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My Insurance vs Workmans Comp ???'s

AnonymousUserAAnonymousUser Posts: 49,671
edited 06/11/2012 - 8:41 AM in Health Insurance Issues
My first post here and could use some help. I'm 44 yrs old and work for a small commercial landscape company and during the late spring,early summer my lower back started really bothering me. By Oct 2009 I was saying I really I have to see a Dr. when mid Nov came it was so bad I couldn't get my socks or shoes on and one morning told my boss my Dr would see me. My Dr. gave me a dose pack prescription and sent me for an x-ray. I got some quick pain relief with the medicine and a few days later they said no disc problems just arthritis and DDD. They also approved me for an orthopedic Dr. but I didn't follow up right away because I was feeling better. Then I had another big flare up just before xmas. Because Dr.was on vacation I had to go to the emergency room. They prescribed more steroids,flexeril,and tramadol. Finally get an appt. with orhto get an MRI mid Jan 2010 find out I have 2 herniated discs. Now I'm on my way for a ESI end on Jan 2010. It works semi good after five days I can do PT. I going for one more injection this week I never thought it would take all this but I never new what I had until Jan 2010. I really feel I made a mistake not going on my employers WC the first day I went to the Dr. My boss did know my back was killing me I complained constantly every morning and walked with a limp. This type of work you try and complete the season. Is there any way WC could take over medical bills I have a lot of co pays and might be heading for surgery in the future. Any help appreciated thanks.


  • You need to get the form for WC filled out by your Doctor. Your Supervisor should have told you to do this. I took my own STD and now on LTD and told if I would've filled out WC weeks later I would have to pay back everything to the Insurance. If you're in a Union talk to them. I'm not sure if this other site may help. http://www.disabilityinsuranceforums.com/
    Take care. Charry
    DDD of lumbar spine with sciatica to left hip,leg and foot. L4-L5 posterior disc bulge with prominent facets, L5-S1 prominent facets with a posterior osteocartilaginous bar. Mild bilateral foraminal narrowing c-spine c4-c7 RN
  • I think what you going to have to establish is wether your employment caused your condition or not. While I understand the job is very physically demanding and that certainly could have caused your injury it will be up to the courts to decide that. When you originally went to the doctor how did you tell them the pain started or what did it? That maybe what decides it. If you said you just woke up one day and were in pain you may have issues putting a claim through work comp. If you said at that point and time you injured your back while working then you could be in a different situation. Typically the wording in the work comp laws is the prevailing factor of the injury. What i would do is read up on the laws in your state regarding work comp. Keep in mind if you enter the work comp system you enter a whole different game. In some states they pick the doctors say what treatment you can and can't have. So you may want to check your laws and what is reasonable notice of injury for a work related incident or injury.
  • SpineAZSpineAZ WiscPosts: 1,084
    There are advantages to using your own health insurance (if it's good insurance) as you'll l get better care more efficiently and with less of a fight often when you use your own insurance. You often get to choose your doctors (or at least choose from a list) and can schedule things like MRI or injections with insurance approval.

    Under WC, the WC carrier chooses what physicians you see, what tests you can have, etc.

    With WC the WC carrier will first have to establish if there is a certainty in the compensability of the illness/injury (proving the cause is work related). Any delay in filing will lead them to wonder why you didn't file earlier and thus likely trigger an in depth review.

    However, WC can be good in that it can provide payment for lost wages if you are unable to work. If your employer offers STD/LTD there may be funds under these benefits available for you if you become unable to work. Though the size and type of employer you denote would lead me to believe STD/LTD would not be offered.

    The biggest key as Tamtam said is you must be able to prove that your condition is directly and solely related to your employment. For example, if you saw a doctor in 2005 for back pain and was treated with mediations, x-ray, etc - and then got better. Then you take your job in 2007 and claim WC for back pain. Then the WC company would be looking to see what changed that makes the problem/diagnosis now WC and not related to your prior back issues.

    Now,that doesn't mean WC won't accept the claim, but it can be harder to get that way. I've had 3 lumbar surgeries. If I were to go back to work in July of 2010 and a filing cabinet fell on me and caused the hardware in my back to break that is work relate3d and WC would likely accept liability. But they'd be very vigilant in what they'd agree to pay for, care they'd agree to fund, etc. They'd scrutinize everything.
    2 ACDFs, 2 PCDF, 3 LIFs; Rt TKR; Rt thumb fusion ; Lt thumb arthroplasty; Ehlers Danlos 
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