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My little shop of Horrors!!! It never stops..

 
 
fetdav
 
Reply Fri 29 Jul, 2005 06:10 am
In 1998 I went to the doctor for a simple case of carpal tunnel and tennis elbow. I had cortisone shots, physical therapy and surgery. No big deal. That's what you say.

The story gets real good.

This was a Workers' Compensation case because I was a Information Systems Manager for 17 years for the same company. So the doc says, turn it into Workers Comp and do what you have to do. I have the surgery and go through all the post op routine but my pain is now worse than before I had surgery. Uh oh somethings wrong here. So now my surgeon sends me to a pain specialist because he says I've developed something called RSD (never heard of it). Now my arm still hurts, my elbow still hurts and now I have excruciating burning and other various pains. And while I'm going through this whole mess, the Workers' Comp insurance company is saying, well, she's had her surgery and by our guidelines for the condition she came in for she should be all better, sends me to some quack that says i'm only partially disabled and they cut my payments from the wonderful $400.00 a week maximum to $132.00 a week.

In the meantime, I'm getting worse instead of better and I now have pain doctors concurring with my surgeon that I have this RSD and I need shots in my neck called Stellite Ganglion shots to relieve the pain that is now racking my shoulder all the way down my arm to my hand. The Workers' Comp. Insurance company sends me for another consult with their quack that says there is nothing wrong with me and instead of getting shots, I get cut completely off workers compensation as far as my weekly stipend goes. They are still paying for my regular medications and for my doctors visits, but they are refusing to pay for the the shots because their doctor doesn't agree that I have this condition that my doctors say I have.

After 2 years of fighting, the Workers' Compensation Board finally made the insurance company send me to a different doctor and that doctor concurred with my physicians and I finally started getting my shots. We are now like 3 years into my illness and I'm really suffering and still not getting paid by the way. My attorney at the time was doing absolutely nothing for my case as well. The initial attorney I hired left the firm to take a seat on the bench for family court and left me with one of his affilliates so I was kind of pushed to the side for a while if you know what I mean.

Finally in 2002 after harrassing the lawyer that took the case over it got back to court and the preciding judge made the ruling that I was to start getting my shots, I was to start getting paid $400.00 a week again and I was to get all the back money for all the years I hadn't been paid.

I got the shots but it was too late because now I'm totally disabled and I'm racked with cronic pain every day of my life. The 2002 decision appealed because the Insurance company found a period of time that I didn't go to the doctor for 50 days and they say you have to go to the doctors every 30 to 45 days in order to qualify for their benefits. The board of appeals recinded that decision but made the insurance company continue to pay me at the highest rate of $400.00 per week.

I've had another judge again award me the money for the years that I was not paid and tell them they have to pay me the maximum for the rest of my life which is $400.00 a week and again it has been appealed.

I'm riding a never ending roller coaster and the Insurance Company can do what ever they want with my life.
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squinney
 
  1  
Reply Fri 29 Jul, 2005 06:21 am
Dang, fedav! You've really been through the wringer.

I know it's hard to keep up the fight after so much time and hassle, but I hope you do. Another appeal... Well, there can only be so many appeals by the insurance company, and so far it appears they have failed to win any.

Fret and complain as much as you need to, but always keep your chin up!
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Debra Law
 
  1  
Reply Fri 29 Jul, 2005 06:53 pm
It's frustrating; but that's the point. For on-the-job occupational or traumatic injuries, your only (exclusive) remedy is worker's compensation.

And, of course, most worker's compenation insurance programs are designed to frustrate you and wear you down and to eventually weed you out of the program. One of these times, you will be so frustrated or worn out that you will fail to appeal. You'll give up fighting. Then they win. They stop paying. It works so often, why should the program change its ways? After all, you have no recourse but to jump through all the hoops or forfeit your exclusive remedy. Hoops, hoops, and more hoops are placed in your way until one day you don't have the energy to jump through them anymore.

It's not JUST your little shop of horrors. IT's every injured workers' worst nightmare. What can YOU do about it?
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Debra Law
 
  1  
Reply Sat 30 Jul, 2005 01:23 pm
"What can YOU do about it?"

This was not a rhetorical question--there probably is something you can do about this frustrating nightmare if you're willing to retain a top-notch "bad faith" insurance lawyer and fight the battle.

It's one of those "choose your battles wisely" scenarios. Perhaps, if you win the next appeal, the insurance company will be done with its attempts to frustrate your claim and wear you down . . . maybe not.

But, depending on the statutory and case law of the state (assuming this is a state workers comp claim and not a federal claim), if you retain a really smart lawyer who is an expert in bad faith claims, perhaps you can file an independent action against the insurance company for "bad faith" handling of your workers' compensation claim.

If you live in Texas, you should read this article:

SIGNIFICANT NEW BAD FAITH DECISION USES EXCLUSIVE REMEDY PROVISION TO LIMIT EXACERBATION INJURY CLAIMS

http://www.phillipsakers.com/LawReport.asp

This decision is a hurdle to bad faith claims in Texas, but not a complete barrier.

What state do you live in?
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Debra Law
 
  1  
Reply Sat 30 Jul, 2005 01:44 pm
If you live in KY--the KY Supreme Court has ruled that an injured worker may not sue the insurance company for bad faith. The only remedy that may be sought against an insurance company that engages in bad faith handling of workers comp claims are administrative fines.

The statutory language in the 1996 Kentucky law authorizes only administrative remedies, not a private cause of action for "bad faith" violations.

Of course, the insurance industry applauds the state court ruling. (WHY? Because governmental administrative oversight over wealthy insurance companies is about as effectual as the fox guarding the chicken coop.)

http://www.insurancejournal.com/news/southeast/2003/01/28/25697.htm
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