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Shoulder Injury
#1
In August my shoulder popped out at work and pain and weakness followed. I have had shoulder injuries in the past from playing softball for 22 years, but I have never had a torn rotator cuff. I had told my supervisor after it happened and went home. The following Monday I went to the doctor where he sent me for a CT scan. Kept me out of work until I got the scan. Then I saw a different doctor to review the scan. She said she HIGHLY suspects a torn rotator cuff and said she put me on light duty, but where I work at doesn't have any light duty. (I am dealing with the Indian Health Service for my care) She referred me to get an MRI but Contract Health (IHS) refuses to pay for it because they said I have to file for workers comp. I didn't do it at first because....I felt there may be others who need it more. Yes I am an idiot, So I went back to my employers and showed them the denial letter. They said I had told them it was a softball injury and turned it in to their insurance as such. They twisted my words around and now they are saying it was a previous injury, but it wasn't. I didn't have a torn rotator cuff until now. Now I have to sit with no income, and wait on them to figure out if I can even file for it. If I can't then the IHS will pay for it. Do I have a case or did I screw myself when I told them about the old softball injury? Sad
Thank You for reading
I am not suppose to use my right arm at all. Doctors orders. My dominant arm.
 
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#2
You may have a case.
you can have an old softball injury but that's not why you need treatment now.
You are not a physician and are not expected to diagnose the cause of your injury; neither is your employer.
does the doctor that suspects a rotator cuff believe it was caused by your job duties?
Aggravations of pre-existing injuries/conditions are considered new injuries.
Contact the comp carrier directly and get your claim filed.
If it's denied you can appeal. The decision rests with the carrier not the employer.
Are you under state workers comp jurisdiction or is it a tribal claim?
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
State comp. And yes the doctor says I did it at work a repetition injury, My employer told me it doesn't work that way and that I can not file, but I kept pushing and she said, "fine I will make some calls". She said that it would make them liable for a injury I received in softball. They know very well I told them it was an old softball injury. They are stopping me from making a claim. How do I get one?
Comp Carrier? How do I find out who that is?
 
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#4
the employer doesn't make coverage decisions for their carrier; it's up to the carrier to decide.
most states require that the carrier information be posted on a bulletin board or in an place where employees get information.
many states also have a site where you can look it up online.
what is your state?
if you can't contact the carrier, it's time to file with the work comp board and litigate the claim.
it may also be time to file for comp fraud against the employer.
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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#5
They had a change of heart this afternoon, I wonder if the lawyer I talked to said something. Anyway the person who files it had a totally different attitude then she did earlier and was more than happy to help me. She even said they may just skip all the doctor stuff and send me straight to a specialist.
 
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#6
probably talked to the carrier and employer was told they needed medical evidence before making a fight on that issue--that's why they are getting a specialist.
if your doctor is supporting your position, I would not change treating doctors before you know what the specialist thinks.
talk to your doctor and if they think you need a specialist now then let them refer you to one.
each state has different rules about changing doctors, identifying coverage & carrier etc. and I don't know your state.


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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#7
Don't go believing they had a change of heart, they are just setting you up for a let down/screwing you over. They pretend to be nice and once your not paying attention they get ya...
.
 
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#8
They never look out for you.
You are getting sent to the specialist so they can prove it's an old injury.
I hope it proves to be a new injury.

Be very careful what you do or say, they write everything down, and use it against you later.
Little small things, like;

"how are you doing?"
"I am fine"

Patient is in no pain........
 
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#9
They didn't have a change in heart they are just putting on a different face in front of you. They have looked at the reports that say this is a WC injury and are now looking to get their doctor to say other wise. Once they do they will use this to say it is not covered and make you fight to get it covered. Now this specialist may agree with your doctor and they might fix this but you can bet money they are looking for a doctor to say this an old injury. It maybe hard for you to believe but there are doctors out there that will write about anything these companies want as long as they pay the price
 
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#10
Yes I understand and thank you. I talk to much and I need to stop like you said. I have an MRI from 2010 if it is needed to prove it is not an old injury. So you mean like when you go into the office and someone greets you and asks how you are doing today? Say I am in a lot of pain right now (which is true)
 
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