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WC law on prior WC injuries and its effect on claim
#1
Ive been out of work for 15 months and receiving WC benefits.The insurance company has sent me for an IME 5 times. First with a Chiro, then the remaining 4 times to the same Orthoedic Surgeon. All reports were that I'm presently unemployable and surgery was the only thing that might help. I recently saw a top surgeon in NY and he is reccomending a spine fusion with instrumentation. Problem is that I have a past WC case back in the 1990's whereby the same disc was at issue. I was out of work for 10 years collecting WC and SSDI. I had settled out the WC case and a year later, I notified SSDI and started working. I continued to work for 8 years without ever needing medical treatment again, until I was assaulted during work and substained injuries to this same disc 15 months ago. The insurance company is asking me to provide them with more information about this older injury but truth be told I don't remember the doctors I was seeing. I was only able to provide the main doctor I was seeing and she has since retired. I have not been able to get the surgery approved as they are researching this prior WC case. Does WC law provide standing for this insurance company to deny surgery and possibly future benefits?

Also I'm set to see SSDI Doctor ( IME) Should I hand over these 5 previous IME's from my current WC claim to try and keep him honest?
 
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#2
"standing" is a very specific legal term that refers to the right of any party to participate in litigation.
it requires that the party show how it can be harmed by the court decision.
so yes. the carrier can easily show that it will have to pay benefits when/if the cause of a injury or condition is from the job because the legally binding insurance contract specifies that obligation.
if you believe there is another policy contract that supersedes the carrier's liability for your claim, then you need to get a court hearing to rule on liability and bring the correct party into the process.
It's likely the carrier's standing has already been agreed or admitted to the court at the time litigation was filed.

a doctor should have access to all of a patient's medical records before reaching a conclusion on disability. a doctor is not bound by prior medical opinions and is free to give a separate and contrary opinion.
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
Thanks for taking the time to give your opinion. I do want you to have a clear. Picture... The first injury was a Workers Comp case that was settle with a lump sum amount releasing future liability to insurance carrir under Worker compensation judge. I returned to work without any medical issues and without a doctor visit with this injurty. Eight years pass and I'm injured at work with a similar disc injury.. I cant see how the 1st WC case or carrier could be brought into the picture. But I also am clueless to WC Law.

PS. I'm new to the site and am grateful as I can educate myself through the experiences of others..

Thanks
John
 
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#4
of course you'd be confused about how prior injuries effect benefits for current injuries if you don't know the law.
the comp laws are different for each state.
many states have laws that exclude liability for permanent disability that preceeded or can be attributed to a prior injury or condition or one that is non-industrial.
some states even have such laws that apply to medical treatment. employers only want to pay for their injuries; they don't want to pay for the same bad back over and over again.
your state could be one.
the court is not going to take your word for it any more then they would take the employers.


so the court will certainly want information/evidence as to how/if the two are related.


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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