denied workers comp for total knee replacement

[Dolly]

Hello Everyone, this is my first post after reading all the workers comp nightmares. Here is my story briefly. In Nov. 2004 I had meniscus surgery on my right knee. It was all done thru workers comp and I got a small permanent impairment award. Now 5 years later I am having problems with my knee, miniscus is torn again and I have arthritis. I went to a very reputable Dr. who told me I needed total knee replacement. It scared me to death. I am only 51 and I am really scared about it. So I decided to get 2 more opinions to make sure I was doing the right thing. I informed him I was afraid of knee replacement so he suggested another arthroscopic surgery to clean up my knee but I would need a new knee in the future. Then I went to my original Dr. who informed me he could clean it up but knee replacement wasn't necessary. He also stated that when you start asking workers comp for new knees they don't like to pay. Arthroscopic surgery over and over again makes arthitis worse. Needless to say I had to have an IME. He said all I need to do is exercise and it should be ok. Not sure how opinions can vary so, but I am going to be depositioned in August. They seem to think it happened somewhere else. While working (as a techinician) climbing a ladder my knee caved inward and I almost fell off ladder. Scared the heck out of me and left work. I have been out of work since May with no pay. My employer found me another job at a desk that is 75 miles from where I live starting Monday . Can I get anyones opinion on whether or not they think worker's comp will come through. I am in Vermont. I am beside myself. Thanks

[1171]

liability looks complex; i suspect it'll have to be settled.

[Bad Boy Bad Boy]

SETTLEMENT AGREEMENT
It is hereby agreed by and between the injured worker, whose address is
, and
**insurance carrier **employer, that worker claims a work injury
on ,20 by the said worker while in the employ of
whose address is
causing the following injury:
and resulting in temporary total disability which began , 20 .
That the employee’s average weekly wage before the accident was $

This an agreement in which the claimant agrees to accept $ , in full and final settlement of all claims for:
(describe injury) sustained as a result of the accident referred to above, including **his **her claim for past, present and future compensation for temporary total disability, temporary partial disability, permanent partial disability or permanent total disability, dependency benefits, medical, hospital, surgical and nursing expenses, and vocational rehabilitation benefits.[b][i][u][size=medium]

If payment is to be in a lump sum please complete one of the paragraphs below:
Claimant agrees to accept and the employer/carrier agrees to pay a lump sum of $ . This lump sum is
Compensation for permanent impairment that will affect the claimant for the rest of his/her life. The claimant’s remaining life
expectancy is years or months. Therefore, even the paid in a lump sum, claimant’s benefit (after deduction
of attorney fees of and expenses of ) shall be considered to be /months
$ per month beginning on the date of approval of this settlement
OR
Claimant agrees to accept and the employer/carrier agrees to pay a lump sum of $ . Claimant expressly
Requests that the lump sum not be prorated as otherwise required by 21 VSA §652©.
APPROVAL AND REVIEW
This agreement or any settlement thereunder shall not be binding or operative unless and until this settlement

[Dolly]

what does that all mean bad boy? workers comp reopened case to see dr.

[Bad Boy Bad Boy]

I was showing your State general settlemt form was all.

I'm glad the reopened the case. But, it's my opinion it would be a new case, brought on by a new injury which then aggravated the old injury.

You may wish to ask an Attorney about your legal rights now also.

[Dolly]

thanks !!!

[1171]

if a new injury aggravated an old injury all liability goes to the new injury and aggravation.

[Bummer Knees]

Welcome to the forum Dolly!

I will share my story, maybe it will help.

I was injured 2005 bilateral knees, 5 months after the injury I had meniscus surgery of the right knee. After the surgery I continued to have problems.

I was placed at MMI and given a rating.

I continued having problems with the knee and hired an attorney to reopen my claim.

I was successful in reopening my claim and was sent to a treating doctor and learned I needed a total knee replacement.

The insurance company denied treatment but after 31 months of appeals and denials I received the replacement.

In total I was sent to 12 surgeons, all said I needed the replacement.

[Dolly]

thanks for all your comments. I do have a lawyer and he is depositioning the IME doctor and the company wants to deposition me. I have not had any other injuries it is just wear and tear from climbing ladders and kneeling and squatting on cement floors. Job is very hard on the knees. They seem to think that I must have had another injury in the past 5 years but that is not the case. My deposition and the deposition for the IME doctor is secheduled for the 18th of August. Not really sure what to expect, but if I am not lying I feel I have nothing to worry about. I just don't want to be raked over the coals like bummer knees has been.