QuestionDiane,
I went to my own MD. The worker's comp lady at my place of employment didn't seem all that concerned about it. I know where I worked before, it was a big deal. When I would go to the MD, I would tell them that it was worker's comp. and they'd ask me who to bill to. I had to call the lady at work and get the name and address of the 3rd party administrator and give to the MD's myself. At one appt., the ladies in the MD office called the WC people who asked to speak with me. They did not have me in their system and weren't aware of my injury. This was about 3 weeks after my injury which was on 12-13. The lady at work had not even reported me!!! I am very worried as I am not getting any benefits. The lady at WC wanted ALL my medical records, not just records related to the hernia. I guess they're going to try to find it a pre-existing condition, which they will not. But anyway, I am very upset with my employer for not getting the ball rolling. I basically had to report myself, get them all the details, round up my medical records,etc. My surgeon wanted to go ahead with the repair. He said we'd work out the insurance, that if I ultimately got declined on WC, my insurance would kick in. I feel like I'm in a real rut here. I am worried about my job, as I've only been there since Oct. and I'm still in my probation period. I am not a problem employee. I've been a nurse almost 14 years and this is my first claim, other than being exposed to TB or something like that. I just feel like no one has gone to bat for me, and I'm kind of doing it alone. Any suggestions?
Thanks so much!
Jolynn
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The text above is a follow-up to ...
-----Question-----
Hi Diane,
I'll try to make this brief as possible. I had gastric bypass in May 2006 and have lost 110 lbs. I was a nurse in an administrative position and after losing the weight, wanted to get back to "real" nursing. I took a job in a local hospital and was doing great until one day I strained my gut when a patient layed down on an exam table just as I had it unlatched and was lifting the head of the table up. I felt an immediate burning pain that lasted several hours. I thought I'd just pulled a muscle, but the next morning when assisting with a transfer, I felt the same pain again. I realized I'd really hurt myself and filled out an incident report - within 24 hours.
I subsequently had surgery, last Tues. the 9th and the surgeon told me that I had the "swiss cheese" effect, I had the one obvious hernia and several smaller ones. He repaired them all with one large piece of mesh - 20 cm.
I asked an MD on this site about what causes the "swiss Cheese" effect. He stated most likely very poor physical condition, but also stated with such a large piece of mesh, risk of recurrance was near zero. I am hopeful as I'm working on my physical condition and with low risk of recurrance I plan on returning to work soon. In the meantime, worker's comp has never approved this. I am worried as I will be off another 4 weeks with no income. Here are my questions:
*Even though I felt the obvious pain at a specific time in the workplace, do you think this will be an approved work injury since it was probably due to "poor physical condition?"
*Since it wasn't one hernia, but several, will they say it is "preexisting?"
*I'm just wanting your gut feeling on this Diane, what are my chances?"
Thanks so much for your time,
Jolynn
-----Answer-----
Dear Jolyn,
This is a rough call. It depends on how the treating physician dictates his report. Did you go to a doctor appointed by WC?
In most WC cases, a WC claims adjuster determines whether the case is compensable under worker's comp. The case then get referred to a case manager who obtains approvals for procedures and treatments from the adjuster on an ongoing basis.
You stated this has never been approved by WC. Did they make a determination? Under WC you are paid 66 2/3 % of your pay.
This is very debatable since you never had any problems with a hernia before. You said you reported it but have you followed up with it? Usually your health insurance company with ask if this might be covered under any other insurance or whether it was a worker's comp injury. This is called subrogation.
Ask your treating physician how he advised the injury occurred. That will give you a better idea as to whether comp will cover.
Let me know.
Diane
AnswerYour employer is obligated to report this to their WC carrier. That is why you were not in the system. Discuss this with your supervisor or manager.
They need to get this called in for review and make a determination. Your insurance company (health insurance carrier) usually would want informatoin if this claim is covered by WC
If you do not get anywhere with you manager or supervisor, contact your HR department.
