[my2xyz]

I live in Virginia and it seems that the Laws/Statutes of Workers Compensation are not employee friendly. I did retain an attorney when the workers Compensation carrier was not returning my phone calls. All I wanted prior to getting an attorney was to get treatment and return to work; no harm, nor fowl. To make this more confusing to me is that the company I work for is in Virginia, but the injury happend in Washingtion, DC (where my assignement was at time of the injury).
I was injured July 2010. The orthapedic surgeon that our carrier sent me to wanted to take me out of work at time of the first visit. After talking with him, he did allow me to work providing my employer agreeded to light duty and this was not a problem. I returned to work (light duty) and from July 2010 to December 2010 attended physical therapy appointments 3 times a week and doctors appointments. During that 6 month period, I also received a series of 3 injections for lumbar injury. After the injections, no additonal physical therapy or treatments have been done to lumbar injury. January of 2011, the doctor and WC carrier made a decision that I needed to be taken out of work. It took 5 months for the WC carrier to approve Surgical treatment for cervical injury. Finally in June of 2011, the surgery, anteriorcervical dissection and fusion was done; this was from C-4 through C-6. Recovdery seems to be going good; some aches and pains in the base of the skull, across the shoulders and some pain and numbness in left arm and some pain in right arm (I am left handed). I am being released to sedentary duty effective July 27, 2011. Sadley, my company will only allow me to return to work when I am 100% released for duty. The carrier is requiring my to look for work effective my sedentary release day to maintain benefits. Another twist to the situation. November 2008, I had a lumbar injury, same area that was injured in July 2010. I was treated with 3 lumbar injestions and 8 weeks of PT that worked great and had no other issues in the lumbar area until my work accident of July 2010.
Medical benefits awarded to me by Virginia and WC carrier was for both Lumbar and Cervical treatment. Now the orthepedic surgeon is saying that no additonal treatment will be given to lumbar area as he has determined that it was a prior injury to July 2010. From the beginning of all this, I was up-front and honest about prior lumbar injury but I was told, since I had recovered fully from the lumbar injury of 2008 and the work place injury of July 2010 aggrevated it that it was all part of the WC claim and treatment. While the Cervical area seems to be healing as expected, the Lumbar area does not seem to be getting any better; infact the pain at times is severe; I would rate the pain at a constant 7 to 10 on a pain scale and travels down the entire left leg with numbness in the lower leg and foot. My attorney has told me that neck and back injuries are not considered ratable injuries and has said until I am fully released that this cannot be addressed with the WC carrier.
The questions that I have from those of you out there is:
Since the state and WC carrier have already agreed and awarded medical benefits for both Lumbar and Cervical Injuries, and treatment was already started (Lumbar Injections), is the WC carrier obligated to fully treat the area or can they just stop based on the doctors opinion that the Lumbar was a previous injury after the fact? And, is there anyone who has had the same injuries, and if so, what was your out come? and did you get a rating? And if so, What type of rating or settlement? Please, any questions to my mess here, please ask....

[1171]

I'm not clear on what kind of decision was made on your benefits.
was it by the comp court?
if the comp court made a finding that your back and neck complaints were from the 2010 injury then if the carrier wants to deny treatment they have to appeal the court decision.
while the orthopedist opinion may be evidence it does not overrule the comp court.

sounds like you don't really trust your attys opinion. you can change attys at any time. generally there will be a single fee that will be shared among all the attys.

[my2xyz]

(07-17-2011, 12:35 PM)1171 Wrote: I'm not clear on what kind of decision was made on your benefits.
was it by the comp court?
if the comp court made a finding that your back and neck complaints were from the 2010 injury then if the carrier wants to deny treatment they have to appeal the court decision.
while the orthopedist opinion may be evidence it does not overrule the comp court.

sounds like you don't really trust your attys opinion. you can change attys at any time. generally there will be a single fee that will be shared among all the attys.

---

Thank you. It's not really trust of my attorney; she has told me that until I am fully released by the doctor and there is a rating, she really does not want to speculate on the outcome, rating or settlements. There has been no court decisions yet, I have not been released by the doctor yet or to full work at this point. What I was referring to as to state and WC carrier award is; when I filed my claim to the sate commission [when injury occured] they forwarded to the carrier and the carrier agreeded to the claim so the state awarded me benefits.

[1171]

i think i understand: you want explanation.

without evidence to the contrary there was no basis for the carrier to deny back treatment.
now that another contrary medical opinion has surfaced there is evidence to support a denial.
in the interest of providing benefits promptly, a carrier/employer can change a decision whenever there is newely discovered evidence/information.
administrative actions are not the same as legal findings/determinations.

hope that helps.

[CheriLovesJesus7]

[quote='my2xyz' pid='136663' dateline='1310919340']
I live in Virginia and it seems that the Laws/Statutes of Workers Compensation are not employee friendly. I did retain an attorney when the workers Compensation carrier was not returning my phone calls. All I wanted prior to getting an attorney was to get treatment and return to work; no harm, nor fowl. To make this more confusing to me is that the company I work for is in Virginia, but the injury happend in Washingtion, DC (where my assignement was at time of the injury).
I was injured July 2010. The orthapedic surgeon that our carrier sent me to wanted to take me out of work at time of the first visit. After talking with him, he did allow me to work providing my employer agreeded to light duty and this was not a problem. I returned to work (light duty) and from July 2010 to December 2010 attended physical therapy appointments 3 times a week and doctors appointments. During that 6 month period, I also received a series of 3 injections for lumbar injury. After the injections, no additonal physical therapy or treatments have been done to lumbar injury. January of 2011, the doctor and WC carrier made a decision that I needed to be taken out of work. It took 5 months for the WC carrier to approve Surgical treatment for cervical injury. Finally in June of 2011, the surgery, anteriorcervical dissection and fusion was done; this was from C-4 through C-6. Recovdery seems to be going good; some aches and pains in the base of the skull, across the shoulders and some pain and numbness in left arm and some pain in right arm (I am left handed). I am being released to sedentary duty effective July 27, 2011. Sadley, my company will only allow me to return to work when I am 100% released for duty. The carrier is requiring my to look for work effective my sedentary release day to maintain benefits. Another twist to the situation. November 2008, I had a lumbar injury, same area that was injured in July 2010. I was treated with 3 lumbar injestions and 8 weeks of PT that worked great and had no other issues in the lumbar area until my work accident of July 2010.
Medical benefits awarded to me by Virginia and WC carrier was for both Lumbar and Cervical treatment. Now the orthepedic surgeon is saying that no additonal treatment will be given to lumbar area as he has determined that it was a prior injury to July 2010. From the beginning of all this, I was up-front and honest about prior lumbar injury but I was told, since I had recovered fully from the lumbar injury of 2008 and the work place injury of July 2010 aggrevated it that it was all part of the WC claim and treatment. While the Cervical area seems to be healing as expected, the Lumbar area does not seem to be getting any better; infact the pain at times is severe; I would rate the pain at a constant 7 to 10 on a pain scale and travels down the entire left leg with numbness in the lower leg and foot. My attorney has told me that neck and back injuries are not considered ratable injuries and has said until I am fully released that this cannot be addressed with the WC carrier.
The questions that I have from those of you out there is:
Since the state and WC carrier have already agreed and awarded medical benefits for both Lumbar and Cervical Injuries, and treatment was already started (Lumbar Injections), is the WC carrier obligated to fully treat the area or can they just stop based on the doctors opinion that the Lumbar was a previous injury after the fact? And, is there anyone who has had the same injuries, and if so, what was your out come? and did you get a rating? And if so, What type of rating or settlement? Please, any questions to my mess here, please ask....








Hello, I completely understand what you are going through. I have cervical and lumbar also. I have had complications with my cervical spine and my back has been on hold. Two + years ago I was is so much lumbar pain that I asked for shots which were givin and paid fo by wc. When the next coarse of action was lumbar disc replacement, wo carrier sent me to an IME she said no go and that was it regardless of my treating doctors opinions. My Attorney has set a hearing date for my lumbar in Jan. 2014. In the mean time wc says they want to settle and they are forcing me back to the same IME office to get me shut down even further so they can get away with a lessor settlement amount. Your attorney should have already set a lumbar hearing for you. I would start there. God Bless you