I think most have problems with the system when they have a 'hard to prove" injury.
Something that does not show on a xray or Mri or other concrete tests.
Or if they cannot find a dr that is fully knowledgeable in whatever injury they have?

If you can share some tips on how best to deal with the wc system when you have a chronic or difficult claim?

I know my claim was kind of messed up - because I trusted the system, and I assumed the atty, the drs, etc to knew what was supposed to be done.
I didn't really have clue back then.

Jo55 said:


I understand, because even with my experience we were unable to get my partner's COPD claim allowed as an industrial injury. She had never exhibited any signs of asthma or lung issues, including she never had bronchitis or pneumonia in her entire life. However, after working a couple years at her new employer, following her period of unemployment during my surgeries and recovery, she developed bronchitis and pneumonia which was followed by asthma. Her place of work is an extremely dusty environment, which would be like working in a chalk factory where they grind the mineral into fine powder right there before forming it into the little sticks. (This is not what she does, but a spot-on analogy . . . I don't want to reveal her employer, as her claim is ongoing. She essentially works with the same materials, and comes home dust covered almost every day.)

She now uses two types of inhaler and takes oral meds as well as prednisone when it flares up. But the independent doctor said it was only an aggravation of her preexisting asthma and not brought on solely by the dust at work. We know that is bull, but even her own doc agreed! Short of hiring our own lab to to air sampling (Labor and Industries will only do this if they think they will find a toxic substance, but copious amounts of dust don't matter!) and pulmonologists to evaluate her complete medical history, which we would have to ay for, and hire and attorney, we were sunk.

So I understand the challenge of, say, TOS which is either caused by repetitive movements at work, CTS, which is both work related and can come on in mid-life and later without work aggravation, back issues, etc. I have handled them all. The sad part is if the employer is self-insured, in many states they can be, they are usually more responsive to these kinds of claims and injuries. I know her claim had better chances of being an ongoing, work-caused claim if her employer had been self-insured. The state might have practically forced them to accept it, but the state operates here by complete different standards. I find this reprehensible, ad two people, one who works at employer A (state fund) and the other at employer B (self-insured) get completely different handling of their claims. i wish I had the power to work to stop this. . . .


The best advice I can give is that you never want to rely on anyone handling your claim. This is not about trust so much as being able to manage your claim as much as possible. This means you find a doctor who will support your claim, (or give you a good, clear explanation why it might not be covered.) However, if if it is not found caused by work, you might still be able to say the aggravation was caused by work. Then this is where you will have to direct all of your efforts, to prove that work is making your condition worse or not allowing it to get better.

I am sorry that there are health issues that are either caused, aggravated by, or arise during one's work life that are not found covered under worker's compensation. The program initially was set up to cover accidents, and over the years has evolved to cover other illnesses, like black lung, etc. Even today attorneys advertise for clients for some of the difficult lung issues, which indicates to me that workers still have an uphill battle proving work caused their illnesses.

That said, each and every person here with a difficult diagnosis, and a correspondingly difficult workers compensation issue, would need an individual evaluation of the situation. This is because, as I have said, every state's laws are different, and every employment is different, and every worker's physiology is different.


The steps I would take to approach filing a claim for TOS (I have handled several that were covered back in Iowa) or other repetitive injuries, would be:

1. File the claim with an onset date when you first noticed symptoms. If the statue has passed it is likely you may only get an aggravation claim with a more recent date date.

2. Gather all the medical history on yourself that you can to show you were never seen or treated for this condition before your work for this employer. If it began with a former employer, but continues to be aggravated by the current one, you may have to file against both.

3. Gather job descriptions from each task you perform (or performed, if a prior employer), with specific details as to the physical requirements and the amounts of the repetitive activities you do that you believe caused the condition.

4. Get medical testing that defines the nature of your conditions. I believe TOS requires some kind of Doppler exam, as well as x-rays or other means of pinpointing where the impingment is.

5. If the claim is denied, I believe it may be in your best interest to hire a good attorney who specializes in the condition you are filing for. Hiring a friend or you own personal attorney is a waste of time, and if the attorney you do hire finks out on you, fire them and look elsewhere. We have experienced this personally, with an attorney who held our file for review right u to the deadline then declined to take the case. Gr-r-r-r!

I know the above sounds like something the claims person should do. . . but they have been known to include only that which will support their position, and sometimes doctors even leave out incriminating information. Record will cost you, but it is often worth it.

The hardest thing for me to say is that it is always possible that the facts and records and symptoms simply do not compute to enough convincing evidence of an allowable claim no matter what you do. TOS, CTS, and many spinal issues carry that "normal aging" curve with them, that medical "don't know the cause" reputation, and are resisted as work related with great frequency.

The "system" was originally set up to allow filing of legitimate work injury, but over time it has been fraught with the reputation of being rife with fraud, unfairly hard on the employer (I say, what about the worker's bodies?), and an expense that must be reduced or controlled by any means possible. The ergonomics laws passed in the 90's have been so watered down or eliminated by disuse that we do not see the workplace evaluations of potential injuries that were intended to come out of the legislation.

Another factor that doesn't help is the political climate we live in. I believe beginning with the onset of big breaks to industry when they began whining about profitability, we saw a steady decline in their responsibility to the workers of America. We are back to being machines parts, expendable and replaceable. Rare is the employer who truly cares, and whose corporate structure includes safety and prevention on a large and honest scale. Most do it to front the impression that they are complying with any applicable laws. Hopefully we will see a change in this as the political climate warms under a new administration.

Imagine how universal healthcare might alleviate this. At least the treatment part. I envy workers in some European countries whose employers insist on taking care of their employees. I am afraid with our influx of workers willing to undercut everything in our system -- wages, living standard, working conditions -- we do face an uphill battle.

I will do what I can to help. W/C is not cut and dried. Being an examiner has some horrible stressors attached to the salary: we had to close claims to get paid for our work, we had a greater workload than we could handle (and we had them by client, and I had some of the tougher clients), there was constant pressure by the clients(employers) to reduce costs, and every one of our files had to be highly detailed and in perfect order (a full-time job in itself), and we were expected to sit in b.s. meeting that were no more than marketing for our service providers (nurses, vocational counselors, attorneys). In an 8 hour day were we supposed to review all diaried files, return all phone calls, monitor all medical and legal aspects, make sure all checks were issued (very important) and file an endless stream of paperwork with the state or suffer penalties. In addition, some phone calls would take much longer than average, and we were always ridden to cut them short. However it was my philosophy that if I explained claim issues to a claimant and listened to their frustrations, I could help avoid issues by increasing communication. Think so? Heck no . . , I was always under scrutiny for spending a little time with a hurt worker rather than giving quick replies and hanging up!



Enough about why claims are frustrating and why your claims person is not warm and fuzzy all the time. Enough about the reality of claims. If anyone has a question I will do my best to help you find some answers. . . . .

thursday asked me to repost this response to her "Sweating over claim closure," so bear with me, some of it might be repetitious:



I was a Senior Claims Examiner with over 13 years of experience in worker's compensation in several states before my last employer put me on disability. Let me preface by saying every sate is different. I urge anyone on W/C to read the basic on how your state's w/c works.


A claim will stay open as long as your doctor can document that further treatment will improve your condition. Once he can no longer justify your being in treatment (even if the physical therapy, etc. keeps you from sliding backwards), you will likely be declared fixed and stable. At that point your claims examiner with do one of several options: a) prepare the claim to be closed, b) request a permanent disability evaluation from your doctor, or c) set up an independent medical evaluation for determination of permanent disability and/or restrictions.

I advise anyone nearing claim closure, that unless you feel just as healthy and fit as you did before your injury, and sometimes even if you do, request a permanent disability rating from your doctor. If he can not do one (not all doctors have the certification to do this) ask him to refer you to a doctor for a consultation for closure and determination of permanent impairment.

A permanent disability or permanent impairment rating should take into account all factors such as loss of strength, loss of range of motions, loss of sensation, residual pain, your age, and perhaps even your physical condition, and your education level. If your hand is injured, ask that your rating be to the arm, if your thumb, to the hand, etc. If you have a back, shoulder or hip injury it should automatically be rated as loss to the body as a whole. However, remember, your state may vary somewhat . . . but you can ask for a copy of the statute on disability/impairment (they are the same thing) ratings.

I urge you to not let your claim be closed without addressing permanency unless you truly feel so fully healed that you can not imagine ever having the injury site give you any grief as far as being able to work. Disability is rated with regard to ability to work, not with regard to bowling, playing golf, or climbing mountains or skiiing! (I have had every question in the book asked of me regarding sports and activities that a claimant could no longer do.. . . but unless it is a work activity, your industrial injury is most likely not going to be responsible.)

You will not get rich from your permanent impairment rating and award. It likely will seem like a mere pittance for what you have been through, unless you have suffered a severe injury like amputation or a severe head or back injury, requiring major surgery or extensive rehabilitation. if your rating seems too low, ask the doctor to explain how the figure was determined. If the state arranged your independent/rating exam and it seems unfairly low, ask for a second opinion, with your own choice of doctor.

Carpal tunnel surgery never used to carry an impairment, as it was believed surgery restored 100% function, but that was changing when last I worked. Fractures of the arms, hands, legs and feet should be rated for impairment, as should back injuries with residual pain and/or loss of flexibility, even if you did not have surgery. Hearing loss always has impairment, as does loss of sight, taste, or any of your senses. I once paid impairment for a claim for loss of the sense of taste when the treatment for the injury caused the loss, even though the injury itself did not. I also paid out a huge claim on top of the work injury when a therapist treating the work injury dropped a patient and cause paralysis! (The additional costs for the second injury went to subrogation, meaning the therapist was responsible for everything over and above the initial injury . . . but it was messy, as the patient was not nearly to the end of her treatment when the therapist dropped her!)

(Speaking of subrogation, if a third party is responsible for your injury, they will have an interest in what is paid out on your claim. However, do not let them have undue influence over the claim, or push for closure, early end of treatment, or less treatment than necessary. And do not deal with them directly . . . your employer or the claims person is responsible for dealing with this.)

The best way to deal with your claims person is to be calm, reasonable, not angry or upset, and to educate yourself as best you can, as this will get their attention. The worst thing you can do is threaten, act like you are or have an attorney (your ability to talk directly with a claims person, and sometimes even your employer, about your claim, ends when you get an attorney), or indicate that you expect to "own the company" once your claim is settled. Believe me, I have heard it all where closure, money and punishing "bad" employers and their representatives are concerned.

I used to tell my claimants who asked up front if they would need an attorney on their case: "not if I do my job correctly." And then I would tell them if at any time they feel they can no longer get what they think they need from me or the system, then that is when they might want to speak to an attorney. Fees can range from flat-rate hourly with the clock ticking on every phone call, even the ones that are not returned (number one complaint about attorneys is that they do not return client calls on w/c claims) to anywhere from 20% to 30% and more, plus expenses/costs. Some of the best reasons to get an attorney are:
1. Your claim is denied and you truly had an on the job injury. Not an accident, but an bona fide injury. An attorney will know how to best present your case before whatever review board your state provides.
2. Your claim is only allowed for part of the injury and you or your doctor feel that your injury is greater than what was allowed.
3. You are refused benefits and you have been unable to protest them out of your claims person. Remember, every order issued to you is likely able to be protested in writing. Learn to write a decent and neat (with spell check) business letter. It is beeter then righting one that culd make them laff and not take yu seeriusly.
4. Your claim is closed before you have finished treatment. Your doctor should protest this, but if he doesn't convince them, you might need an attorney.
5. If, in your state, your employer/claims person has the right to dictate which doctor treats you, and this doctor is seriously downplaying your injury, an attorney might be needed.
6. If your claim is closed without a disability rating and your claims person disregards your second opinion doctor's rating. Attorneys love ratings cases because they know approximately how much money they will make and have to spend to get it.
7. You have not received all of your time loss/loss of earning power benefits and your examiner closes your claim. After you have submitted a protest with your calculations, if you still feel they owe you for lost time or lost income benefits, you may need to get an attorney. Included here would be if your time loss rate was not calculated accurately, or does not include shift premiums, overtime or bonuses in the calculation. However, these usually must be protested within a specified period after you have received an order for payment and calculation of benefits. Do not miss this deadline . . or any deadlines, for that matter. You will be left out in the cold!
8. Your employer does something that appears to be retaliatory for your filing a claim. e.g. Your employer fires you for filing a claim and ruining their perfect no-injury record, or they treat you differently when you return to work, like forcing you to take a job that pays less even if your job position is available, or move you to another shift when there is an opening on your regular shift. This is a fuzzy area in the law, which is why you should at least ask an attorney if you feel any kind of discrimination or retaliation, and especially if it is for filing an injury claim.

This list is incomplete and may not apply to all cases in all states. I have tried to provide a summary of ideas to help you educate and protect your rights when it comes to on-the-job injuries. Learn if and how to protest any actions you feel are not timely or done improperly. Learn to speak up and stand up for yourself. It will feel like work. . . but hey, you are getting paid something in the neighborhood of 2/3 of what you had been earning before you were injured. Get to work protecting yourself!!!
__________________

Hi lefthanded,
I just have a couple of questions for you.I had a work related injury back in 2002 and worked under docs care for a year and a half and they let me go on October 3, 2003 because I brought back permanent restrictions and they said they did not have anything i could do with those permanent restrictions so it was odios to me. Also while being under docs care wc decided we weren't getting anywhere so they dropped my case as well. By the way I live in Iowa. Can wc do that legally and can my place of employment do what they did to me? I have been fighting them for 6 yrs now. We did settle out of court 2 yrs ago with them making up the agreement. All I wanted at that time was an open file since I can't get health insurance due to my rsd. That is one thing I got. It was also processed through the state and all signed sealed and whatever else it goes through. Wc decided they are not going to oblige by what they agreed on. They are not paying docs visits or for my meds. I do still have my atty and we are still fighting them due to what they did. Is what they did as far as not doing as they agreed to legal and why do we have to fight them again? If we already settled why don't they have to do what the agreement was? Also I can tell the rsd is not getting any better if anything in my opinion I feel it is spreading but i can't get any doc to diagnose the right hand arm, and shoulder as well as my lower legs and feet. The weakness and pain and swelling i deal with on a constant basis has to be obvious.I think the docs just don't want any part of the lawsuit so they won't diagnose it. Am I thinking right or am I way off base here? My left hand was injured and it moved into my whole left arm, shoulder and neck and that is what the first settlement was based on but now that I am getting worse in my opinion and can't get a doc to diagnose it but goes as far as to tell me verbally that i need a cane or walker to help me walk now but not put it in his records. What can i do? And The next case can it be based on all my new injuries I guess you would call them or how does something like this work? I am still paying for all my meds and my hubby is the only one bringing in the income because I hurt so much more. My attorney said this time we can go after them for punitive damages this time. Is this true and if so what all am i looking at for this second case? I am scared and don't know what to expect. Please help me!!!!!

Sincerely,
Tracy

Tracy,
I am afriad I do not know the ins and outs of the "settlement." When I handled Iowa claims (up until 1995) a full and final settlement was just that -- the last word. So a settlement that provides any kind of agreement beyond "done" is something I do not know anything about. This is why you have an attorney.

As far as your case being dropped . . I am not sure what you mean by this, given you mention having some kind of a past settlement. W/c claims are rarely, if ever, left open for extended periods of time, or for medical follow-up. Even total disability pensions usually only paid a monthly wage-replacement benefit, and did not medical care. I know a few years back that the value of medical insurance was included in the evaluation of wages of determining your weekly benefit in many states, but I am not sure about Iowa. I am aware of only a few cases that were left "open," and those usually were because the condition was one that was expected to deteriorate a good deal, such as a closed head injury that caused a stroke, leaving a claimant unable to care for himself.

RSD is relentless, and still not fully understood. And unfortunately our society still does not deem it necessary to integrate individuals into the workplace that have lost functioning due to inexplicable and often debilitating pain. I know . . . because my employer was one of "those" that thought it wasn't worth the effort. So almost 15 years of training and experience get wasted, and I disappear. I don't have RSD, but I do have neuropathy in my feet, carpal tunnel in both hands, arthritis in my right wrist that needs a joint replacment, and Crohn's. I know how you feel . . .

I don't know if this will help you or not...but here is the link to Division of Worker's Compensation --- Iowa.

http://www.iowaworkforce.org/wc/

Lot's of information there... you may have to do a little reading to find the answers for which you are looking...

I wish you the best...

Abbie

Dear lefthanded,
i want to thank you for taking the time to answer my questions. As far as wc dropping me it was while I was still working but under doctors care and they said that I was at MMI even though i was not fully diagnosed and just dropped the case. I am so glad you were here to answer my questions. it really helped me out. Thank you again.

Sincerely,
Tracy

Hello Lefthand...

This is my first time posting on this site, I'm hopeing you get this. I need some advise, don't know what to do or who to trust. I had an accident at work 18 months ago, fell and hit my head. I was taken to the hospital where I spent 2 days, then was released. The horrible symptoms started. Noiwse in my head, ringing, sensitivity to light,sound, headaches. Just felt like I was going crazy. I had to "beg" , "treaten", worker's comp to get me a doctor that there was something seriously wrong. That took 3 months. The neurologist they sent me to looked at me and said "she's just depressed", gave me Elavil and I went home and slept 15 hours a day for three months. When I went back to the WC Neurologist she took me off the medicfine and said there is nothing wrong with me, sent me back to work. I was stiull having "serious" symptoms, but living my life as an athlete, I went back to work. I have not had ONE day symptom free. Eight months later...I* couldn't take it any longer and went out of FMLA. I was fired two weeks prior to the three months ending. Yesterday I had a deposition, next week a mediation. I have had the Neuro Pyche testing done by two PHD's.One of them say I am suffering from a CLOSED HEAD INJURY, the other one says I'm exxagerating. I feel like I can't even trust my own attorney, believing that they only want to settle to collect their money. This is my life!! I'm not sure I'll ever be able to work again or be normal. Any advise would truley help???

I am not at all familiar with Florida's worker's compensation system. And I am very sorry I did not get back to you before your mediation. All I can do now is ask how it went.

Against my attorneys...I didn't settle. I feel thata my attorneys will drop me next week, then I don't have a clue what to do next?