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Originally Posted by imalikalotapuss
well, i went to a surgeon yesterday, and it looks like i will have an operation in two weeks. I am pretty sure that i will lose my job. Ever since i filed the accident report things have really went down hill there. I found out that things are a little worse than i had thought tho. I found out i also have nerve damage that will have to be reapaired as well as the tennis elbow condition repairs. Kinda scarey, dr said that these surgeries have only a 65% success rate, which i guess is better that 50-50. I am not the type to sue people, however i th ink that i have a case here...i just hate all the b/s. Why can't i just get the arm fixed and go back..but i guess it doesnt work that way..If anyone has an opinion or comments, please give it to me!
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What I am about to say might add insult to injury...but I hope it helps in how you are handling things thus far imalikalotapuss!
The reason they keep asking you "Are you sure this is the first time this has happened to you?", is because they (the bosses, disability and Worker's Comp) want to determine if this is a pre-exisiting condition that you are now tryng to claim as work related but it could have happened from any activity that you do on a daily basis! Read on for a lesson that'll knock your socks off!
From what I gather from your initial post...the Dr's have decided that this is a worker's comp case and have been sending you to worker's comp doctor's for all your care...right?
Has Worker's Comp aknowledged your case and determined that it is indeed legit and will pay for lost wages and medical care yet? If not...BEWARE!!!! As they determine a case, they try with all the gusto they can muster to find a loophole so as NOT to pay a thing. Very rarely does a case get a quick and favorable (to the patient) decision! The caseworker in charge of your case will try any/every angle to disprove your claim...and the statistics of pay-out are almost never in your favor. They know every trick in the book to find ways to not pay and the success rate for getting compensated is extremely low. Even if you do sue successfully...it could take years to see any money and your personal costs for lawyers fees and lost wages, if not dismissal, will be a bigger burden than you can imagine! Google "Worker's Compensation" and read some of the links from actual people who have tried to fight the system and are still in the poor house because of it. It's quite a wake up call to read what is actually happening out there!
Keep PERFECT records of dates of doc visits and lost time and EVERYTHING pertaining to this...this cannot be stressed more!
Here's what I know of Worker's Comp and how they handle a case that wasn't initiated by an immediate injury...but instead was an injury that over time worsened (which is what I gather is your case).
My husband has a bad back...but never had medical attention to treat it when it began. At times it was severe...and at times it wasn't...so he just took each day as it came and worked through the pain and never complained. Till one day...while on an overtime job on a weekend (very rare situation for him)...he hurt his back so bad that he couldn't move without excruciating pain for a month! He came home that day (a Saturday) and called and told his boss what happened. His boss told him to rest and if it still hurt on the next Monday, he should see a doctor. By Monday it was unbearable! He reported to work to find his boss was vacationing. Hubby was "HMFIC" (head mother fucker in charge) now and yet he could not do a thing without screaming out in pain. He went straight to the emergency room and, as they questioned how this happened, the doc's determined it would be treated as a Worker's Comp case.
BAD BAD mistake! And if hubby could have known how this would unfold, he would have never, ever told the doc's he did this on an overtime job, or on the job PERIOD. He now knows that the only way he'd ever tell a doc that an injury happened on the job is if it was something that never existed till the moment it happened...such as cutting a finger off (most severe scenario). He'll NEVER complain about an ongoing, and then complicated by an extreme movement, injury again! The Worker's Comp people call this a "pre-exisiting" injury that could have happened from any activity...even if it was complicated by an on the job action. THEY WILL TOSS IT AROUND FOR MONTHS AND THEN AFTER YOUR BILLS HAVE PILED UP TO THE CEILING...THEY STAMP YOUR CASE WITH A GIANT "DISAPPROVED"!!!
They...not the doc's...the Worker's Comp peeps...determine if a condition is caused by an on the job related action and more times than not they will find a way not to approve the case. In the meantime you are going to Worker's Comp doc's who seem to charge more money than any other doc because they keep making you make appointments for this, that and the other thing...including consultation visits just to tell you what they "might" have you do at your next visit. I cannot, for the life of me, figure out why a doctor would make a specialty out of seeing worker's comp cases exclusively. How they get paid promptly is totally beyond me!
So anyway...here's what happened in Mr. Lixy's case...
He went to the hospital...they said it was a worker's comp case and they made him get an MRI. Then they told him of a worker's comp doctor who would be handling his case and that they would send his MRI results to him. He went to the recommended doc and they had no clue why he was there...but they took his case anyway. He filled out all the paper work (all the while in excruciating pain) and sat and waited for over an hour to be seen. The doc had to have more x-rays, even though we told him he would be getting the results of the MRI. He had more and then even more x-rays and was given a few different pain meds and was diagnosed with damage to his L-4, 5, and 7 disc's in his back and was told by this doc that it was an aggravated injury by a chore preformed on the job. This was over a period of two weeks. Sounded like our case was won...right? HA! We were fooled for over a month into believing that the medical bills and compensation money for lost wages would be handled in time and we just had to wait for the offical approval.
Got a notice...DISAPPROVED. The explaination? His injury was never initially reported and there was no ongoing treatment for his condition. His worker's comp doc sent a report to the worker's comp case worker that he had some deteriorating disc's caused by excessive lifting through the years and that one disc was injured further by something he did the day the pain worsened. Now remember...all this while Mr. Lixy was confined to our recliner in a pain I have never seen him in. He never complains much about minor aches and pain and has a very high tolerence for handling severe pain (went for 3 weeks with an imploded appendix which infected his colon and made that explode)...and so I know he was in dire straights and that it was most certainly a job related incident.
I called the worker's comp case worker with an anger I have never felt before. I blasted him for making us wait so long for an approval/disapproval! I told him he couldn't possibly be serious that they aren't going to approve the case. Here's what he told me...
"Mrs. Lixy...In all the years that I have been doing this job, I have never run into a case such as your husband's. He is one of the most honest people I have ever encountered. Most people who make claims through our office have lies piled upon lies as to how they injured themselves. Your husband told me, truthfully, that he wasn't sure what particular action caused his injury that day...just that he was fine when he went to work and hurt when he came home. Now, he could have injured his back as he got out of his truck upon arrival at your home, for all I know...I just don't know that he did something "specifically" that day while on the job to cause his pain and make it our responsibility. Had he told me he bent to pick up 75lbs of something and heard a pop and couldn't move, I might have approved the case. Most people tell me it was something specific and then make up more to make it seem worse. But your husband was so honest and I can only thank him for his honesty, but I still can't approve his case. On top of that, the doctor has determined that his injury was pre-existing and deteriorating. Had your husband had treatment for his initial injury and then it was ongoing, I might have approved his case".
Here's what I said...
"You mean to tell me that had my husband been bilking the system (insurance and worker's comp) for all the years he has had back pain...he would have been approved for this injury? My husband has never been dishonest or faked an injury in his life. If he says he hurt himself on the job...you can rest assured he didn't do it while flying a kite on the beach! So, what you are telling me is that it is better to lie and to try and steal money from insurance companies and worker's comp for years...than to make one claim in your entire lifetime (which, by the way, he wasn't making the claim, the doctors who saw him at the hospital made that determination for him, he just went to the hospital and answered the questions they asked) and expect to get compensated for a short term disability that would have been cleared up in no time had he went to his usual doc and not made to spend ungodly time and hours in consultation and dertermination visits before they actually decided all he needed was some therapy and a tiny bit of pain meds to help him recover???????" I never want to hear that we insurance holders are responsible for the high cost of insurance due to us "stealing" from the system! It's you and your industry that makes it impossible for honest people to make an honest claim! AND...I'll remember this conversation (and your name) for the next time a situation like this arises. Because...I am going to lie, cheat and steal just like every asshole out there who gets a misguided approval from your company and other companies like it!"
"Mrs. Lixy...I understand your frustration and I am truely sorry I had to determine the case based on the truth".
HE ACTUALLY HAD THE BALLS TO SAY THAT ^^^ TO ME!
It made me so mad I started to cry on the phone and I just told him if he could live with his decision and still sleep at night, knowing we are up to our asses in bills and it will take a months to recover from this set back, then his conscience is in shut-down mode and maybe he should get out of the office once in a while and take a look at real people instead of what he reads on paper! I asked him if his wrist ever bothered him from pencil pushing over the years...and if it did and then one day he did something that he wasn't sure of but he knew it was job related from that day, because he was fine when he came to work but as he left the office for the day and couldn't bend his wrist without excruciating pain...would he lie and say he picked up a file and it was too heavy and his wrist snapped...just to get his own compensation approval? I offered to have him come to our house to visit us and and get to know the real people behind the paper work. Then I retracted the offer and told him I wasn't on this earth to help ease his conscience, he'd have to find a way to do that for himself. But, should he ever run into a case that was similar to ours again...I asked him to consider it more carefully before stamping it disapproved, because it is HIS determination that starts the landslide that could put someone in the poor house! I told him I had to hang up then...because I had to call the bill collectors who are awaiting our call to let them know if we could pay something...anything...that month, towards our arrears because we were waiting for approval from Worker's Comp and had been waiting for over a month. I told him that he needn't worry about us though...because I am sure that, regardless of his pain and injury, my husband will be going back to work tomorrow because he will lie to the doc's that his pain is gone now and he can do his job in the usual manner, just so we can pay some bills. I thanked him for the lesson in humanity and I thanked him for teaching me that lies are so much better than the truth. I told him that our parents (hubbies and mine) must have been insane to tell us to never lie...that they should have never been allowed to be parents and should be jailed for their child rearing techniques! I told him it was a shame we didn't have parents more like his...AND THEN I HUNG UP!
He tried to call me back but I just picked up the phone (saw his name on caller ID) and hung it up several times! He finally gave up...but I bet he couldn't get our conversation out of his mind for days! I'm hoping that to this day he thinks of us from time to time when he is considering a case. I'm willing to bet he can't help but remember us every now and then.
Sorry this is so long and drawn out...but it's worth it's lesson in gold! The system is set up to never pay a claim.
Oh...and get this...my husband's company's disability insurance cost went up for his case being the third claim in less than a year. Not that hubby had 3 claims...and his company never had another claim before these 3 current claims...but because during this time one claim was made by a new guy on the job who made it a practice to get a job and then "get hurt" on the job and sue for compensation, which was, of course, denied. Another guy sliced his arm on machinery that worker's comp disapproved and said the maker of the machine was at fault. Then Mr. Lixy's case which was disapproved. All cases were denied...yet the insurance cost rose. This is probably why your company has suddenly become "assholes". They have a claim...their insurance cost rise!!
Don't pay worker's comp and you are up the creek if an employee gets hurt. Pay worker's comp and then have an employee file a claim and the employee and you are up the creek. The employee gets shit on from both ends and the employer has to find the fodder to shit on the employee (usually in the form of making the employee quit or by firing them for "another" reason not related to the case) and they get hit with a bigger insurance bill for having someone make the claim! It's a vicious circle and the employee ends up paying through the nose, whichever course of action he takes!
If you need more info you can PM me anytime imalikalotapuss!
Good luck and please keep us updated!
P.S. Within the past four months, Mr. Lixy has had a touch of "tennis elbow" in his right elbow which is most assuredly a direct result of his job. At times it's so severe that he drops things and/or can barely lift a simple cup of coffee to his mouth and has to switch hands to complete a/this simple task. Some days aren't so bad and some days are horrible. He outright refuses to see a doctor about it because of this last incident with disability and worker's comp. I know him welll enough to know that he'll not see a doc till he can no longer use his arm for anything. It's so sad and so hard to see him in this pain...but I can't make him go for help till he sees no other way to cope. The system has broken him to the point of suffering and I curse the system everytime I see him cringe or cry out in agony!
I just want to be able to live without this pain. thanks again for your input!
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