Our Trip to the Workman's Comp Dr

[Shown]

How would you feel if you go to the doc that workman's comp sent you to and they ask you "And Why are you here seeing me". Well that is what happened our first WC visit was the one that should have been last, this doc was to do a evaluation to see if hubby was able to return to work and had got the maximum benefit from his medical treatments, but like he said there has not been any medical treatment, I explain to him that I thought that medical treatment was the reason we were in his office, he said no his was an evaulation.

So this is what he told us to do, Contact the Division of Workman's Comp and let them know there has been no medical treatment, he said they definitely need to know what is going on with hubby or maybe I should say what is not going on with him. They did do a fiunctioning test on him and lifting 20 pounds made his head hurt (1 or 2 pain scale) he lifted 25 pounds and his head pain went to a 3 or 4 and when they asked he would try 30 he told them no, said his head would hurt him for 3 or 4 days if he did not stop.

So where are we NO WHERE, but at least we had a wonderful weekend, his head was clear, he could think clearly, and there was NO PAIN. We now live for days like this.

Emailed attorney and told them what the doc said but one thing he said to me alone was, "YOU KEEP PUSHING DON'T LET THIS GO" I am, and I will keep pushing.

One more bit of good news, where he worked they fired the HR lady who did not get his paperwork filed and who has caused all of this grief and my hubby's worsening condition, if she had only did her job then maybe he could be back at work and doing his.

Thanks for being here!

Shown

[j*sunset]

Was that dr supposed to be for an IME {you'd get -official paper in the mail stating to see dr for IME exam?} or just a regular eval apt with company managed care dr?

[caudaequinasyndrome]

it sounds like either you went to a IME or a FCE.
eater way you should have received a letter from wc stating what you were seeing their doctor for.
also in most states you need to see a doctor for your injury every 6 weeks while you are on temp disabilty.
the fact that you have not been going to doctor can really screw you up..
your lawyer should have explained this to you,

[Shown]

I believe it was an IME, he said we were there to see if he had reached maximum medical benefits from the treatments he had been receiving, however he has not been seeing doctors through workman's comp, that is whats so frustrating. He needs to see a doctor for his brain whether it is a NS or a Neurophysiologist. Bavck in August when all of this started that is where we were headed. We saw the WC doctor, he had an MRI done, he referred us to a Neurologist, she reviewed his MRI, called us and referred us to a Neurophysiologist, this doc was verying all the payment information and when they contacted workman's comp that is when everything came to a halt. WC said that he was never seen for his brain and they would not cover him being seen for his brain.
Real quick history: 10-15 had a roller skating accident, 18 stitches under right eye, 8 in lip, CT found a 2.5 pineal cyst, Hydrocephalus formed. 11-16 Brain Surgery to help w/hydro. 1-13 Returned to work. Involved in several altercations at work 5-22 was the worst, student slugged him in the face, grabbed him around the throat and they went to the asphalt scraping his right elbow and his left shoulder blade, the lens on his glasses had to be replace, his right ear was red and the right side of his neck swelled up, he saw the WC doc for his neck but at the time nothing showed with the brain, then on 7-25 he went over a desk with a student and that was the last day he worked. He went to our family doc on 7-31 he told us to file immediately for SSD (he did not know of the fights at work) contacted WC doc. However WC said they will treat the right arm and the right shoulder and the neck but they will not treat the brain.

We may not have been seeing the WC doc but I have made sure that he goes to our doc so he has been seeing a doc every since he stopped working on a regular basis, not where we need to be but we do see a doc. The doc told me that all the records in the world can not complete with seeing James in person. It just breaks my heart but he is havng a good week and that is what we strive for right now.

Thank you for comments, never been here before, it is a hard ride.

Shown

[caudaequinasyndrome]

did he file a wc accident report for the brain injury or any of the problems?
in nys you have to file a wc claim in you are injured. injured party fills it out.
best bet is to talk to a wc attorney asap, there are time limits on the reporting of on the job injuries

[Shown]

More answers and lots of questions, James doc visit was a MMI and we have the report back from WC aqnd I now know what the doc was trying to say to me without really saying anything, he told me to not let things go like they were to contact the Division of Workman's Comp and tell them that he had a brain injury because there was nothing on his paper work regarding the brain. It really didn't make alot of sense that day but now I understand. The MMI only talked about his neck and shoulder nothing about the brain. We received paper work from the attorney saying she was not going to appeal the report and James has to sign off on it saying he does not want to appeal. I told him to check the one that says he does want to appeal and get back to the attorney. You only tells me that his attorney his not hearing what we are saying, we have told her from day one it is the brain. We have received a attorney bill for the Workman's Comp Division and I am debating on disputing that also she is not listening and I am not paying her for something she has not done. I told her the first time we talk that we did not care about a settlement we wanted medical treatment.
I know this is rare he filed for Social Security Disability in August and he has already be approved 3 1/2 months and it is his head that got him disability.
I am frustrated but not out of fight.
To answer your question yonkersguy, his employer's human resource office had an internal personnel problem, she never got off her backside and got everything filed like she should have. To say the least she is no longer employed there. I am emails where I asked her a number of times to get all of his paper worked filed so we could get treatment, there is also an emailed that was not to friendly if you kow what I mean telling her she was preventing James from getting the medical attention he needed.
I did not drive from Houston TX to New York City to get my husband a Miminal INvasive Brain Surgery to just walk away from this now, he was on his way to having his life back and now this are just a mess.
But I have alot of fight in me and I will take this to the Supreme Court of Texas if necessary, he deserve medical treatment for the injuries he received at work.
With the support of BT and you guys listening to me venting, I will not give up, it is to important and I made a promise to him that I will take care of him.
Thanks again so much!
Shown

[Dabbadoo7]

Shown,
As your atty. is trying to tell you, Comp. is not responsible for any treatment of your husband's brain tumor. As you have mentioned in other posts, it was pre-existing. They have apparently treated those injuries sustained in the scuffle, which is all they are required to treat. You have had an IME, and apparently the dr. feels that any of the problems related to the brain, were not exascerbated by the scuffle. You can, of course, have another dr. examine your husband, at your cost, to refute this opinion. But W/C is not meant to cover any and all illnesses a claimant has at the time of the covered injury, only those casually related to the injury.

I was on Comp. for 16 yrs., and it would have been so nice to have any medical problems during that time covered by Comp. But it wouldn't be right to expect them to pay for any illness, bumps, sprains, etc. that come up during that time, unless they were caused by the original accident.

I am certain you will not agree with this. I will suggest that you have your atty. explain fully how the W/C system works, or do a look-up on your computer of the W/C law for Texas. It may save you some anger and frustration. Also, if your husband has already been approved for SSDI, has he sought treatment for his tumor thru Medicare? That should be a source of treatment for him. Did he have a hospitalization plan at work? That could be another source. In any event, he does need treatment, and sitting back and preparing for a battle with W/C is not getting it for him.

Good luck.

Dabbadoo

[Shown]

Dabbadoo7:
Sorry if you misunderstand what I am trying to say. For one thing my husband has a cyst in his brain not a tumor and his recovery from his brain surgery was going well until a student decides to slug him in the face, grab him around the throat and fall to the ground with him. The injuries that he substained that day were enough to get this young man felony assault charges and if you were to have seen his injuries that day you would know that there is no way that a brain recovering from surgery would have not been jurt in the ordeal. Our family physician that he has seen on a regular basis believes like me that his brain aggravated by the fights.

If you have researched hydrocephalus as I have you would too understand that his brain is not like mine it can be injury if it is shaken violently. I have a very good understanding of workman's comp. I am in the Human Resource Department of a large company and I handle our workman's comp. I am not asking them to treat anything pre existing.

On his job he was involved in more than one fight, personally I know of 4 fights, one of which he and a student tumbled down a flight of concrete steps to the asphalt. His brain was aggravated by the incidents at work and there is not question about it.

As far as the pre-existing conditions, his MRI reports states that there had been no change in his cyst or his hydrocephalus since the original one done after the surgery so his pre existing condition has not change at all.

Also since you seem to find me uneducated here, there is one little fact regarding the brain that seems to be missing here, a small brain injury may not show right away it may take a few weeks to start showing signs and that is exactly what happened here, symptoms started showing the same time BT went down that is how I found out the site was down, I wanted to go on the hydro forum and ask about the signs he was showing what they meant.

I have done my research and we were in the process of having his brain checked out from the fight but when the doctors office called workmans comp to verify they said no and all treaments stopped. Sorry if I did not tell to kindly to what you had to say but unlike you his doctor believes that his condition was caused due to the fights at his job not his cyst (which by the way has remained unsymtomatic this whole time). Yes there are symtpoms like projective vomitting or real deep gragging and this has not happened.

Go to the Tramatic Brain Injury Forum read about how small blood vessel in your brain can get broken and mess up things after you have had a tramatic brain injury such as the one my husband had last October.

MayZoo I've found that our brain is connected with a lot of tiny blood vessals. Think of a potato with a lot of toothpicks stunk in it. The toothpicks being blood vessals. When the brain is shakened some of theses vessals break, not to mention damage to the central nevous system. When something like this happens to a younger person the brain finds other courses to take. Repairs its self so to speak. When this happens as we get older, it dosen't work like that. In all you might feel better but their is still damage. Think of what the central nervous system controls and you will have a better look at your condition.
Hope this helps
Kevin

Believe me I have more things to do in life than fight for something that really is ours to fight for, seems to me like the burden of proof should lie in their laps not ours and if the believe this is pre existing then send him to a doctor and prove it all they have done is deny treatment.

Shown

[caudaequinasyndrome]

i don't know how Texas wc works, but in ny state the injured person can fill out injury report and mail it directly to worker comp, this protects the injured party's rights since you don't have to worry about internal problems with the employer, or the employer not filing. in ny it called a C3 and the injured party files it directly with workers comp.
there is a time limit, you still may be able to file a c3 on the brain injury from the last fight.

[Dabbadoo7]

Shown,
I understand what you are saying, and why you would think the way you do. But, be it a cyst or a tumor, the dr. you saw did not feel that it effected his brain in any way. That's why you must go to a brain specialist, and get a written report from him stating whether or not the brain was effected by the scuffle. Though you may be certain it was effected, only the doctor's report matters. Without a positive report, you are spinning your wheels. You won't have the evidence needed to support any treatment.

Dabbadoo

[Shown]

Dabbad007
We do have a supporting doctor, he sent information to the Division of Workman's Comp Friday. Now, I can not see how that would take the word of a doctor that only seen him once over one that has been treating him for 10 years and has been watching him closely since his brain surgery last year. Our doctor supports the fact that his brain was aggravated by the fights at work and he does not have a problem stating these facts.

Shown

[Dabbadoo7]

Shown,
Great! As long as that dr. is a neurologist , and not just a GP or dr. without specialized training in the field of brain trauma or related illnesses, then all you are ghoing to have to do is wait on a ruling from Comp. But, if this report went to Comp, directly, rather than thru your atty., you may have a much longer wait. You have to remember that your atty. is your agent, and unless anything goes to Comp. thru him/her, it very likely is not going to be tied to your case. You should make sure that your atty. has a copy of the report, as well as yourself. Don't let any reports go to Comp., unless thru your legal counsel. They are what counts. Once again, good luck.

Dabbadoo

[Shown]

His attorney called today, it only took 4 voice mails, and email and finally a fax. Shw has received the letter from our doc she needs and she has started the appeal process, she said he has a really good case, so things are taking on a different direction. You know Daddadoo7, the WC doc that did the evaluation on him the first time, he is the one that to pursue this, he could see what was going on. Our doc told us prior to seeing the WC doc that no amount of records comes close to just talking to my hubby in person. Their own doc has seen for himself how mentally challenged his is today, there is no way he could have maintained a teaching job in that enviroment in the shape he is in today and it is so obvious. I know that it is a uphill battle, but it is one worth pursuing.
Thank you for all of your comments! NNed all the suggestions I can get.
Shown

[caudaequinasyndrome]

i just found out that in nyc its the employees responsibility to file a claim with wc. even if the employer takes all the info ,says they are going to file the claim and drop the ball, the employee has 2 years to file a claim with wc not the employer. if the statue of limitations passes the claim will be denied, even though there is a record of the accident and injury and medical care.
i never knew this.

[Dabbadoo7]

Shown,
Great! It looks like things may be changing, and, unless I can add any thing you may think helpful, I'll stay off of this thread. Yell if you would like an opinion, good or ??.

By the way, I think Yonkersguy is still trying to help out, by telling you that your husband should file his own First Report of Accident, which could be very helpful. You can download one by going to the Texas State Gov't. site. I know it is there because my son lives in Austin, and I have one here just in case. Best of luck.

Dabbadoo

[Dabbadoo7]

i just found out that in nyc its the employees responsibility to file a claim with wc. even if the employer takes all the info ,says they are going to file the claim and drop the ball, the employee has 2 years to file a claim with wc not the employer. if the statue of limitations passes the claim will be denied, even though there is a record of the accident and injury and medical care.
i never knew this.

You are absolutely correct, and that is the case in just about every state law I have read. If the employee doesn't notify the employer of an injury, they have no responsibility to report it, except in the case of death, or in the case of an obvious injury observed by others.

Dabbadoo

[caudaequinasyndrome]

. If the employee doesn't notify the employer of an injury, they have no responsibility to report it, except in the case of death, or in the case of an obvious injury observed by others.
Dabbadoo

no its not that, the employee has to notify workers comp of the injury and fill out the wc paperwork and file it with wc , not the employer.
if the employee reports it to the employer and assumes the employer has filed , and the statue of limitations passes, wc court will deny the case, this is even if there is proof of wc injury , proof of medical treatment with notes stating it was a wc injury , proof of reporting injury to employer,, all that doesn't matter, its the employees responsibility to file with workers comp, not the employer.
i got this from a wc lawyer, it was news to me, and i have now heard of people that have been denied benefits since the statue of limitations has passed, and they had filed with employer and received medical treatment

[backless]

Maa'm stay in the fight.I'm finding out that the state you come from and how aggresive you are determines alot.Your hubby is lucky to have a fighter on his side. W/c is designed strictly for the benefit of the employer. Anyone that wants to argue ,lets get it ON.Ive been through a couple and because of fools,I have permanent disabilities that will prevent me from working the only way I know how. With heavy labor/.Ive been cheated out of amt I was to be paid,they tried to make stuff pre-existing,called problems arthritis,denied meds,and then filed for bankrupcy.Insurance companies have big bucks,and spend it on attornies to figure out how to deny you. Without the help of a good atty.Your not going to get your fair treatment.The very idea that you NEED an atty.that you must pay,more than PROVES the system unfair.What else would it be.

[Dabbadoo7]

no its not that, the employee has to notify workers comp of the injury and fill out the wc paperwork and file it with wc , not the employer.
if the employee reports it to the employer and assumes the employer has filed , and the statue of limitations passes, wc court will deny the case, this is even if there is proof of wc injury , proof of medical treatment with notes stating it was a wc injury , proof of reporting injury to employer,, all that doesn't matter, its the employees responsibility to file with workers comp, not the employer.
i got this from a wc lawyer, it was news to me, and i have now heard of people that have been denied benefits since the statue of limitations has passed, and they had filed with employer and received medical treatment

Yes, it is the workers responsibility to file a First Report, but the employer must also file their First Report at approximately the same time. If the employer does not file his report within a certain period of time, they are subject to a fine.

Dabbadoo

[caudaequinasyndrome]

Yes, it is the workers responsibility to file a First Report, but the employer must also file their First Report at approximately the same time. If the employer does not file his report within a certain period of time, they are subject to a fine.

Dabbadoo

what your stating does not apply in ny state. there is no fine if the employer doesn't file.