Workers Comp Help
Injured Again While Recovering From a Fall
My case is somewhat complicated. First work-related injury occurred in attendance office of large high school on 4/4/97 when I tripped and fell over several cords. Injured neck, shoulders, back. While off work recuperating from this injury, on 5/22/97 I had a trip and fall accident on a public sidewalk. Primary injury to neck, also injured back, left leg, etc. I wasn't completely healed from the 4/97 accident, and with the new injuries I hurt everywhere 24-7 and could hardly walk.
Taking 800mg of Motrin or Vicodin 3 times a day soon caused me terrible digestive problems and I was constantly in and out of Kaiser's emergency room, swallowing those horrible green Lidocaine ""cocktails"" to sooth the volcano that my stomach had become. Tagamet and Prilosec were added to the growing list of pills I was swallowing each day. I had one attorney for personal injury, another one for workers comp. case. Ended up using same attorney for both cases because of confusion. Doctors were a royal pain. When they found out I had overlapping injuries from two accidents, their first consideration was always which case would pay them the most money rather than giving me good medical care.
Experience with employer's first insurance company was awful. After this woman found out that I was being treated by a soft-spoken Asian chiropractor, she seemed to be on a mission to intimidate her into sending me back to work before I was able by threatening not to pay her. The doctor buckled and apologized to me as she wrote the slip in June 1997, and then the insurance company ended up not paying this weakling anyway. The next doctor decided that he only wanted to see me for the personal injury accident.
I kept telling my attorney that I needed her to refer me to a doctor for the workers' comp. case, but she kept ignoring me. She did not notify me that the school district had changed insurance carriers nor did I receive any notice from them., etc. The new insurance company was State Fund, and the claims adjuster assigned to my case seemed like he had nothing better to do than follow me everywhere. When I went to my medical appointments he would be there. He would be sitting in cars outside my apartment, walking down the street, and he following me up to Reno one weekend, even had the nerve to come up and talk to me like I was crazy or something.
Checks would start showing up with no written explanation and then stop, again with no explanation. When I contacted my attorney, she would claim that she didn't know what was going on. I eventually had to visit her office and I asked to see my file. I found that they had been receiving copies of all the notices from the insurance company but never seemed to see that the dates were incorrect and that they had been send to the wrong address.
When I contacted the claims adjuster and asked him about this, he told me that my attorney was supposed to be sending me copies of all the documents. I thought this was strange because when the kooky claims adjuster authorized checks for me, the check was always sent to the right address but the notices regarding the checks were sent to the wrong address or not at all. Tried to work off and on balance of 1997. Constant problems getting temporary disability checks on time from employer. 9/97 I lost my apartment, ended up moving in with my sister. That same month I also lost one of my brothers who died under suspicious circumstances.
In November 1997 I lost a second, part-time job because I no longer was able to do the work. For some strange reason, my attorney never considered the lost wages from the job when dealing with the personal injury or the workers' compensation case. All kinds of problems with doctors, employer, attorney, and insurance company during 1998. Attorney kept promising that case would soon be settled and then another delay would come up. Concerns regarding apportionment caused problems with personal injury case and workers' comp. case. All parties involved going back and forth about who was responsible for what percentage of my injuries.
Doctor at that time continued to give me treatments that were doing more harm that good and never listened to me, so I didn't keep all the appointments. I think he probably was billing insurance company for services he never performed. Because of financial situation, I was forced to consider returning to work in August 1998. Told doctor that full duty would definitely be much too strenuous, but he decided to send me back to work anyway. Attorney told me to go give it a try and if I was re-injured, we could just sort of say, ""I told you so""!
Sure enough, in September 1998 I did re-injure myself at work. I went to Kaiser and in October 1998 they sent me to the doctor who had sent me back to work. His staff had me fill out workers' comp. paperwork and then I started seeing him again. He never re-examined me or anything, just started the same old painful treatment as before (T.E.N.S. on neck and shoulders with heavy moist heating pad placed over electrodes). In November 1998 I moved back in with my elderly , disabled parents (father has prostate cancer, a heart condition, and he was manic depressive, among other things; mother has bronchitis, hearing and memory loss, etc). Although I was trying to recuperate from injuries, they expected me not only to give them over half of my income, but also to help take care of them. Although they were eligible for a home health aide, my father refused to allow one into the house.
It has been extremely difficult for me here. I can't have any visitors, I don't have any social life, I can't conduct my home-based business, I have to limit how many showers/baths I take or when I wash my hair (I can't be running up the PG&E or water bill), I have to drop whatever I'm doing and go run errands with my mother whenever she decides to go, and before he was given a new medication to calm him down my father was subject to go off at any moment (he has put me out, either threatened or has actually struck me, and constantly showered me with verbal abuse because due to my circumstances I wasn't able to give him as much money as he demanded). I have been so overwhelmed and so depressed and sometimes at the end of the day I have been so tired that I've just crawled in my bed and pulled the covers over my head and cried.
I have asked myself over and over why God has allowed me to be in this situation. Although I have stopped attended religious services, I am still very much a spiritual person and I have faith that I am going through this ordeal for a reason and I have faith that in due time everything will be revealed to me. I also believe that after I learn the lesson that I am unwittingly being taught, my life will change for the better and that is what sustains me and gives me hope.
Meanwhile...With no notification from State Fund, in March 1999 I stopped receiving temporary total disability payments. After calling the insurance company and my attorney for over a month, I finally found out that for several months the doctor hadn't been sending State Fund their monthly medical reports. They said that they had called his office and written him several letters, but when they got no response they took action. Only the action was against me, the unsuspecting injured worker. What sense did it make to cut off my checks without warning because the doctor wasn't meeting their requirements? What control did I have over him?
After another month or more of confusion, I went to the doctor's office and started questioning his staff. I found out that when I had come into their office in October 1998 they had never made a separate workers' comp. file for me. Instead, they had misplaced the original paperwork, and each time the doctor had been seeing me, they had been giving him my personal injury file and he never noticed! Can you believe that? So now here it was April 1999, seven months after I had started coming in for treatment, and the doctor's office was rushing me to complete another set of workers' compensation forms for my file. I had been receiving treatment mostly from his assistants, and when I finally saw this doctor, it was obvious that he was confused and wasn't sure what was going on. State Fund was hot on his case, asking him all kinds of embarrassing questions.
The doctor's response was to prepare a lengthy medical report in which he outlined a treatment plan and requested tests that should have been done months ago (he did manage to have an MRI of my cervical and lumbar areas which did reveal damage to my upper and lower spine). State Fund's response to this report was to refuse to accept anything the doctor said and to continue to refuse to pay me. After the fiasco with this doctor, my attorney finally decided that perhaps she did need to refer me to another doctor. This doctor was a chiropractor and I had a very unpleasant experience with him. He was a ruggedly handsome former Navy seal and he was a very good doctor. He explained everything he did in detail and he was very proud of the mostly good results he got with his patients.
I must admit that after several adjustments to my neck and back I did feel much better than I had in a long time. But it was just his attitude sometimes, and some of the things that he said to me when no one else was around. He was calling me at home at unusual times and demanding that I bring some of my family members in for treatment. I told my attorney about it and she recommended that try another doctor. But I liked the results that I was getting, so I tried to ignore the things the doctor was saying. We also had a couple of heated discussions because after he found out that I wanted to start a business he tried to send me back to work even though he knew I wasn't ready and he denied that I was a ""Qualified Injured Worker"" and eligible for vocational rehabilitation.
He said something about not letting ""people like you use the system to climb up the ladder"", and ""...your kind sitting around all day eating junk food and watching Oprah and the soaps while thinking of ways to beat the system"". After he started making these veiled racial comments I couldn't control my feelings any longer and I knew that I was long overdue to change doctors. This was in June 1999. It was during this month also that I had been scheduled for an appointment with a Q.M.E. My attorney had told me that he might be okay. I was uncomfortable with him from the beginning.
When he found out that I was receiving treatment from a chiropractor he told me that he didn't consider them to be ""real"" doctors and that the one I was seeing was probably just saying and doing whatever he could to run up a big bill. Next he tried to make me say that I had been injured in an accident that had actually involved my brother. I was glad to leave his office and make the long and painful 2-1/2 hour trip back home. In July I started seeing an orthopedic specialist.
The Q.M.E.'s somewhat unfavorable report came back around this time. Among other things, he had decided that I was permanent and stationary as of April 17, 1999, one and only date that he saw me. I didn't agree with that statement or many others that he made in his report, but since I didn't receive a copy of the report from my attorney or the insurance company until months later, I had no opportunity to outline those objections to anyone. Meanwhile, things were going on between my attorney and my employer's attorneys that I wasn't being informed of. In November 1999 I received a letter from my attorney informing me that I had been scheduled for a December appointment with an Agreed Medical Examiner. That appointment went well.
In December I found out that in September the attorneys had met in court and decided that I should stop receiving permanent disability payments and start receiving vocational rehabilitation benefits. I didn't receive a letter or a phone call notifying me of their decision until I called my attorney's office to ask about the status of my personal injury case. Depositions and a trial were scheduled for my personal injury case, and when my attorney tried to get the A.M.E. to testify, he left the country. That trial was cancelled.
In January, or was it February, vocational rehabilitation maintenance checks just started showing up in my mailbox with no explanation. Rather than call my attorney, I called State Fund and asked them about the checks. I already knew about the $16,000 cap and although I wasn't aware of all the rules, I didn't want to be sitting at home using up my funds and not receiving whatever training I was entitled to. The insurance company told me to contact my attorney and she would recommend a vocational rehab. counselor. That didn't go well either.
At my first meeting with the counselor I told him that I wanted to do a self-employment plan. I told him that I was certain that I would be successful because I already had a home-based business in place and I had already purchased most of my office equipment. I told him that at this point all I really would need would be a $250 Small Business class, and less than $10,000 for inventory and miscellaneous expenses. After hearing me out and reviewing my paperwork, this counselor said that he didn't really foresee a problem and he would be glad to help me achieve my goals. He explained what was involved and said that the insurance company wouldn't make it easy for me. For the first time in years my spirits began to soar and I thought that finally maybe things were about to get better.
But then on my next appointment there was another counselor. Among other things, this one told me that I would have to do very well on their tests in order to do a self-employment plan. When he saw that I had attended college, he seemed to be surprised when the scores revealed that I did have college level skills. In spite of that he came up with all kinds of reasons why I should take some other course and do the business on my own time and with my own funds. Somehow I ended up choosing from pharmacy technician, hotel manager, and preschool teacher. Next thing I knew I was walking around the corner to tour the ECE/hotel management school.
The people seemed to be nice and they were really anxious for me to sign up to end their school. I still can't explain why I signed that Preschool Teacher plan when I knew that that was not what I wanted to do. My friends and family couldn't believe that I was going to be going to school so I could end up ""chasing other people's children around"". Physically, I knew that I wasn't ready to do anything like this, but after looking over the watered down job description, my doctor signed the form although he said he felt I should have gone for the home business plan. So I started attending the school and the checks kept coming on time.
The first class was easy and I was on my way to an ""A"", but my father had a heart attack and my attendance became irregular, which lowered my grade. One of my brother's was getting married and he and his bride asked if I could help out with the wedding. Now this type of creative venture was right up my alley. I was just as excited as he and his bride were! The wedding was in July in Florida. I had stopped attending classes to help my mother out with my father, and since neither of them were well enough to travel, they insisted that I attend the wedding to stand in their place. I made all the decorations for the wedding, packed them up and had them shipped to the bride's hometown. I put together gifts for the bride, her parents, her bridesmaids, the groomsmen, etc. When my brother and I arrived in Florida I ordered the flowers and a hundred other things.
Even the Celebrex that I was now taking couldn't control my pain, but I was determined to see that my brother's wedding turned out beautifully. It was a truly uplifting experience and I was glad that God has blessed me to be able to be a part of it. After the wedding I returned to California and ran into a lot of turmoil. I wanted to change my vocational rehab. plan but the insurance company refused to hear it and told me that if I didn't complete the ECE classes they would cut off my funds and settle my case right then and there. So under the cloud of that threat i returned to school and got straight A's. A four-week unpaid internship is required before you receive your certificate and I had already done two weeks in November.
I was supposed to have done the remaining two weeks starting the week after I graduated, but I haven't been well (high blood pressure, kidney stones, headaches, depression, serious pain in neck, shoulders, left leg and foot. My non workers' comp. doctor thinks it is all stress-related). The new year started off with a bang alright. My parents are pressuring me for money that I don't have.
Creditors are ringing my phone off the hook (you can't squeeze blood from a turnip, and I'm seriously thinking about filing bankruptcy on their asses). The phone might get turned off any day now. I just received a notice from the state tax board claiming that I owe them almost $8,000. I just laughed until I cried about all their threats, because I don't have any property for them to put a lien on (the damn storage company slipped around and sold all of my worldly possessions without notifying me, including the tombstone for my son's grave), I don't have any money to put in a bank account (or a bank account for that matter), I don't have a job, and my credit went to the dogs a long time ago. I guess I'd better contact somebody to find out if they can put the clamps on my settlement money. I flipped out and decided to drawn down my retirement money, so I better find out if those greedy buzzards can try to snatch that up too. I still can't do anything with my cosmetics/gift service business. I have no love life. My daughter isn't speaking to me because I couldn't afford to buy my grandson any fancy gifts.
Remember that A.M.E. that had examined me in December 1999 and who had done the EMG on me in April 2000? Well here it was December 2000 and my attorney still hadn't received his ""final"" report, the one she said she needed in order to start settling my workers' comp. case. She said she also needed to see the findings of that report to determine whether they could release over $2,000 of my personal injury settlement that they were holding in an escrow account. The doctor's office said that the reason for the delay was that he had to thoroughly examine the records before he made his determination because apportionment was such an important issue in both of my cases.
My attorney's office contacted me last Friday, and wasn't I surprised to find out that she had finally received the A.M.E.'s report and she was ready to contact my employer's attorneys and make a settlement demand. Now please keep in mind that I haven't even seen the A.M.E.'s report and have no idea what he said, but apparently attorneys and insurance companies seem to accept these doctor's reports as gospel truth, without giving the injured worker the opportunity to review and challenge the doctor's statements. Apparently some of them don't even consult the injured worker's treating physician to find out if s/he goes along with the A.M.E.'s report.
The figure that my attorney named was incredibly low (not even a year's wages) considering the fact that I had had two work-related accidents and that I haven't been able to work for over two years now. I need enough money to get my business rolling and I'd like to be able to do something nice for my two grandchildren as well as pay for a nice headstone for my only son, their father's grave. And as I stated much earlier, the wages from my part-time job were never factored into my case. I was so disgusted with everything that my attorney said that I didn't even challenge the figures, and I even told her to go ahead with a ""Compromise & Release"", which I had sworn I would never accept. But that was Friday evening.
Wish me luck, because I'm going to fax my attorney and tell her to up the figures and that I want to keep my medical options open. It makes sense, don't you think, for a 53-year old woman to expect that in all likelihood her arthritic spine will get worse instead of staying the same or getting better. I think it would be reassuring for me to be able to continue seeking medical treatment when necessary with the same doctor and getting the proper medication without going through changes. And what about if my injuries do get worse enough to allow my disability rating to go up? Yes, I'm definitely going to send my attorney an urgent fax followed by a phone call.
Anyway, I know that this was hardly a ""brief"" description, but once I started writing I couldn't seem to stop. I've never really had the chance to tell my story. God bless anyone who takes the time to read it all.......