Workman's Compensation Questions?

by admin on July 18, 2010

This is really directed towards the last person who answered my other WC question. I wish you had your email enabled. 🙁

To clarify any confusion. I have two claims. A back injury from 2006 and a shoulder injury from 2008.

I had my second mediation today. They denied my settlement offer for my back claim, but accepted my settlement offer for the shoulder claim. They said I was asking too much for my back, even though it’s just what medical costs the doctor recommended and PPT. It’s really strange, they initally accepted my back claim but when I wanted further treatment, they denied it, but offered to settle. They are saying I am not eligible for PPT because I did not go to my last doctor’s visit in late 2006/early 2007 and did not follow up with them until a year later (late 2007/early 2008). I have medical notes from 2007 that document the back pain, I was just naïve and thought workman’s comp was over. My adjuster never followed up with me so I thought that was it, even though I was in pain again 3 months after my last WC doctor visit.

They also said I am not eligible for PPT because I am working now. I’m confused on this because I though that only made me not eligible for receiving wage loss benefits, I thought I was eligible for PPT. Any thoughts?

On a side note, my shoulder was okay for 5 months after physical therapy and then got worse so I went back to physical therapy (that was perfectly fine with WC and I’m eligible for PPT even thought I’m working). Is that okay only because I went back to a WC doctor? So me misunderstanding the system and seeking my own doctor for my back in 2007 was wrong? I’m confused.
I added up what the spine specialist recommended for treatment (two surgeries, steroid shots, physical therapy, etc) and included PPD (30k) into that for a total of 130k. I got the cost of everything from the doctor’s office. I negotiated during mediation down to 100k, but my adjuster got cut off so she couldn’t counter an offer and we are supposed to continue negotiations during emails, but no one responded to my emails. My bottom line is 70k, I don’t think I can get decent treatment below that. That cuts out PPD completely and one recommended surgery. I think I’m being reasonable. Can you email me?

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{ 1 comment }

A decent answer July 18, 2010 at 7:01 pm

Typically you want to go back to your WC doctor. In most states they have laws that you can’t just up and leave to see another doctor w/o any notifications from you to the insurance company and w/o approval.

Assuming PPT meaning training like vocational rehab, if you returned to work and your company provided you a job with regards to your restrictions you won’t qualify because you have work. If memory serves me right you are also in college, thus you will be getting a degree that can help you find a job thus you technically could be over qualified for the job. Also how much you earn…if you are a minimum wage earner you wouldn’t qualify at all because you can just go apply at a fast food joint and get a job.

They have every right to deny you medical benefits due to you not showing up to the doctors appointments. Many states are strict regarding this because it’s your treatment, if you don’t treat and don’t respond to any inquires or notify them of your status they have every right to deny benefits because they assume that you are now done treating. In this case you where not done treating.

How much where you asking for your back? If you said $500,000 due to pain and suffering I won’t blame their legal department refusing this. This would be an offer that won’t get much of a response because first of all pain and suffering has no price. Reason being I don’t know how much your pain is worth, you say $10,000 I say $0. So you and your attorney (if you have one) should come up with another offer, try $80,000. They’ll come back with a counter offer. If I understand this than this would be settlement of the entire back claim and would completely close it for good correct?

If your willing to do this and pay for your own medical treatment than go settle the back. However if you believe this is something you want to keep open for the life of the claim (Palliative care) than your best not to settle and keep medical open.

It also looks like mediation fell through for the back, which means that there will be a trial regarding ongoing medical benefits and what you’ll be asking (PPD). If you don’t have an attorney than you might want to consider one since most attorney are only paid with what they win.

Good luck, hope this helps.

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