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Complex Meniscus Tear and Arthritis=WC Covered Total Knee Replacement
#1
I was injured at work last month. My MRI shows a lot of damage to my knee. I had a consultation with a WC Ortho Surgeon. He says I need a Total Knee Replacement (TKR) but he would only scope and try and repair or remove part of Meniscus, because of my age (45). He says the bone damage is from Arthritis. I will be seeing another surgeon soon for 2nd Opinion.
My question is: Will WC pay for it (TKR) if it is aggravated by this work injury-complex tear to Meniscus? I have been on this job for over 16 years. I have never filed a claim before. Thanks for you input.
Allison So. California
 
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#2
It is tough getting work comp to pay for a TRK, it took me 36 months in court, with being sent to 12 doctors, my surgeon was the 13th doctor I saw on the knee.

I worked as an Early Childhood Teacher for 10 years, my job required constan kneeling, bending, sqatting, sitting on low chairs and on the floor. I was working with a special needs student at the time I was injured.

Perhaps 1171 can his view on this.
 
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#3
depends on the medical evidence and how far you want to litigate the issue.
treatment options are controlled by utilization review and use of the American College of Occupational and Environmental Medicine guidelines.
if the evidence is ambiguous as to whether the need for total knee is due to the work injury and whether it is the proper treatment option according to ACOEM then the judge will have to decide.
either party can appeal and/or negotiate a settlement.

http://www.dir.ca.gov/dwc/UR_Main.htm
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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#4
I wanted to add to my post:

WIth a meniscus injury the normal course of treatment is to repair the tear and sometimes that does mean removing part of the meniscus.

My meniscus surgery was 5 months after the work injury, it was a failed surgery with the knee never tracking right. I was told from the start a knee replacement was in my future.
 
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#5
OP here, I had my second opinion with Ortho Surgeon. I feel so much better. He explained everything, in great detail. He will be removing part of the meniscus, because of the damage it cannot be repaired. I don't need a Total knee replacement... yet.Big Grin He went over MRI report with me and explained it all. So I can relax a little now, Smile and focus on pre-op preparation and recovery. I don't have a surgery date yet.
Allison in Calif
 
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#6
I pray your surgery is a success!

Just keep an eye on how that knee is tracking after surgery.
 
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