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Florida WC insurers benefit, injured suffer
#1
Hello all,
I will try & make this short! (ha, tried) My mother has been employed continuously for over 65 years. She was working F/T dishwashing at same place since 1995. Within the last 3 years approx. she hurt her back at least twice lifting the 25 lb racks of dishes. The insurers never made a formal filing of previous injuries to the State just sent her to therapy after work. I'm sure they have the records from their therapists. She had asked to maybe fold sheets but they put her on waitressing. We have made numerous requests for insurer to provide her records & have been met with defiance, still have none of her records. Only ones I have been able to gain access to electronically through some doctors & the hospital. I also have at least 40 or 50 emails, I am a "Black & White" not a "he said, she said person" My mother is far too trusting & "they" are her friends. They are not, they are corporation people sent to Pt. Charlotte, FL from the Home office. Now she is finding that out! Also please note I have been saving the Ace in the hole, for a 1 time change of Dr. Because of their lack of interest in providing appropriate care.
My main reason for posting here is to get opinions, advice & hopefully find a lawyer to represent her & fight against these self regulating Insurers who job it seems to be is securing themselves a Bonus by providing less than adequate medical care. As well as to find out if I read the statutes right concerning the Insurers are the ones making the determination of one's MMI? Please also note between my mother & I we have over 100 years of working & this is the 1st ever WC Claim & wouldn't wish Florida's system on my worse enemy! I would go as far to say repeal the 2003 law as it takes away our constitutional rights & the only ones benefitting from it are the insurers, their rates have consistently been reduced every year & the injured people are so restricted & limited to care. My family has been in FL since 1818 & I'm mad! If she was a resident instead of employee, she would have way more options & we have never sued anyone in our lives. But this ordeal has been a travesty! I've dealt w/ Medicare for over 10 years (mom & husband) & it's twice as hard to find a WC Dr (so the insurers say, reason I've been given many times, we're trying to find a WC Dr.) than it is to find a Medicare Dr. which is almost non existent & mom had to change her advantage plan this year just to keep her Dr. an extra $50 monthly, but she trusts him & he has been her PCP for a very long time!
Feb. of 2014 she stuck to the dining room floor 3 times recovering twice, 3rd time falling hitting a chair on the way down breaking the head of her humerus. The ER Doc was assigned as her Doc from WC insurers as she was transported by ambulance. All they did was x-ray her shoulder. She was 84 years old! By the time the Dr. got to asking questions she had been drugged and wasn't feeling much of anything. Is there not an ER "protocol" when a person of that age falls hard enough to break the head of her humerus, they should maybe xray the neck, spine, ribs, hips etc. Or did they just see WC & did as little as possible?
Dr. decided surgery was not necessary & after a week in the hospital, she was admitted Skilled Nursing Facility for 3 months. The 1st place they chose had a 1 star rating on their own website from bad inspections from the Health Dept. Her 1st case mgr was great ONLY because she had a recent realtive in such a place & she fought to get my mom into a better place. After that, we were assigned a new Case Mgr & Nurse who instead of working together to get my mom back to working condition have just seem to bide their time paying small checks, no real treatments & hardly no communication. They very rarely returned mom calls Approx. 1 month after admission into the SNF the same ER Doc decided he then wanted to do surgery on 3/25/2014! Well for a young person it takes like 3 months for break to heal & considering her age, we decided give her a chance to heal! WC Insurer scheduled a 2nd opinion on 4/17 & the results stated "indicated that your fracture healed with slight misalignment but acceptable alignment. He indicated that he did not anticipate that she would need shoulder replacement surgery. He did recommend continued physical therapy."
She had her case mgr changed on 4/21/2014 & was released home approx 5/6/2014. On 6/2/14 Treating Dr. noted he was passively able to abduct her to 60 degrees, 45 degrees forward flexion, external rotation 15 degrees & internal almost full. Her grip range of motion about 50% mostly noted w/ MCP flexion of the middle finger, but she is able to pinch.
On 6/19/14 she had a FCE to which they stated she could not perform even sedentery work, she performed w/ good & consistent effort & demonstrated approriate pain behaviors. Musculskelotal exam demonstrated significant AROM of upper left extremity & near normal on right. Fair strength during manual muscle testing on right & a trace to none on left. 7 of 12 Pain questionnaires were considered high, however her pain behaviors were appropriate throughout the evaluation.
On 6/30 follow up w/ Doc again. still limited range of motion w/ pain & her grip range of motion actually decreased to about 30%. She is able to pinch w/ index finger & thumb He gave her shot of steroid & discussed total reverse shoulder replacement. Noting her hand has some dysfunction & refers her back to same doc that did 2nd opinion. 7/31 Again another 200 mile round trip for me & I saw xray it was healed, a little misaligned. Said her hand problem was like rusty hinges! Said she should have OT. That never materialize & she has not gotten better to this day! Before this appt. I shared my concerns by just observing her & she shared her anxiety that she is still in pain & very anxious of her inability to do anything, drive, shop & had broken about every dish in her home because of her inability to use her hand, just index & thumb. I then requested a re-evalution of her injury due to lack of care rec'd at hosp as they only checked her shoulder. Her hand continued to worsen. It would turn blue at 1st, then her palm became sunken. (Have pics) I looked up the Anatomy & saw all the nerves & vessels of course their answer is & has been "We can't tell the Docs what to do!" I noted to the "specialist" that half way down between shoulder & elbow, on outerside she had a huge lump. I felt it 1st in SNF & pulled my hand back so quick because it felt the head of her humerus, I even called nurse in & said feel this. Specialist attributed it blood coagulation & I have to fill in the coagulation as he couldn't think of the word, Really????
No treatments or follow up till Nov. (4 months!) & once again, he wanted to do surgery but said he could not guarantee it would help her hand. Risks vs Benefits, NO! Plus the WC Insurers would not pay for cardiac procedure for clearance. It was a circular conversation as she would not of had to have it done if not for injury! They refused canceled her transportation & did not even notify her, the transporter did. I didn't want her going under but she was so fed up she was going to have surgery! But couldn't afford the costs! He referred her to a hand Specialist, he looked at her hand & said make a fist & that was about it! 5 minutes tops, 400 mile round trip!
He ordered a nerve conduction study. Which I had requested in like July of 2014 (email proof)! Her appt didn't come till March of 2015! He said Carpal Tunnel???
Last appt w/ another hand specialist approx May or June of 2015, he said nothing could be done & something about the nerves on the backside of upper arm. I could not attend this appt as my husband had been hospitalized w/ heart problems. He said she would have to see disability Dr. I'm confused there, is there such a Dr. or is it just her WC Dr.?
Aug 2015 back to original Doc, he looked at it , asked her to make a fist & lift her arm, which she was unable to do. DONE!
She has had no medical problems, surgeries etc. except for BP meds & Thyroid meds. Had regular check ups only She is almost deaf which one could contribute to her work environment besides her age. She was never offered any ear protection. But she has never complained just always worked, excellent work record. Not my main question but the insurers are using this to take advantage of her as I was supposed to be included in all calls by conference calling. I was not! I have emails lots stating everything!
She cannot drive, she has no reasonable standard of life, compared to before she broke her shoulder. The Insurance Co. doesn't communicate! Been really rude, never returned calls. That is why I have at least 50 emails communicating my concern for her! When they choose NOT to share info w/ me citing HIPPA, but had done so as a courtesy to me previously. Only when advantageous to them. But when I we want real information, reports etc. they won't! So they already broke the law, Insurer nurse tells me one thing & I prove her wrong w/ test results! Silence.
I had to refinance her home 5/2015 w/ less than 2 years left, the 1st time in her entire life she has found herself in that position! Starting over @ 85 & stuck at home has been bad for her overall health. There are some other factors, as I sent her to her own doc between the non communication between July & Nov. of 2014 I was worried for her & didn't care if she had to pay or not, well they wheeled her over & admitted her. She had become so upset, they thought she was having a heart attack. 3 days of tests she was fine. She has a genetic "floppy valve" which has been in check for years. The insurers are using her age, her heart & Osteo against her. Yet in 2/2014 she was able to throw a heavy mop around & wait tables 40 hours a week! So the only thing that has impaired her has been her initial injury. Women in my Family since the 1700's have lived to be 90-100 years old! She is not ready & now cannot afford to quit work & cannot live off their "compensation" But is unable to to work, what is a person to do & how does this law protect employees? It doesn't!
The other day she was sent 3 additional checks 1 $200+ 1 $100+ & 1 $20+, 1 check said for wage adj? I told her not to cash them.
Today, she rec'd a letter saying she got a 25% rating that the insurers rated themselves? They never enquired w/ her long term PCP to collaberate or find out her health status before & after injury. She made 8.19hr after 20 yrs & new hires get 8.05! This is a Global Billion $$ Corp that buys or builds all inclusive retirement Condos, Philanthropists their website says. They offer her no severance & she & all the girls had been cut to 20 hrs not long before her injury, as to not have to provide healthcare & when mom said she'd lose her home without F/T work, they realized she had Medicare & returned her to F/T status but not the other girls.
How can you go from swinging a heavy mop & waiting tables in 2/2014 to only being able to use 2 fingers & cannot raise her arm @ all since she broke her shoulder, but only rated 25%. She has been totally independent since 1965 when widowed, how does one adjust from nothing but work to nothing but sitting?
I knew they were going to screw her over from the beginning because of her age. The insurers even stated verbally they had affidavits stating she was unstable on her feet, they're bluffing & intimidating because she had very little contact w/ anyone. If it were true once again they put her at risk for cheap labor! The same day she stuck to floor, other employees did as well as some residents. This I know because I met some when they visited her in SNF! I would be interested in seeing their Purchase Orders for cleaning fluid, as I was employed as a F/T housekeeper @ one home & took care of 5000 sq. ft. of wood floors & know different solutions & improper measuring can cause sticky or slippery affects! But I would also argue they knew of her previous back injuries & put her at risk! She just was glued together again a few months ago on her own dime because of back pain. She could not do anything that would have caused new fractures. I'm sure her neck & back fractures were caused because she has been putting all her weight/stress on the 1 side (which was great during the FCE).. She has for years used her arms to push herself up & off sofa, but has had only the use of 1 for a year & half, Finally she could bear the pain no longer. Report also stated there is a prominent left renal pelvis. There is evidence of old trauma to the left shoulder with significant degenerative changes noted in report as well.
The employer, insurer & therapist put her health at risk from her previous injuries, she asked to fold sheets, they took her off dishwashing & put her on waitressing!
Opinions Please & I would welcome any lawyer that would undertake a lawsuit! They have just bide their time w/ little paychecks till they could write her off!
Everyone her pharmacist, her PCP, nurse & me says she has aged 10 yrs in just 1! She only gets paid for 5 years?, what happens if she lives the next 10? Since we had to refinance w/ less than 2 years left, they never offered any options, they did little as possible & if they'd done the nerve study a year before when I asked & not wait for a Doc to order it a year later, she might have gotten proper treatment. That was my beef all along, how can you treat something you don't know what is causing it?
Sorry for ranting, but tried to present a clear picture. I need some help for my mom, advice or representation. The 2003 law screws the injured & self regulating companies can make their own MMI's ?? Where is the justice there?
Please & Thank you Theresa
 
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#2
your mother can find legal representation here
https://www.wilg.org/index.cfm?pg=publicdirectory
or
http://www.avvo.com/search/lawyer_search...ida&commit=
or
from this site
http://www.workerscompensation.com/forum...php?fid=10
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
(09-22-2015, 04:58 PM)1171 Wrote: your mother can find legal representation here
https://www.wilg.org/index.cfm?pg=publicdirectory
or
http://www.avvo.com/search/lawyer_search...ida&commit=
or
from this site
http://www.workerscompensation.com/forum...php?fid=10
Thank you! I was hoping if anyone could answer the very real question, Do insurers have that much control? As well as protocol questions concerning the care in the ER & virtually the non existent care she has gotten. With so much BS about people losing everything & the ACA would keep that from happening. Of  course it is not affordable to me! Nor does it seem to help the elderly who have worked so hard & so many years! After over 65 years of working she gets 868.00 a month & has still paid into SS for an extra 20 years, twice for Medicare for an extra 20 years! This whole process is totally unfair toward the injured & the family. Just paying bills has been a struggle & has maxed my credit out trying to keep a roof over her head & I live an hour away.
Also if anyone could please tell me if I figured this right @ 25%, that 6 weeks for every point & is 75% of which she has been getting? I've searched & searched for any case summaries, anything where I might find if it is even worth the fight, we just have no fight left in us & seems to be "tough luck", it's the law! Anyone? Please, what is the "hypothetical" out come if we were to expend more time & energy pursuing this?
Thanks Again!
 
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#4
for help with the "justice" issue contact your state legislator; they have the power to change the laws.
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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#5
I suggest hiring an attorney a work comp attorney to help your Mom. This system is much too complicated for the average person who has a severe injury like you wrote about. It does not cost you anything up front and they just take a portion of the PD (worth it in my opinion). The best thing you can do for your Mom and yourself is hire an attorney.

 I am not familiar with the laws in your state about ratings or how to appeal them.This system is supposed to be set up to get medical treatment, and many have found the disability payments do not cover the amount of income that was lost, or will be lost due to the injury. 

I do not understand not cashing the checks that were sent, especially if she needs the money.Is there a reason why you do not want her to cash them?

You mentioned Medicare. Has your Mom applied for Social Security and if not I recommend it?
I am not an attorney.Anything I write should not be considered legal advice.I am writing from my own personal experiences,which is not from any sort of legal background. You should consult with an attorney over legal issues. In California, if you cannot get an attorney you can consult with an I&A officer.
 
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#6
(09-23-2015, 07:53 PM)California_Help Wrote: I suggest hiring an attorney a work comp attorney to help your Mom. This system is much too complicated for the average person who has a severe injury like you wrote about. It does not cost you anything up front and they just take a portion of the PD (worth it in my opinion). The best thing you can do for your Mom and yourself is hire an attorney.

 I am not familiar with the laws in your state about ratings or how to appeal them.This system is supposed to be set up to get medical treatment, and many have found the disability payments do not cover the amount of income that was lost, or will be lost due to the injury. 

I do not understand not cashing the checks that were sent, especially if she needs the money.Is there a reason why you do not want her to cash them?

You mentioned Medicare. Has your Mom applied for Social Security and if not I recommend it

She was 84, so there is only the SSA, No disability. Correct about payments, it would be tight. Would it be worth it to a lawyer to take it? Considering their rate of compensation I don't think is great for their services.
I am not cashing the reduced rate checks because I don't want them to constitute an agreement to what "They" decided.
I have a call in to State, for like mediation or settlement & if that can't be done, I guess one needs to try to get a lawyer to do that?  (cuz Florida covered their Arse) Then I would opt for 1 time change of Dr. I had the insurers send all her records, ALL, huge stack mom said & I'll be getting them tomorrow. Self executing & substandard seems to be way it works! Her Corp dba will be sending her employment records. I don't want this to drag on & would really just like to get her life back. If not possible, what would be the chances of getting a lump sum instead of weekly pymnts, she could pay of mtg. & survive on her SS & whats left over from settlement. Adding 5 years of payments if at the rate of 52 weeks, w/b approx. 56,000.
I will be writing my state Reps as well
Thanks!
 
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#7
I know you are trying to help you Mom here, but in my opinion an attorney would best serve her. 1171 provided some good links to search for workers compensation attorney's in your area. Why has she not pursued representation for this?

I don't see why cashing the checks would prevent the issue from being litigated later. Again, things like this are why I am recommending your Mom hire an attorney. It is very sweet you are trying to help her. I think the best help you can give your Mom at this point is to assist her in finding an attorney.

Lump sums are negotiated all of the time.

Take care.
I am not an attorney.Anything I write should not be considered legal advice.I am writing from my own personal experiences,which is not from any sort of legal background. You should consult with an attorney over legal issues. In California, if you cannot get an attorney you can consult with an I&A officer.
 
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#8
there is no florida work comp statute that allows the cashing of checks or accepting benefits to constitute acceptance of a legally binding agreement. comp law requires signature to specific language and approval of the comp court for an agreement to be binding.
where did you come up with a contrary understanding?
if your mother is not competent to handle her comp claim, a guardian can be appointed by the comp court to make decisions in her name on her case.
you can apply for guardianship.
as it stands now the carrier or the court is not required to deal directly with you.
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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#9
Thanks! I just asked for a lump sum to pay off her home, instead of the max 5 years of payments. She can survive on her SS then & still have some cash in the bank.
I have no basis on the checks, I was just being over careful. We don't want a long drawn out battle, just a reasonable standard of living & the lump sum would do that by eliminating her mtg.
So we'll see what happens?
thanks again!
 
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#10
your mother should not forget about the SS offset at the 80% point:
If the total amount of these benefits exceeds 80 percent of your average current earnings, the excess amount is deducted from your Social Security benefit.

http://www.socialsecurity.gov/pubs/10018.html
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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