Anyone know anything about Workers Comp?

My fiance has injured his lower back. He's a licensed heating/AC and appliance tech and has done something to his sciatic area.

Tuesday he went to the local chiropractor after one of his customers talked about how helpful his chiropractor had been. The chiropractor did 2 x-rays and lots of manipulation. He also wanted to set him up to come in every day this week and then 3 times a week for the next 6 weeks.

Wednesday my fiance was hurting so badly he could barely walk. He went in to work anyway that morning and the boss said they were going to file under Workman's Comp. Fiance came home and there were numerous phone calls back and forth about details. I also called and managed to get him in to our PCP yesterday afternoon for pain meds, anti-inflammatory and a steroid burst pak. I suggested fiance also go see my pain specialist in case the meds he's on don't take care of the pain.

Our PCP doesn't handle workman's comp claims so we're out the money on that visit as well as out the money on the chiropractor visit or at least I think we are.

After all the phone calls we have a case number and an appointment with my pain specialist on Monday.

I've never dealt with a workman's comp claim so I'm wanting to know if there's anything I should beware of.

Fiance's employer is the one who suggested filing this under Workman's comp so no attorney are involved and that seems to be confusing the different Doctor's offices.

What should I look out for?

different set of rules and procedures for Workers Comp claims. You might need an attorney to help you through the filing process. It may not help that the employer suggested a claim since it's usually the insurance company that will contest it.

and a case manager from the insurance company? Do you think we still need to contact an attorney?

and most wc attorneys won't charge for a consultation. Just don't go to some guy that has ads on tv :-)

It might be good to get a consultation. Then, if problems do arise, you have an attorney you can always go to.

he will probably get his care faster without an attorney involved...I have to leave to go teach a class.but it sounds as though they are admitting injury if that is the case..he should go treat and if he doesn't get better in the next few weeks..post again and I will follow up..right now just get him his medical care and see if he recovers. Sciatic pain can be simply due to irritation if the sciatic nerve...it isn't always a surgical event.

I will say this..most states have very strict rules that you MUST inform the employer of an injury in order to receive care..delaying reporting could harm his case.

The employer is then obligated to send him to a doctor unless the carrier decides the circumstances are suspicious in which case they can delay. It is important that he be specific as to how he was injured ...if he has EVER had back pain before, it is important that he express that he made a full ancd complete recovery with NO limitation of activities if that is so as well.

delivery/installation caused the injury. His employer also has officially sent him to my pain doc and has supplied all the information the doctor's office required from them. I'm having my Doctor fax me forms we need to fill out in advance.

He's worked for the company for 3+ years and his boss values him even if the boss is a republican. Fiance is one of 2 techs and is the only one who's licensed to do A/C work. If there are any roadblocks it isn't going to be his employer but will be ignorance on the part of his employer or us in how Workers Comp works.

. . . is covered under Workers' Comp. So, if your fiance misses work to attend treatement from THOSE docs, he still gets paid and no sick leave is taken. It's pretty rare that they'll let you see your own doctors for a WC claim, but it can happen.

The firm's WC docs will set up a treatment program with a schedule and an analysis of the severity of the injury. He'll be re-evaluated regularly to determine the status of his condition (cannot work, can work with restrictions, can work with no restrictions, etc.). The thing to be careful of is when the WC physicians say he's ok to work without restrictions, but he still hurts badly enough to not be able to work. That's when you really need an attorney.

Conversely, if he sees his OWN doctor without prior approval from the firm, there's no coverage from the firm, and he would be docked sick leave for each appt.

An attorney can help to ensure that he receives the appropriate care. If he isn't getting it, it may be the only recourse. If he's ok with the treatment, then getting an attorney will only be an additional cost to you.

my pain specialist from the insurance company.

His employer is co-operating fully because everyone bottom line wants to see fiance back at work and healthy. It's a small town shop and health insurance coverage isn't offered so that's why I think the employer was so willing to go Workers Comp.

he should just be very faithful to see the doctor whenever he's scheduled and do the exercises - etc. Sounds like you have an ideal situation! Hope he gets better soon. As someone who has struggled with back pain, I know it can be pretty awful.

Go see an orthopedist. Getting a manipulation on a recent injury can be really dangerous, especially if there is a herniation or worse.

My ex-brother-in-law was a chiropractor and while I love him, I don't believe in chiropractors. That's why I suggested my pain Doctor instead and the insurance company gave the go-ahead to go see him.

as soon as possible! find one that spec. in workmans comp. in your area. it`s alot easier to find out what to do and who will pay,etc. believe me i`ve been thru work-comp and it`s easier. they work on contigency so you shouldn`t have to pay anything-if there is to be a settlement with the insurance company. at least your husbands employer seems cool about the whole thing-but those insurance companies aren`t...good luck ,hope his back gets better soon...oh yes i`ll second the no chrio!!

All we're wanting to do is to have workers comp pay for the doctor bills where fiance can get back on his feet and get back to work.

What kind of settlement are you referring to? (See....I said I didn't know what I was doing! :) )

- Every time I saw a doctor I was required to then see an insurance company doctor so they could "verify" my doctor's reports. Insurance company doctors wrote reports before they examined me saying that I was not injured. My attorney said they get bonuses for those reports.

- The exams I actually received from their doctors were usually 30 second visual exams with no tests no no physical exam and basically no substance. Yet their reports always read as if they had spent hours poking, prodding and running every conceivable test.

- They had a Private Investigator follow me for 6 months with a video camera to try to prove I wasn't hurt. When the video showed that I really was hurt they refused to provide the video.

- The insurance company constantly lost paperwork to delay proceedings. Keep copies of everything and plan to submit everything 3 or 4 times.

- In doctor's appointments and interviews they questioned me repeatedly about everything I couldn't do, and if I said I was capable of doing anything they exagerated this in their report into a supposed admission that I wasn't hurt. The admission that I could make lunch for myself resulted in the conclusion that I would work full shifts doing physical work without any limitations. (Making a sandwich had nothing to do with the warehouse job I was working.)

- Get a loud, mean and stubborn attorney.

I found it online. It appears that in Oklahoma if you report an injury you CAN see a doctor of your choice so long as you report it. I understand you sent your husband? to your pain doctor. He is only entitled to temporary disability benefits after he has been off of work for 3 days.

Most states have specific reporting requirements for doctors treating a work injury..so it is important that you make sure your doctor understands the reporting requirements according to the accompanying regulations guided by code sec 85.

I understand people in the thread told you to get a lawyer. I disagree in the early stages of the injury when what you really want is medical treatment. I would wait 30 days to get a lawyer as if one gets a lawyer prematurely, it often makes the compensation carrier more combative and less accomodating. Most adjusters in the EARLY course of an injury WANT to assist you. Let them. If he isn't better in a couple to a few weeks..THEN go get a lawyer as more likely than not, his injuries are going to result in some form of permanent disability.

I have been involved in work comp in my state for 22 years and this is my recommendation as a LAY person..to get what you need.

The few weeks lapse in time will allow you to get some references for a competent lawyer in the field should you need one...rather than running to the first person who may not be a very good lawyer.

Most state bars have some form of certified specialists in various areas of law. YOu can check with the OK state bar to see if such a specialty exists.

Hope this helps.

Thank you for taking the time to look the information up and to help me watch out for any landmines.

What kind of temporary disability benefits would he be entitled to? His employer isn't docking him for lost time so he'll have salary continuation (He is salaried since his employer refuses to pay overtime!)

Since none of us had ever worked with Workers Comp before I had called my pain doctor to see if they handled WC claims. I'll go in on Monday armed with the necessity of our doctor needing to understand code section 85.

The injury occurred last Saturday and he worked Monday and Tuesday after it happened. We were treating it at home with Motrin and heat packs but the pain got progressively worse. He left work early on Tuesday to go to the chiropractor after being told by a customer that chiropractors had cured their pain. That was the first time he'd ever been to a chiropractor and more than likely will be the last time as he wasn't impressed.

What made me think of my pain doctor is periodically I receive injections in the joints of my shoulder and in between the vertebra in my neck to relieve the pain I have. I decided my doctor might determine those types of injections might help fiance if the doctor thought they would help. All of us are hoping for a speedy resolution to this!

I did spend enough years as an insurance underwriter to have some vague understanding of this.

What NSMA is saying is spot on. Right now, treatment is essential. Not only does he want to get better, but he doesn't want to make the injury worse with chiropractors and home treatments, which could screw him in other ways down the road. Best that nothing look like it could be his fault-- it may or may not make a difference, but why take the chance.

It appears that your state is like mine, and you can choose your own doctor and the comp underwriter has to pay the bills. So far, they are working with you, which is a good thing. It rarely pays to piss off insurance companies when they're not screwing you outright. It could get sticky when future treatments and diagnoses come up and the company disputes some of the findings. That's when he probably needs legal advice. He may also want legal advice if there is someone to sue over the injuries or if there looks to be a permanent disability. Plenty of time to worry about that, though. Your state may have time limits on when to file a claim, so don't waste too much time.

Don't sign anything that looks like a release of liability or closing the comp claim without getting good advice somewhere.

What kind of temporary disability benefits would he be entitled to? His employer isn't docking him for lost time so he'll have salary continuation (He is salaried since his employer refuses to pay overtime!)

Usually temporary disability pays a percentage of one's salary while they are unable to work (usually in the 60% range unless they are a police officer or firefighter..the intent being to get the injured person back to work as soon as possible)
His boss is covering his salary now but might not in the future if he is disabled long term.
Look into any disability coverage you may have on private insurance policies and credit cards now, in the event that you end up having to survive on less for a while.

Since none of us had ever worked with Workers Comp before I had called my pain doctor to see if they handled WC claims. I'll go in on Monday armed with the necessity of our doctor needing to understand code section 85.

Call the insurance adjuster and they can fax the reporting requirements to your doc...frankly if he is having sciatic pain, I would recommend a Board Certified Orthopedist. No offense but pain specialists tend to rely on opoid medication too much and it can be addicting.

The injury occurred last Saturday and he worked Monday and Tuesday after it happened. We were treating it at home with Motrin and heat packs but the pain got progressively worse. He left work early on Tuesday to go to the chiropractor after being told by a customer that chiropractors had cured their pain. That was the first time he'd ever been to a chiropractor and more than likely will be the last time as he wasn't impressed.
Chiropractors can be effective in helping sprains and soft tissue muscle spasm, but if there is leg pain then I would recommend against it having had a huge herniated disc and back surgery myself.


What made me think of my pain doctor is periodically I receive injections in the joints of my shoulder and in between the vertebra in my neck to relieve the pain I have. I decided my doctor might determine those types of injections might help fiance if the doctor thought they would help. All of us are hoping for a speedy resolution to this!

A good window of time to see if conservative care will help is 4-6 weeks. If he has leg pain beyond that, he should get a CT scan or MRI..injections..especially cortisone or epidurals are only temporary and not really good for the back as they tend to mask pain making patients injure themselves worse. Also steroids cause scar tissue between the muscle fibers...they are OK for joint pain if one wishes to avoid surgery but are only temporary measures for the spine.

Physical therapy combined with a MCKenzie strengthening program is the best route to treat the pain provided he does not have a surgical lesion..again..it's best to wait a few weeks before obtaining an MRI as some sciatic pain can be cause by muscle spasm...unless it persists or travels to the ankle or toes and believe me if it does...he will know.

I didn't say DON'T get a lawyer..I simply said wait about a month...and in the meantime make sure you research the one you get...as in most states, Workers Compensation is your exclusive remedy to an injury (meaning you cannot sue outside the work comp system in most instances)> Therefore, an attorney botching up your case can hurt you in the future should his injury be serious.

Ideally, you WANT to have an attorney at least 4 - 8 weeks prior to the doctor releasing him from his care so that if the doctor UNDERSTATES his injury, the attorney can challenge the doctor's report (via cross examination or with a report the attorney procures)

Hope this helps.

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have email from me now.

Hopefully soon. That's strange.

Hopefully it won't be regarded as spam!

I use hotmail as my email address because when I was working I was transferred so often it became too much of a hassle to continually notify friends/family of a new email address. Since hotmail was web based I stuck with it as my permanent email address.

Maybe you can send me a private message here on DU?

Private Message.

You've got mail.

I need your help now!

Thanks

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