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work comp pay ending! Help

CMatthewCCMatthew Posts: 49
edited 06/11/2012 - 8:43 AM in Health Insurance Issues
I was told that my work comp weekly checks will be ending in 5 weeks. It has been almost 2 yrs since my injury and I was told by the WC agent there were 5 weeks left and she set up an appt. with a DR she found on the internet to have a 2nd look which is actually my 5th DR. I had an IME in August of '09 and was told he thought I should try to be weened down on meds and try to get back to work w/ a 24 lbs. weight restriction and I shouldn't bend or stoop and I should be able to either sit or stand every twenty minutes. He wanted me to return to my current treatment at the pain clinic and when they discharge me that I should be put at MMI and get a rating. Well my pain clinic DR doesn't see it that way and says nothing had been done prior to seeing him really I've been bounced around from one clinic to the next. My issue is that I had asked right after my IME if I could go get a 2nd opinion from a neurologist since I had only seen one and he wasn't good and I have a alot more nerve issues since I saw him a month after my accident in '08. She said no that she thinks I have seen enough DR's and I should just report back to my pain clinic and more than likely they will discharge me. Well it's been 8 mo's and still not released for work or discharged. I can barely walk or sleep or sit or get out of bed even yet. My issue is that now WC wants me to go elsewhere to get another opinion when she wouldn't let me do that, and on top of that the DR she wants me to see is a General Practitioner. So I'm going backwards, anyway that's a brief version of my story and does anyone know how or if there are ways to get extensions on payments without just giving up and saying screw treatment for myself and quit it all to go get a job to support my wife and two kids. It's been hard on my family thus far we have nothing and my kids are having trouble understanding, well they do I should say it's not easy and I used to pay for everything and my wife did daycare but it was just extra money, and with the economy that has even dwindled down to a few kids being that parents are getting laid off. Sorry about the rambling just looking for a way to keep the roof over our heads and food on the table without jeopardizing my recovery if that's what you call it when WC is involved.


  • SpineAZSpineAZ WiscPosts: 1,084
    Have you begun the process of applying for Social Security Disability? And will you receive any type of final settlement from WC that will accommodate your financial needs for personal needs and future medical needs?
    2 ACDFs, 2 PCDF, 3 LIFs; Rt TKR; Rt thumb fusion ; Lt thumb arthroplasty; Ehlers Danlos 
  • From what you say is wrong shouldn't you have had surgery? Something doesn't add up.

    As far as WC there is a process for appealing their decisions. Any chance you were in a union? They often will help. You need to get to a good neurologist and get some help. No reason to spend the rest of your life in pain.
  • What state are you in? Did they make you MMI and issue that rating that you spoke of?

    Workers compensation plays by its own rules, and if they want to get rid of you, they will unless you put up a fight. I am not an advocate of litigation, but unfortunately it sounds like you need to hire an attorney to ensure that your rights are met. Don't let them make you MMI if you are not at maximum medical improvement. It sounds like there are things still needing to be done for you. An attorney can set up another IMI for you, and/or get you switched to a competent doctor. Sending a spine patient to a general practitioner just doesn't sound right, in my opinion.

    Once they make you MMI, the weekly time loss benefits stop. It sounds like they want to stop them at the 2 year mark. I am wondering if that is routine, or if there is something you can do to keep the checks coming in. Either way, you need to get to a doctor who will treat you and get you better. I would suggest you find a good spine specialist and send a written request to WC for authorization to see him. I can't hurt to try.

    I wish you the best. Sorry for the added stress of dealing with workers compensation.
    Surviving chronic pain one day at a time, praying for a reprieve because living another 40 years like this doesn't sound too fun!
  • Kris-NY: I'm not a candidate for surgery I wore a brace for my fractures for 9 months and after that my bulges were off the sciatic nerve enough to not want to shave my discs. They talk about fusions and a Spinal Cord Stimulator but, they keep putting me from one place to the next it's like a hurry up and wait routine constantly. Since I have posted last I have come to find out that even if I could get released for just sitting at home and answering phones and I get a part time job doing something within my restrictions it will start me on another 2 year deal and they would have to make up the difference on my checks. Good news for my family and I don't have to jeopardize my treatment or lack there of by saying that I'm doing better than i actually am just to keep the roof over our heads. Even though my Doctor knows better and wouldn't buy it but at the same time what other choice would I have had. I just hope my Doctor sees it the same way I do. I will see next week. This takes place in Minnesota by the way and WC is only required to pay 104 weeks of pay.

    Spine AZ yes I have started the paperwork but a year later than my lawyer wanted me to. I guess I thought I would be a lot further then I am with the whole injury. And I'm sure I will see some sort of compensation, I had done concrete construction for 15 years and I am 33 years old with a lot of years of work ahead but, unfortunately it will more than likely be behind a desk. My IME stated that he thinks i should be at 20 lbs permanent for lifting and every other DR said that would be max, and I now walk with a cane so I would think compensation is in order.

    Neck of Steel: No I have not been placed at MMI nor have I been rated yet. I have a lawyer but he has not written a letter of intent to have me as a client. He is a friend of my fathers and helps me for free (so far) but i will eventually have claims against the insurance company which then i will need him to represent me.
  • I'm afraid I can't offer any advice as I live in Ireland & don't have the first idea of how this works in the US.
    I just wanted to wish you (& your family) well, it must be very frustrating having to deal with all of that while trying to recover.
    Best of luck
  • Have you applied for state disability? After I was MMI I applied for SDI. I'm not sure how it works in your state but in CA, when you first apply they use that date to determine your benefits. They go back a year from date and look at your income. I told sdi that I was on WC and they let me use my date of injury instead of date applied. If they had use the date applied I would not have a income because I was on WC.
  • SpineAZSpineAZ WiscPosts: 1,084
    There are only a few states that offer State Disability:

    New Jersey
    New York
    Rhode Island
    Puerto Rico

    Of those, all offer 26 weeks of STD which mostly run concurrently with WC (they will deduct from STD whatever is received from WC).

    CA is very different in that if offers 52 weeks of CASDI (State Disability). They also have very different rules for WC and STD running concurrently, etc.
    2 ACDFs, 2 PCDF, 3 LIFs; Rt TKR; Rt thumb fusion ; Lt thumb arthroplasty; Ehlers Danlos 
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