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Change in physical condition form help
#1
My question is on the Employee Verification of Work and Change in Physical Condition Form(PA)


I live in mechanicsburg, PA. I was injured on the job at weis markets where I slipped and fell on a broken container of liquuid laundry detergent that a supervisor had broke. He never put up a wet floor sign or made in effort to clean it up, there were also empty boxes blocking sight of the broken container and spill area.I was never offered medical attention that night. I had to go and get my own accident report from the office. They never asked me if needed to go home or anything. I was clearly in pain as I was having trouble walking because my back, and legs began to tighten. I was told to come back after I finished my shift for a meeting with the store manager where I was fired. They said it was due to lack of speed in stocking. Plus I was still in my probationary period. They said that they would not brown slip me so I could go to concentra urgent care. This was several hours after the injury. I was given xrays and some medication from the dr. I was then scheduled for physical therapy and started that 3x a week a few days later. I was receivng treatment for my back, legs, & neck. Maybe a month later I was complaing to the therapist about more neck and shoulder pain, I almost always was treted by a intern not the actual therapist, they pretty much acted like it was no big deal. It took over a month of of me telling them about the pain increasing in the shoulder before they decided to send me for an mri, and to a physiatrist. It showed multiple tears to the routater cuff. Which my PAC told me was due to me trying to stop the falll with my right arm during the fall.

My question is on the Employee Verification of Work and Change in Physical Condition Form(PA)

#5 Is there any information you are aware of that is relevant in determining your entitlement to, or amount of compensation?


I am not sure how to answer this question I have been out of work for over 3 months now due to this injury, and have not been receiving any payment compensation for the injury during this time.

Thanks in advance for any insight or info you guys can give me on this matter.
 
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#2
you can just put that you slipped and fell at work and your doctor took you off work because of the injury.
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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#3
I normally just have my clients check no. However, on a more important note, why aren't you receiving wage loss benefits? From the facts you outlined, it certainly appears that you have a potential claim. If you do not have a lawyer, it is time to get one. You are clearly being jerked around.
I normally just have my clients check no. However, on a more important note, why aren't you receiving wage loss benefits? From the facts you outlined, it certainly appears that you have a potential claim. If you do not have a lawyer, it is time to get one. You are clearly being jerked around.
 
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#4
(08-22-2011, 09:14 AM)Timothy Belt Wrote: I normally just have my clients check no. However, on a more important note, why aren't you receiving wage loss benefits? From the facts you outlined, it certainly appears that you have a potential claim. If you do not have a lawyer, it is time to get one. You are clearly being jerked around.
I normally just have my clients check no. However, on a more important note, why aren't you receiving wage loss benefits? From the facts you outlined, it certainly appears that you have a potential claim. If you do not have a lawyer, it is time to get one. You are clearly being jerked around.

I checked yes and gave a brief outline of how my injury happened and where it happened in the store.

I have an WC attorney now works at the Katerine Niven Law Office. They actually denied all benefits through WC their reason was that I was not permenetly and totally disabled as a result of a work injury. But Weis Markets is a self insured company and they are paying my medical but not under WC. My attorney said she had never seen a company do this before and she hopes that they will agree to pay benefits before my court date on 9/13.


 
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