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Re-injured a Worker Comp past injury in a L&I state on the job.


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#1 Bradmph

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Posted 05 August 2012 - 05:21 PM

Hi,
Here is my dilemma and request for the thelaw.
Several years ago, I received an injury on the job and awarded a lifetime stipulated medical award for the injury. This covers me for life on the injury, only if it causes and is completely related to an additional injury caused by the initial injury. This was confirmed as being true in my case, which a knee surgery caused additional damage that now has caused me to require a knee replacement.

This initial injury claim needs to be reopened, but finding the responsible party after so many years is not as easy as it seems.

Anyway, this initial injury was silent for many years in my life after the operation I received. Everything seemed normal except for the occasional pain from the injury every now and then. It was nothing that couldn't be handled with a couple ibuprofen. By the way, this injury was a Worker's Comp case claim in California.

Jumping into the present time, I was working at my job and a repetition of a job duty caused this initial injury to flare up to an extremely painful problem. I did not know at the time that it had anything to do with the initial injury, so I filed a Labor & Industry claim. I had moved from California to a northern state that injured work's claims are posted with L&I instead of Worker's Comp. I went in for an exam to have this injury checked and start my claim. The doctor took X-rays and advised me the left lateral knee joint needs to be replaced. The bill was sent to L&I for payment which was almost $300 and not paid. During this time, L&I assigned a doctor to recheck my injury, which is normal procedure. This doctor said that this claim cannot be honored on the grounds that this is a re-injury of a past claim. He said I needed to contact the responsible party and start reopening the claim for coverage. This sounded easy enough, but if you are ever in this situation, you will find out it is a hide and go seek problem of catching an insurance company to claim responsibility. At this point, I can't do much without locating this insurance company that is required to accept the responsibility for the original injury, but I continue to search them out.

Now, for my FindLaw question...here is my request. I researched into work related injuries for the state of Washington. As I understand the wording of the law for this type of injury, L&I is responsible for any and all initial examinations for a work related injuries even if the claim is not excepted. The first doctor visit to be examined for injury becomes L&I responsibility, unless of course you are caught trying to claim a false injury. The laws are always worded so the average person sometimes doesn't have a clue what they actually are stating, but I read it over and over and it kept telling me that L&I must pay for any and all initial exams for injuries thought to occur at the work place, no matter what. If this is true, then they have caused an outstanding doctor bill to go into collections on me and the bill is still unpaid. How do I get them to accept responsibility for the initial exam I had to have for re-injuring myself.

This re-injury of this first injury has caused me unable to work at this point and disabled. I receive SSA, but their date of acceptance does not go back far enough to accept this exam for payment.

I really would like the ground facts on this type of case and not suggestions or maybe if you try this type of answers. I need confident replies that I can approach with legal standings that places L&I resposible for this initial exam I feel they responsible to accept and pay for.
Thanks for viewing my request,
B

#2 Guest_FindLaw_Amir_*

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Posted 06 August 2012 - 11:58 AM

Have you consulted with a local Lawyer to address this issue?

#3 Bradmph

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Posted 10 August 2012 - 06:20 PM

I think that is what is going to be required for it. During the claim here in WA state I did get a lawyer to represent the case, but I felt he just didn't really put any effort into the case at all. The case ended up being declined because the injury was caused by a repetition of a job duty, but the repetition duty was not classified as a job duty when I was hired. The lawyer seemed to just roll over and play dead once he heard this was how I re-injured myself. I think he was hoping it would be a clean and cut case of injured at work, collect money claim. I gave him supporting evidence, but just could not get him to lift a finger.
I am in contact with the mediator company that works inbetween the clients and the insurance companies of the intial injury. Company named *****, I heard bad things about this company when trying to get rightful benefits, but can't hurt to try. All I need done is the original case claim to be reopened at workers comp. The case has already been reconstructed from my records. We'll see what excuse is used not to honor it I'm sure.

Edited by FindLaw_AHK, 13 August 2012 - 06:32 AM.
This post has been edited to remove personal or identifying information. -Moderator





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