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On going injury case
#1
Hello Everyone!

Let me first say that I found this board by typing in workmans comp info into the search engine. I've read a few threads, and I'm impressed with the way people respond with compassion and knowledge. There doesn't seem to be the usual smart a$$ degenerate comments that come with most forums. It's a nice atmosphere for a change.

Now for my scenerio and problems, that I could use some advice
and opinions on. This is going to be long winded so to get whoever wants and can voice on it, can see in some depth my issues. Thanks in advance to those that are willing to bare with me.

I work for a bread company in California. I'm a 23 year employee of the same company. In 1992 I was injured when I was on the job. The time lines are not exact but ruffly stated for understanding purposes. I was moving 2 trays ruffly weighing a little over 30 pounds. I was taking them off another stack and going to move them to the floor to work on the bottom shelves. A young small child suddenly appeared to my left as I was turning with the trays, and I had to stop my momentum so the trays full of bread did not hit the child and knock 'em down. Something made a crunching and a pop in my lower left back. Fast forward through the emergency room and xrays muscle relaxers bed ridden for months and several months of PT. I was young 30 year healthy and stong able bodied adult. I was able to heal up with just some moderate pain issues that I worked through. I was never givin' a settlement from w/c but all the medical bills were paid. I turned in all the company claim forms and reports. For the next 2 years I worked with no reinjury and never gave it a thought.

Sometime in '94 I had a small exacerbation. I was picking my 2 year old daughter up and wham. I did modified duty for a couple weeks and PT and worked through that. Same w/c doctor and case. Then again in '97 I exacerbated it again. With the same scenerio of modified duty and PT for treatment. I had an MRI and xrays to determine it was the same existing injury. I learned how to take care of moderate flair ups my self using a borrowed tenz unit, ice, heat and anti inflamitorys.

Here's where it gets tricky: I suffered a nervous break down do to work issues ( harrassment ) and some family problems. I was of work for 9 months do to that. I gained some weight and could never really lose it all. When I say alot of weight.. I mean 60 lbs. When I came back to work... I suffered another exacerbation about 6 months into my return, this time I was getting out of a chair after working all week at home. The next morning I couldn't move without major, major discomfort. Of corse they didn't want to cover it. I was made to go to a QME and it was established it was connected.

The next several months I started receiving checks from W/c. I had no idea what they were for. I filed these away for almost 9 months and then called the State to see what was up. They said it was a settlement for my injury. It was the results of the papers and stips I had signed. But... I hadn't signed nothin'. Then comes the human resource department with paper work to retrain me as I had been reported permently disabled.

Hell No! I didn't sign any of this stuff. So I go back to the Dr. he has misplaced all his files on me. They make me go get another qme and the detirmine I'm not permently disabled and can do my job. It's stipulated that I have future medical care, but I have to see an orthopedic and not a general MD. There W/c Dr. I'm under care of a Ortho they picked for about a year. Nothing goes on until '01. Then I have a mild episode and do PT, but still work.

2003 I take a fall in the Depot fixing a large roll up door we drive our trucks in and hurt my foot. I hobble to my first stop ( Grocery stoe) and limp to where my stacks of bread are burried behind some of the stores pallets. I get the stores pallet jack and proceed to move the pallets to get to my bread. When I start pumping the pallet jack my back pops! I tell the store receiver, call my boss. I tell him I think I can finish the route if I can skip a few of the little stops and I'll call him when i done. I do just that. I work through the pain of both my foot and back for about a week. The foot being worse than the back. Finally I just can't bear the foot anylonger as it feels like I stepping on a marble. I tell them I need to go to the Dr. They sent me to the new W/c Dr. He takes xrays and sends me to a foot Dr. Diagnosed with plantar something or another. I never missmiss work. But need PT for my back. Then they start fighting the injury saying they don't agree with the dignosis. They say that the back is being denied for PT. Because... I need to sign these papers and stips from the previous injury. I refuse to sign the stips on terms that I am supposed to get future medical care and the wording is not there, plus they are denying treatment right now.

They get a high powered attorney, take me to court. Demand I sign the papers. I tell the judge nope and I want an attorney. I have a consultation with an attorney, he come to a court hearing. I end up not signing the stips, going through another QME. The Attorney decides it's not worth it for him to represent me because of the checks I got yars ago and says he might represent me if all the cases are rolled into one. Now it's been a year and the QME doctor won't give them a permanent and stationary until I get another MRI. I get it... The QME doctor still hasn't sent in a final PanS. Which brings me to where I am now.

I pulled my back out last Monday morning loading my truck. This one so bad I can't straighten up. I wait for 2 hours until the W/c doctor opens up ... get a ride there and he takes me off work temporarily disabled to work my job. Orders meds and PT. I get a call from the PT saying .. " DENIED" I call human resources, they say benifits are denied. No pay no PT. I'm told to contact the adjuster. I do. He tells me they aren't going to authorize the PT because there is no new findings. Also no money compensation because they feel i was PandS so the flair up isn't covered. even though I was at work and lifting company product when the flair up happened.


Can anyone tell me what I'm going to need to do? I go back to the W/c doctor this week. I look to be put back on with modified no heavy lifting. Which my company don't honor unless it a W/c claim. So I'll probably have to get a full release before they let me come back. I don't understand how they can get away with this. By the way my company hasn't ask me for an incident report yet. I'm going to file for State Disability and put down it's on the job. Does anyone have a view on that?

Thanks for any info and help.

coachdad

I've edited this post. I see over 30 some views with no replys. Any knowledge or help will be apreaciated.
 
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#2
Hang on coachdad...someone who can answer, will eventually...your's is a long read, and is complicated.

LillySmile
Injured worker, & tired of it all! I'm too old for games!!

A careless word may kindle strife, a cruel word may wreck a life, a timely word may level stress, and a loving word may heal and bless!
 
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#3
I only read the last couple of paragraphs. basic information and short succinct questions are preferred. followup information and questions can come later if necessary.

whether you have an aggravation/new injury or an exacerbation/old injury is a medical question.
if you think it is a new injury file a new claim form. when the claim is denied take the denial and your medical evidence to a judge and get a decision.
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
Hi Coachdad, and Welcome to the Forum!! I really can't be of Much Assistance to You, Ca. w/c is an Animal of it's own that I have Never been Fully able to Grasp, but there are some Here that do. It's the Weekend and Sometimes it gets a bit slow on the Site, but as Lilly Said Your Case is a Bit long and Complicated, so the Ones that can Answer You with the Info. You need May take a little Time. We have a Great Group Here with a lot of Compassion and Knowledge, and I'm Sure Someone with Knowledge will be along Soon! I Wish You My Very Best, and I Hope You get the Info. Needed!!Smile
 
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#5
Thanks all!

I'll heed the advice that you've posted. I've seen those types of replies on other threads. I guess I was feeling leftout that nobdy posted them to me. I feel better now! Cool

Plus I wanted o see if I would be notified by email when somebody took the time to respond.

Again,

Thank You.
 
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#6
1171 Wrote:I only read the last couple of paragraphs. basic information and short succinct questions are preferred. followup information and questions can come later if necessary.

whether you have an aggravation/new injury or an exacerbation/old injury is a medical question.
if you think it is a new injury file a new claim form. when the claim is denied take the denial and your medical evidence to a judge and get a decision.


Thanks 1171.

I was asked by my HUMAN RESOURCE REP the day of the accident, if it was a new injury or the same old injury? I was still on the job site waiting for a ride (and the OK ) to go to the Doctor. My answer to her was... can't I let the Doctor decide? Because I don't know. She said yes. And told me she was going to give the insurance adjuster my phone number so I could answer the questions directly. I never received a phone call from him. When I called my HR to find out why the PT was denied. She said I'd have to talk to the IA (Insurance). I asked if she remembered telling me he had my number and would call me? She said no! I read a lie in her voice.

Just some info: The IA has been on my case for almost 8 years now. He is the one who hired the Attorney that is persuing the signing of the stipulations ( That say I have future medical for the injury).

Thanks for your post.
 
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#7
Welcome Coachdad. You've found a wonderful place here...so much compassion, knowledge, and friendship. Sorry I can't help you but just wanted to let you know that others will be on after the weekend to give you any info and advice they may have to help you. Sounds like you've been through the ringer with your back and wc. Best of luck to you.
Always love your cubs unconditionally...they are a gift from God and someday they'll pick your nursing home!!
 
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#8
snowbear Wrote:Welcome Coachdad. You've found a wonderful place here...so much compassion, knowledge, and friendship. Sorry I can't help you but just wanted to let you know that others will be on after the weekend to give you any info and advice they may have to help you. Sounds like you've been through the ringer with your back and wc. Best of luck to you.


Again Thanks for your response Snowbear. I've been reading a few more threads. This place is awsome.

I guess my main concern right now, is how can they get away with not paying me out of W/C for loss of wages when I was hurt on the job (again)? How can they make me sign up for SDI? I'm hoping when I sign up for SDI they say... whow now... he was injured on the job, you have to pay. But I'm guessing it's not going to be that easy. And in the meantime... I need some bills paid. Sons of Gunz!
 
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#9
Well, I can tell you that in my state (Mich), one can draw SSD AND WC at the same time. I'm thinking that you may need the assistance of a Cert WC lawyer. In fact you can call around to some of them while interviewing them...ask your questions over the phone. Most will give out some free advise. In WC cases...the attorney's obtain their fee's by what monies they obtain for you...they take a percentage of that, so you don't have to pay up front any retainers. You KNOW WC has a lawyer...you need one too, to be on equal fighting ground!

The other thing WC notoriously does...is not pay or delay pay as long as possible, in order to make interest off the money they owe to you, and attempt to starve you out...in hopes that you'll just go away. So....hang in there and be persistant in your rights!
Take care & Welcome to the forum!! LillySmile
Injured worker, & tired of it all! I'm too old for games!!

A careless word may kindle strife, a cruel word may wreck a life, a timely word may level stress, and a loving word may heal and bless!
 
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#10
coachdad

I have a major opinion for you. Is you stated an Attorney didn't think your case was worth much. Then stated the Attorney would take your case if they could Bundle all your cases together. To me, and mostly any Attorney, out there, I think that would be best. For the time frames in your case, the years they happened in, could become a major proplem. Things such as Statues can run out. Or your case Red-Lined due to lenght of time with no Hearings and such could have taken place.
Reply's are intended solely for informational purposes. They are based on personal opinions, experience, or research and are "not to be taken as fact or legal advice", otherwise, always consult an attorney or a doctor.
 
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