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Cry havoc and let slip the dogs of war!
#1
Sad 
Good Afternoon,

It has been awhile since I posted...I figure no sense it wasting your reading eyes with needless posts. Well in the past few weeks things have developed at an astonishing pace or I should say in the last few days. A quick recap of my injury:

State of Claim: PA
Injury: Knee

I had several knee surgeries which failed causing pain and discomfort due to a fall at work. These surgeries were done by the doctor provided by the WC insurance provider. After an IME in which the IC doctor stated the above mentioned surgeries failed, he stated it would be unlikely I would be able to return to my pre injury status. Well the months afterwards I had no issues and once I heard the words pre-injury status I quickly signed up my WC attorney. Thus far I have not needed him and kept him apprised of all activities, treatment, and WC contact.

Flash Forward to the present: I had a surgery provided by my doctor and in the weeks following, aside from swelling has made my knee feel better and has actually given me hope this will help until the time I must convert to a full knee replacement.

Now sadly the first shots have been fired....Workers Comp retained there lawyers and statrted and inquiry and video survillance...I hope you enjoy catching me going to therapy on my crutches Smile. Today received notice from IC that they are filing for a Utilization Request for the medical treatment I received. The questioning the medical neccesisity for the treatments I received.

Despite the fact that their own doctor addmitted that the previous surgeries have failed and the need for a corrective procedure was needed it amazes me the games these IC will play.

So now my lawyer and I wait and watch the games they are playing, and wait for the inevitable time we will see them them in court. Just a question of when..


Now how do all of you deal with the stress of all this?
 
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#2
what does your recent Dr's operative report read like ? The only real issue would be was the surgery was directed at the allowed conditions of the claim or some other, (currently) non-related knee problem.

Now while that may sound ridiculous it is actually a valid legal argument and comp is a legal arena so a fairly common issue. For instance if the recent surgery was for a degenerative joint disease of the knee and it helped it then you were suffering from degenerative joint disease of the knee. If Degenerative joint disease is not a recognized workers comp diagnosis of your knee then the treatment was not necessary under comp, you see what I am getting at.

So, more info is needed to say one way or the other about your story. Or perhaps another diagnosis is now needed to be added to your claim. Just because it doesn't make sense to you doesn't mean it's nonsense. That's just how comp is.
 
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#3
My first surgery was to correct the issues of patella tracking. It was a very involved operation involving screws, cutting muscle, removing damaged cartildge and shaving ligaments. The second surgery was to clean up the scar tissue, remove damaged cartildge, and remove bone spurs.

The second surgery was a result of the first surgery, as the tracking was never properly corrected. The third surgery was to to give me a new base as the previous surgeries were both failures causing degenrative changes that would have never resulted without the injury and the failed surgeries.

As of now I have my original surgeon, 2 replacement specialists, and the IME doctors agreeing that this surgery was needed, that the previous surgeries failed, and that prior two surgeries did not return me to pre-injury status.

The more I think about it, the more I realize the less I have to worry, and the more I see the IC company is just trying to escape this entire mess. Unfortunately, this will be a life long committment with regard to the surgeries, and preventive care. I am confident, as is my lawyer that this will be resolved in my favor. It just the in between that is stressful.
 
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#4
There just taking a run at you so the atty can bill some more before it's over for them. No worries.
 
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