Settlement

[Mike46]

I have had 3 different work comp. cases all involving hernias, 3 different sugery's, The first one I had the services of a Lawyer to get a final settlement to close the case, after having a FCE done and getting a rating of 9% whole body we finally settled out of court with the company I work for. Now I have had an addition 2 hernia's since then that are work related and the company has paid all the bills but they do not want to settle or have not offered to settle. I told them that since the hernia's simailar that I would be willing to use the previous rating of 9% and not add any addition FCE testing and doctor bills that they would be liable to pay. They rejected my offer and said they don't have any rating to go by so they can't settle the case. They contacted my surgeon and he does not give out ratings so now I am wondering how to proceed. There is always the risk that if you have an FCE that information from it can be used against you to try and get you removed from your job, even though I am still working full time. I am not asking for $$$$ mega bucks I just want to close the cases and receive a fair settlement for my disablity and future lost of earnings if I was to loose my job. They put the ball back in my court so I don't know where to go from here.

 

[Beth3]

If the hernias have been repaired, what permanent disability are you left with? You may not be entitled to a settlement at all.

Since your surgeon doesn't provide impairment ratings (which I find most pecular; sounds more like he won't provide an impairment rating in your case) and assuming your medical reports indicate you have no residual permanent disability, then the WC carrier has no reason to send you for an IME.

 

[Mike46]

If the hernias have been repaired, what permanent disability are you left with? You may not be entitled to a settlement at all.

Since your surgeon doesn't provide impairment ratings (which I find most pecular; sounds more like he won't provide an impairment rating in your case) and assuming your medical reports indicate you have no residual permanent disability, then the WC carrier has no reason to send you for an IME.

Even though the hernias have been repaired, like the first one I had after taking an FCE and finding out that even though repaired you still can have problems with certain positions I may use like squating or climbing ladders just to name a couple. This eliminates me from certain aspect's of the job market should I have to seek employment in the future this is where the 9% came from on the first one. As far as my doctor not providing me with an impairment rating that's not what he does, he is a surgeon and does not get involved in ratings and ratings are done durring an FCE. I would think that the WC carrier would want to close the 2 remaining cases rather than have me keep them open by seeking medical reviews before my 2 years is up and start them on another 2 years. The WC carrier is already liable for any past, present or future bills so if I want to go for a FCE and have them pay for it then that is my choice. Its to bad that it always comes to involving an Attorney to get things moving.

 

[Beth3]

As far as my doctor not providing me with an impairment rating that's not what he does, he is a surgeon and does not get involved in ratings and ratings are done durring an FCE. I still think that is bizarre. I've never seen a WC claim where there was any permanency where the employee's own physician didn't make a suggested impairment rating to the WC carrier. The WC carrier then has the option of obtaining an IME if the employee's doctor's PPD rating appears to be too high (as they inevitably are.)

Even though the hernias have been repaired, like the first one I had after taking an FCE and finding out that even though repaired you still can have problems with certain positions I may use like squating or climbing ladders just to name a couple. This eliminates me from certain aspect's of the job market should I have to seek employment in the future Future loss of earning capacity and being compensated for a permanent partial disability are two different matters.

You're going to have to consult with a WC attorney. Your situation is just to complex to handle in a Q&A bulletin board format and there are far too many unknowns to even guess at an answer.

 

[Mike46]

The WC carrier then has the option of obtaining an IME if the employee's doctor's PPD rating appears to be too high (as they inevitably are.)

You are right the WC carrier is always going to dispute the PPD from a doctor, why would a WC carrier want to listen to a Doctor.
Some what like your statement ( as they inevitably are. ) Seems to me you already have your mind made up about a doctors PPD Without knowing any of the facts, sound like a standard statement that would come from a company representative.

 

[Beth3]

Seems to me you already have your mind made up about a doctors PPD Without knowing any of the facts Seems to me YOU'RE the one with his mind made up. I have seen many, many PPD recommendations from employees' physicians. Some of them are fair and accurate; many of them are absurdly high and unsupported by the medical findings - in which case it's appropriate for the WC carrier to obtain an independent medical opinion.

 

[Mike46]

Seems to me YOU'RE the one with his mind made up. I have seen many, many PPD recommendations from employees' physicians. Some of them are fair and accurate; many of them are absurdly high and unsupported by the medical findings - in which case it's appropriate for the WC carrier to obtain an independent medical opinion.

Like I said before it is amazing how many company representatives will play doctor along with the insurance company and WC carrier. That independent medical opinion is usually done by a company doctor, who never seems to aggree with the employee's physician.
One would think that the employee's physician knows the personally history of there patient better than another doctor who is hand picked by the WC carrier. But your right it is appropriate for the WC carrier to tie up the case and drag it out as long as possible that is what they get paid for.

 

[Mike46]

Please Read My Other Post ( Working Man's Advice)

If you would like to read my other post ( Working Man's Advice ) Maybe you will understand how I feel. I have worked hard all my life and been injured on the job and have seen the way injured people get treated, just like some of the other post I have read on this site. You on the other hand seem to me to be pro company or maybe you are involved as a WC carrier or in the insurance field. Have you personally ever had to deal with being injured on the job?

 

[RAnn]

It is definately the WC insurance company's employee's job to make your life miserable. DH got injured Feb 21 2002. We were "lucky" that it was settled Sept 04 - and that was because SS claimed him 100% a year ago (after 1st try). With their report it was hard for the WC to try to rebut it.
But - with the settlement the court told the ins co that his pain doctor will dictate any treatments needed. (He has multiple disc injuries and is on Fentanyl patch along with dilaudid, & Celebrex to get through the day). Prior to settlement the pain doc wanted to do the intrathecal pump - refused by WC. DH really would like to get off drugs so pain doc says to try electric stimulator. Doc sent a letter to WC stating he was going to do stimulator. WC said DH had to go to THEIR doctor for an exam before they would approve and of course he says he doesn't need it. - What happened to the court saying the pain doc could do it? (Their guy doesn't even DO pain relief stuff let alone an electric stimulator). His report was laughable - he still thinks DH can go back to work light duty and is faking his pain. (Yeah right - how do you manage a farm/tractor work light duty?).
Back to the atty and see what he can do. We suggested that WC send DH to a doc that at least does the electric stimulator to get an actual report and go from there. We'll see - prob have to go to court again.
Also - they are supposed to pay for all meds relating to this. Up until Dec 04 we'd get them on my perscription card and then get reimbursed for the pmts. (No way could we afford to front the $$ each month). Now it's set up with Walmart pharmacy that they bill WC directly. But - ea month when he takes his scripts in there is a problem with WC approving the meds - it's been the same stuff for 3 years.
I keep telling DH - this is the rest of your life pal.
So you're not alone - I can feel for you.
RA
BTW - no union