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Future Medical Question - thx4thefreckles - 12-14-2016

I am in California and I work in front of the computer all day. My WC case is about a year old. I was diagnosed with mild carpal tunnel in my left hand and moderate in the right along with tendinitis in my elbow on the right side. They did nerve tests and thankfully determined that I did not need surgery. From the beginning I just wanted to feel better and to continue working at my job. They gave me two sets (six sessions) of PT and then three sets (also six sessions) of acupuncture and I was feeling great. The Dr. discharged me and said that since I'm still working in the same position and my case was open for future medical, if I had a flare-up to return and he would get me more acupuncture. Problem is, almost a year later and I am having a flare up in my elbow and right wrist but when I spoke with my employer (who I get along well with) she told me that the company is really struggling and me returning to the doctor she "thinks" would cost them more money. I have a friend who has worked at several WC law firms and said that it is not true, the the company's only cost was when their premium went up after I first went to the Dr. for my injury. Now I know it is my right and I could just call my WC rep but instead I would like to find an answer or some sort of documentation to share with my employer to reassure her that it's not going to cost more money.

Any advice would be so very welcome.


RE: Future Medical Question - 1171 - 12-14-2016

it depends on the size of the employer. larger employers are given an experience modification factor that will affect their future premium. generally claims costs for the last 3 years are used. smaller employers pay a flat premium.
ask your employer whether they have an experience modification or EX Mod.
also it may be likely that a return to the doctor would classify this current need for treatment as an "aggravation" and therefore a new injury.
a doctor would decide whether the current problem is due to the prior injury or recent activity.

more on EX mods here
http://www.wcirb.com/guide-to-workers-compensation/experience-rating

consider looking into some job modifications. a work station evaluation by a loss control representative from the carrier is a good first step.
often times repositioning the monitor, desk and/or chair can help. moving to a track ball rather then a mouse or using an ergonomic key board.
all small cost items that may avoid larger surgery costs.


RE: Future Medical Question - thx4thefreckles - 12-15-2016

Thank you for your reply and the useful information. We've done all the ergonomic mods and I'll ask my employer about the experience modification issue. I realize I do have rights of my own however I've been with the company for almost 10 years and I'd like to minimize the detriment to either of us as much as possible.


RE: Future Medical Question - 1171 - 12-16-2016

(12-15-2016, 01:56 PM)thx4thefreckles Wrote: Thank you for your reply and the useful information. We've done all the ergonomic mods and I'll ask my employer about the experience modification issue. I realize I do have rights of my own however I've been with the company for almost 10 years and I'd like to minimize the detriment to either of us as much as possible.

very sensible; employers and employees need to work together to make the coverage useful and fair for both.