Injury denial due to employer mishandling claim...

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Injury denial due to employer mishandling claim...

Postby backlash » March 7th, 2007, 9:39 pm

I was injured over a 2 day period. When I filed the claim after the second injury, I was given the wrong paperwork to file. It turned out to be an accident form for customers who are injured on the company's property. When I was confused by some of the questions on the form, management told me to "just leave those parts blank". I didn't want to do that, so I wrote down all I could to describe what had happened both days. The management sat around in the office, ignored my questions, and pretended not to hear me when I needed their help. Instead, they laughed and engaged in loud conversation with each other. I was told I could go ahead and go back to work if I wanted to complete my shift. None of them showed any concern for what had happened to me, nor did they care to transport me to a hospital; there were 3 managers on duty at the time. I had to arrange my own ride. I then waited to see that the claim would be faxed to the insurer, but the management refused to do so in my presence. I was shooed away to leave the office, but not before noticing that there was a change made to the time I had written on the claim, not made by me. The employer's insurer sent 1 801 form and 2 separate claim notices(1 had the wrong date for one of the injuries. I contacted the insurer and was told to write in the correction on the 801 form, even though it was 2 separate injuries, then have the manager sign it. So I did. Then I sent a copy to the insurer, along with a letter detailing both injuries and the correct dates.
The first doctor who saw me recommended me to an occupational therapy clinic. I went through 2 doctors, both of which treated me poorly and ignored the complete range of injury to my back. The first one yelled at me until I cried. She only focused on my neck and wouldn't acknowledge my other injuries. After begging and pleading for her to attend to those areas(cervical, thoracic, and lumbar), she ordered a cervical MRI. I made a complaint and was scheduled for a second opinion. That doctor also ignored the extent of my back injuries, focusing only on the cervical and thoracic areas. He tried to talk me out of the cervical MRI and arrange for x-rays only. After I got upset about him neglecting my lower spine, he finally told me that he would order the MRI on my lumbar, to add to the previous cervical MRI order. As it turned out, the order was for the thoracic area, not lumbar. He had told me to let him know if I were to change my mind about wanting the MRIs and to just have the x-rays done. I went for both.
This doctor told me the results were "perfectly normal". He immediately ordered physical therapy and I was soon released back to work. The Ombudsman told me I could see a former doctor and that Worker's Compensation would have to pay for it. When I went to see him, he didn't want to get involved, saying "It's too late in the game". The claim was closed with a diagnosis of 'cervical and thoracic strain' only.
Another employee was given my job and the manager put me into another position where I had to lift heavy objects on a regular basis. I told my boss I couldn't do that job. He quietly filled other positions I was qualified for. My co-workers were also told not to help me when I needed it; they did anyway and asked me not to tell anyone. There were also other employees who were either persuaded or too intimidated to file an injury claim. Management refused to lay me off, so I was forced to quit.
I ended up in the E.R. of a different hospital due to inflammation and the 'electrical shocks' I continued to feel in my limbs. There I was again told "Everything's perfectly normal". I chose to see the nurse practitioner who was compassionate about my situation. She ordered the lumbar MRI. As it turned out, the MRIs indicated I have cervical and thoracic disc bulging, a tear in a lumbar disc with scar tissue forming, and mild canal stenosis possibly relating to the lower back injury. She requested an evaluation by a specific physiatrist she recommended, and told me to make a follow-up appointment with another doctor for the MRI results. That follow-up appointment consisted of the doctor completely ignoring my MRI and ordering more physical therapy(which later resulted in re-injury). The next time I saw the doctor, I called her on her refusal to look at my MRI and tell me the results. But, because this time I brought a witness, she then acted like she was concerned, and attended to me in limitation. She gave me an exercise to do at home. The physiatry request was in limbo for several weeks. After several calls, I was told I should have already received a call to tell me that it had been denied; I hadn't.
I obtained a lawyer who filed a request for reconsideration. It suprised me that he did not reply to the request for an argument in my favor, nor did he return my calls. I sent in paperwork on my own behalf out of desperation. The request was denied. I contacted a local organization in an attempt to be re-trained for the workforce. They sent me to their own physiatrist who reported the extent of my injuries, and limitation in my abilities. Shortly thereafter, I received a small award from the insurer for Permanent-Partial Disability. Due to feeling hopeless and depressed, I missed the 60-day deadline to request a hearing for the reconsideration denial.
While I was still working, I had come in contact with an actual injury claim form, not the invalid form I was originally given to fill-out. I believe my employer did something to the paper I had initially written on regarding the injuries, resulting in my claim denial.
My question is: If this manager took it into his own hands to re-write my injury claim, is he legally responsible for the lack of appropriate treatment due to mishandling my injury claim? Would I have to file another claim of injury form?
By the way, the date of injury on the claim doesn't coincide with the injury that happened on such day; I have been treated for the injuries that happened the SECOND day I was injured!
Thanks for bearing with me.
backlash
 
Posts: 4
Joined: February 1st, 2007, 3:54 pm

Employer mishandling

Postby Webmaster » March 8th, 2007, 12:37 pm

We're not lawyers so we could be wrong on this.

You didn't mention getting a copy at the time you filed out the forms. That would be your best evidence they altered them. It would seem that you could file a civil suit outside the work comp system but need more than your word against theirs. You need to inquire with a bunch of non-workers' comp. lawyers and find one who will take your case. Also, you could try to sue your workers' comp. lawyer.

If you're not able to do your original job either you should have got retraining, been offered money in place of it, or your employer should have held your job open the first three years.

On the job issue, you could have a discrimination suit. Although a lawyer can best handle this, you could file a claim at BOLI. A winning BOLI claim would strengthen any civil suit although losing at BOLI would weaken one.

Injured Worker Discrimination - http://arcweb.sos.state.or.us/rules/OAR ... 9_006.html

BOLI Website - http://www.boli.state.or.us/BOLI (see Civil Rights Division)
Webmaster
Site Admin
 
Posts: 133
Joined: February 23rd, 2005, 10:39 pm

Choose you own doctor & get a good lawyer

Postby Webmaster » March 8th, 2007, 12:46 pm

For others who may read this in the future:

These guidelines don't all relate to what happened to backlash. Even IWA's founders made many mistakes in their claims.

Excluding some restrictions in MCO plans where your non-MCO doctor would have to join the MCO, a worker can choose their own doctor. NEVER go for treatment to a doctor the employer or insurer recommends.

Interview lots of lawyers before choosing one. Avoid attorneys in rural areas if your employer is large or has political influence in the community. If an attorney currently works for both employers and claimants on workers' comp. cases, don't hire them. We have helpful information on choosing an attorney in our home page.

Also, learn everything you can about workers' comp. laws as soon as you are injured. That's the main tool of this Website.

Never trust your employer or insurer to give you accurate information or act ethically. Most employers and every insurer is out to help themselves at your expense.

Read more advice at http://www.injuredworker.org/advice.htm.
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Posts: 133
Joined: February 23rd, 2005, 10:39 pm

More regarding my situation along with some questions...

Postby backlash » March 9th, 2007, 11:21 am

The managers were present while I filled out the wrong claim, which was obvious to the them since it was the wrong color(they had prior experience persuaded injured workers into not filing claims). I was still around waiting for my ride, when I was informed by a manager that my claim had already been faxed to the insurer.
Was it fraudulent of them to fax a newly re-written claim(unsigned by me) to their insurer AFTER I left the office?

One of the injuries occured because my employer refused to fix a faulty warehouse door. Who is at fault?

What is the timeline to file a suit against the people involved in damaging my injury claim?

I am still struggling with my work injuries because they were inaccurately attended to by the Work Comp doctors. I made a point to address my pain, inabilities, and concerns during these appointments. Is there a way to obtain a copy of either video footage or an audio recording of these visits( I have since learned that such visits are usually recorded)?

It's been nearly a year since these injuries occured.
Why did I suddenly recieve a Permanent Partial Disability award, without going to court, if the claim states I only have muscular strain?


While I don't know whether or not other employees reported their work injuries to OSHA. I did not know I was required to report mine to OSHA since the managers would not advise me on what I was suppose to do. Would this negatively affect me in court if I decide to pursue legal action?

And on a final note:

The Ombudsman, which differed each time I'd called, have been very vague regarding my closed claim. They have given me the runaround more than anything.
Thanks to all who have taken the time to address these issues.
backlash
 
Posts: 4
Joined: February 1st, 2007, 3:54 pm


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