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denisemariepaulene

service dog workers comp

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Issue: Under Florida worker compensation, medical obligation, Is employer responsible for providing a service dog to a former employee whose medical benefits are open if former employee worker compensation physicians prescribe a service dog for former employee after former employee's service dog of 14 years dies due to congestive heart failure.? Need for service dog occurs due to workers compensation injuries, and former employee acquired the first service dog without assistance from or cost to the employer.   Properly trained service dog expense is $30,000 plus the life time of medical vet care, food, equipment, etc.

 

Edited by denisemariepaulene
added fact that former employee acquired first service dog without assistance of employer

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First if the need for the animal is based upon a pre-existing condition that occurred prior to the injury involved in the comp claim, then no, replacing the animal would not be covered.  Additionally, replacing the dog would not include anything other than the animal.  They're not going to be responsible for the feeding and care of the animal.

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2 hours ago, LegalwriterOne said:

First if the need for the animal is based upon a pre-existing condition that occurred prior to the injury involved in the comp claim, then no, replacing the animal would not be covered.  Additionally, replacing the dog would not include anything other than the animal.  They're not going to be responsible for the feeding and care of the animal.

Thank you.  The need for the service dog was from my wc condition getting worse.  The training of a new service dog is part of the expense involved.  Would you please advise me as to what source you used to find the answer to this question?  I truly thank you for your reply.

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On 9/28/2017 at 10:25 AM, ElleMD said:

It is possible that medical care could include a service dog. It does call into question causal relation if the prior service dog was not part of the claim.

My accident occurred in 1984 and the second one involved being hit by a truck in2000.  Several years after the 2000 accident my doctor recommended a service dog as that injury compounded my former one, and in FL injuries incurrd going to or from the employers approved physician are covered.  Have not been able to work since 2000 accident. Was approved for SS and Medicare.

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Which one was the work injury? Is your claim still active? Has the WC carrier been paying for medicals up to this point? Why was the first service dog not run through WC if it was truly a related medical expense? I say it is possible to have it covered only because there is no law that prohibits the insurer from covering it. There is also no law that says that they must provide a service dog, nor pay for tangentially related expenses. You aren't entitled to the exact remedy you want. If some other less expensive means will do the trick, that can be offered instead. Further, you would have to show that the dog was actually required and not just preferred.

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Why  do you state the worker comp claim should already b closed...years by settlement in Florida? Is there something about FL WC claims you know that I don't and I practiced WC  in Florida....e/c has tried very hard to back me into a corner to do so by not providing surgery and other care, but at the doors for the WC hearing, they realized I meant no settlement....My injuries are lifetime and continuing to require ongoing care?  Please response, as I am not very familiar with this forum and am not certain where to respond to your statement.  The year of my initial injury, the substantive law did not permit settling the medical care. My substantial benefit rights are based on the year of injury.  The procedural laws can vary from year to year.

May thanks.

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It would be extremely unusual for your claim to still be open 33 years later. It would be even harder to claim your medical condition now is caused or even aggravated by something that happened 33 years ago unless that was a catastrophic claim. As it appears you have had other unrelated injuries or ailments, as 99% of the population has since the time of your accident, it is going to be extremely difficult to claim that while the prior service dog was for an unrelated reason, now suddenly that you are facing large expenses for a replacement, you have to have one because of an injury from 33 years ago.

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Hello, not certain if you practiced WC law in Florida, but I still have open medical benefits from the 1984 laminectomy, discectomy, and fusion.  Had received medical benefits consistently every month since then by the pain specialist, neurosurgeons, and neurologist, including epidurals about every 6 months apart to control the pain sufficiently for me to practice workers compensation and civil trial law.  A second laminectomy, discectomy, and fusion were needed in 1999.  When returning from the neurologist for check up after the second  laminectomy, discectomy, and fusion, I was struck by large truck, causing additional injuries to my back, head, face etc..  In Florida in 1999,  e/c had to cover any injuries aggravating or new ones accruing going  to or returning from the physicians assigned by the e/c.

 

The pain management and neuropsychiatrist have seen me on a monthly basis since that time.  I see the neurologist at least once and year for check-up, and for treatment in hospital for the related seizures and resulting falls in 2016 and 2012.  In the fall from the seizure in 2016, a vertebral fracture was found and vertebroplasty was performed to prevent its collapse.  I see a dentist 3 times a year for related issues due to the medication.

 

My service dog was with me until June 2017, when congestive heart failure had me make one of the most difficult decisions of my life.  Been difficult living without the help he provided.

 

I know my e/c adjuster and she is available when there is a mixup or error in medications.  A workers comp colleague has been responsive when the e/c attorney pushed to make me settle my medical benefits.,I simply refused and the judge agreed.   My monthly appointments with my pain management physician and neuropsychiatrist are already scheduled through December.

 

Therefore, the injuries are related and covered under workers compensation per Florida law, and have no problems receiving them.  My service dog is the only new issue under medical benefits I years. Any healthcare not related to wc is paid for my Medicare insurance or cash. I assure you the law firm representing the e/c is an aggressive one but follows the w/c law.  I have never requested anything my physicians have not ordered. I have their prescriptions now to start the search for the appropriate trainer and puppy to develop another service dog for me.......it has to be done bow even though I am not over the death of Scooter my  service dog.

 

Please advise me why you do not believe I still have wc medical coverage, that my injuries are not related and but continue to be treated by the e/c.

My attorney and  i cannot figure out why they re not related, nor does the e/c attorney as a WC judge has ruled them to be years ago..  The big question is whether the service dog is a medical benefit or other benefit with just a different name.   Thanks, and I appreciate

 your reply.

 

Denisemariepaulene..

On 9/28/2017 at 10:25 AM, ElleMD said:

It is possible that medical care could include a service dog. It does call into question causal relation if the prior service dog was not part of the claim.

 

 

My appoints are set with my physicians foreach month hrough thr end of the year,

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The .service dog was not needed until after the second injury which occurred coming back from the check up by a wc neurologist.  A truck struck me and aggravated the current ongoing injuries of 1984 and created serious new ones. I did not have a service dog until after the second wc accident, as injuries occurring going to or from a wc assigned doctor are the wc responsibility.

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If you are an attorney and have your own attorney, why are you asking us? You should already know the answer. I'm not going to re-adjudicate your claim. It is what it is. It is extremely unusual for a claim to remain open for 33 years. If yours is one of the very few that remains open, so be it. If you don't agree to settle, the claim doesn't settle; there is nothing for a judge to rule on. A judge couldn't force you to settle even if that were in your best interest. If your claim has been going this long, you undoubtedly would need a MSA to settle it. Of course the carrier's attorneys follow the law; to do otherwise would be to risk being disbarred. If you are a lawyer, you should be well familiar with the statutes and regulations on WC and there is nothing that speaks to a service animal. As simply a practical matter, you are going to need to explain why the previous dog was not part of your claim but the replacement dog needs to be. Of note, Medicare will not cover the cost of a service animal as they do not consider the animal to be "medical care". There are a number of organizations that help with the costs of training and such.

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Dear ElleMD,

 
Thank you again for your response.  I asked about the service dog and Florida Workers Comp and do have an old colleague who periodically handles an issue with my wc medical benefits/  I asked about this issue on this site because the first thing I learned before ever filing a claim is to know the answer before I ask.  This issue is one that I cannot find an answer, and I have just reached my colleague regarding the service dog issue.  I  was reaching out in this site to see if anyone had been involved in a similar matter.  I am disabled, and have some significant challenges and cannot practice consistently.  Have drilled through Lexis without finding a case on point.   It was not my intent to insult or use you, it was a matter hoping someone had encountered a similar situation and if not, know I am going to have my colleague decide if we should proceed knowing it may be case of first impression in Florida.
 
It would not be the first time my workers' comp claim for certain benefits has been a case of first impression and survived the appeal by the e/c. after I located case law in California that was on point..
 
I have read your letter carefully several times.  All I can add is that I have already researched and addressed issues you discussed with the appropriate state agencies and departments.  I definitely am not anywhere near the oldest open wc case in Florida by any strength of my imagination; even my own adjuster has cases much older than mine.  The states wc ombudsman for wc claimants discussed the matter about the service dog with me at length, I was advised to file the claim as  my medical benefits remain open and there statutory law is silent in this matter.
 
Like you, I know Medicare has absolutely nothing to do with this matter, except when SS determined I was totally disabled by the truck accident, that was the benchmark that determined I was also permanently disabled under Florida Workers  Compensation law.
 
While organizations and non-profits "provide" service dogs, the waiting list is longer than I can see.  And the  mandatory "contribution",  if I am appropriately partnered with a service dog, is as much as $30,000.after a one or more year wait.
I no longer wonder why so many children who need service dogs don't have them.  Just take a look at the "Fund me " sites on the internet.
 
As far as my doctors and husband, the question of my need for another service dogs is a closed matter.  It's the funding, locating the proper puppy and trainer that needs addressing. 
 
 If other resources are not available, I will discuss with my colleague to request the court to release funds from a special needs fund to be used.  The settlement for future wage loss from the lawsuit involving the trucking company that hit me was mandated by the court to be placed into a special needs fund as it found my injuries to be so serious that I was not compentent to manage the money., It is not to be used for medical care,
 
 I have a trustee and the trust was invested by a professional for the purpose of specified needs.  The court would have to be persuaded that the service dog is needed and not available to me by other sources in order for the court to order  release of funds for that purpose. 
 
Until two years ago,  my Social Security disability benefits were issued in the name of a payee and directly deposited to a special bank account.as SS determined my injuries were so serious to that I could not manage my social security benefits.
 
Perhaps you will understand now why my dog was so valuable to me and my life and why my wc medical benefits have not been settled. I am not the collateral damage of some minor curable injury.  I am the injury and deal with it every day of my life

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