain in my back. It continued for weeks while I was off. I had weeks of PT before it went away.

(09-03-2017, 12:17 AM)1171 Wrote: Why did you think it was an aggravation?
I thought it was a fresh injury related to struggling with a broken cargo door. Once I learned of the bone condition I still thought it was a fresh injury and was trying to determine whether WC could ever perceive it as a valid WC case. The pain I am feeling is not like anything I have felt before. The way it appeared after the struggle with the cargo door lead me to believe it was the catalyst. It was not a growing ache out of nowhere. The pain tied in with the motion of that arm and shoulder when opening and closing the door. We move and lift and bend in all sorts of ways all day. You have to discount a lot or you could not do this type of work. It is the nature of the beast. Sliding the door open and closed is all in the left shoulder. The shoulder had felt healthy up to that point. As I mentioned earlier I have had pain and stiffness in my thumb and wrist and sometimes it would go up the arm to the shoulder but this shoulder pain was new, different and severe.

(09-03-2017, 12:17 AM)1171 Wrote: That,s not a very persuasive opinion.
Here I cannot tell whether you are pointing to theirs or my weakness. If merely taking the position "we don't know" is strong enough to uphold a claim denial as you said at the beginning of your previous post I am confused by this statement.

(09-03-2017, 12:17 AM)1171 Wrote: No you are not jumping but you had no chance if you didn,t file. You have to give them a chance.
True, I am just trying to prepare myself so I can address things as they are presented to me. Currently I am off work and can make phone calls and research online. It is very difficult to do anything like that when I am working.

(09-03-2017, 12:17 AM)1171 Wrote: If you go back to work and the systems return file another claim, pick another doc.
Once I am able to return to work everything will have changed and all another doctor will have to go on is the X-Ray and my description of things. Would a review board see that as inferior to doctors who examined me while in the midst of the injury?

(09-03-2017, 12:17 AM)1171 Wrote: To be persuasive the doctors opinion has to be consistent with your history; they can't just make up a reason/opinion.
It seems like all that these doctors have to do is change their words and this case will be approved or denied. My employer has a business arrangement and uses them routinely. If their words support the employer who is going to listen to my objection with any amount of weight/clout? What doctor is interested in getting involved and making a stand for my case when they have a full workload and high insurance premiums?

(09-03-2017, 12:17 AM)1171 Wrote: You can get private care while you appeal the decision.
If the claim is denied I will be paying for the medical expenses accrued. If you know you have to take a lot of time off and you will be using your private insurance you use FMLA. There are some situations when you can receive SSD with others there is no income but it protects your position. As soon as a WC claim is denied my employer could get very demanding. I don't know how things are handled in a situation like this. "Doctors" have stated I need the time off but I need WC or FMLA to take the time off without it endangering my position at work.


Again, this was not meant as an argument I am just describing my concerns bounced off the ideas you have presented.

Thank you
 
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