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rebeldawg36

Denial of medical treatment for on job injury

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My question is simple, after an reported injury at work and request for medical treatment is made, is there a standard amount of time for treatment to be given? Also, approximately 2 months after initial injury, i had to seek medical treatment on my on. On 2 seperate occasions. After the 2nd treatment, i was diagnosed with a slipped disk and told I needed an MRI. I scheduled one through my personal insurance and it was CANCELLED by workers comp. Instead, 20 days after the 2nd emergency room visit, I saw a nurse practitioner. Then 4 days later I again saw this nurse practitioner. 

 

My question is, is this a normal practice for worker's comp insurance to make it difficult for the injured worker to receive benefits?

Is this an acceptable practice?

And

Can I make a legitimate case for workers comp benefits because of the denial of timely medical treatment?

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1 hour ago, rebeldawg36 said:

My question is simple, after an reported injury at work and request for medical treatment is made, is there a standard amount of time for treatment to be given?

 

Seeing as how on-the-job injuries could range from simple cuts and bruises to loss of a limb, of course there's no singular, universally applicable "standard amount of time for treatment to be given."

 

I suggest you consult with a local workers' comp attorney.  Either that or provide some factual details about your injury.

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2 hours ago, rebeldawg36 said:

My question is, is this a normal practice for worker's comp insurance to make it difficult for the injured worker to receive benefits?

Is this an acceptable practice?

 

It's neither normal nor acceptable. In fact, it could very likely be illegal. You should have gotten medical treatment the day of the accident.

 

I suggest you contact the TN Bureau of Workers Comp for assistance:

 

https://www.tn.gov/workforce/injuries-at-work/injured-workers.html

 

Though you may still need an attorney, but check with the bureau first.

 

2 hours ago, rebeldawg36 said:

Can I make a legitimate case for workers comp benefits because of the denial of timely medical treatment?

 

You get workers comp benefits for a work related injury.

 

If the denial of timely treatment exacerbated the injury then WC will just have to pay for whatever it takes to get you properly treated.

 

 

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I have contacted the division of workers comp and I have filed a petition for determinationof benefits with them. Worker's comp has hired an attorney and hes trying to say that my treatment is standard procedure and even gave case law to back up his statements. 

 

I hurt my lower back at work on September 22,2017. I thought it was just a pulled muscle and declined medical treatment. The next week, my symptons worsened and I requested treatment. It was denied. A week later, after complaining every day, i was again denied  medical treatment. The third and final time I requested medical treatment, i was told by the EHS Manager, and I quote, " in my professional opinion the only thing the doctor is going to do is tell you to continue to take ibprophen and to use bio freeze on your back " end quote! I complained every day and week until my back finally went out and I was rushed to the emergency room from my home because I was unable to walk. 

Edited by rebeldawg36
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2 hours ago, rebeldawg36 said:

Worker's comp has hired an attorney and hes trying to say that my treatment is standard procedure and even gave case law to back up his statements. 

 

Then go hire your own worker's comp attorney instead of taking the word of the enemy's attorney.

 

 

 

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Ive contacted 17 workers comp attorneys who all say I've got a good case, just not something that they're interested in. That's why I posted this question to get a better understanding of workers comp laws in Tennessee. If i wanted a smartass answer  I'd of gone to any other site offering legal advice. 

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We are not mindreaders, so how would we know that you have contacted 17 workers comp attorneys? But I question the response of the 17 attorneys. Workers comp attorneys fees are set by statute, and if you had such a good case, that would be like guaranteeing them payment, so maybe they were just shining you on to get rid of you?Again we are not mindreaders, so there is no way I could know, just throwing out the possibility that your case may not be as good as you were led to believe.

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I guess that a 47 year old with no history of a back injury who suffers a back injury at work, reports injury immediately after the injury, denied medical treatment for 2 months, then seeks his own medical treatment, not once or twice in one week. Gets a diagnosis, MRI ordered,( through my personal insurance), workers comp the cancels said MRI, schedules appointment 19 days after last doctors visit and diagnosis with a "Nurse Practitioner ", ( which a NP is not allowed to treat workers comp cases in Tennessee), diagnosed by NP with sciatica, scoliosis and  rheumatoid arthritis, (without any tests or imaging), then released to full duty when said 47 year old is unable to walk, sit, or stand without being in pain for more than  5 minutes max, threatened by said NP for questioning diagnosis, denied medical treatment again for 25 days is not a good case. I guess I should also state that the NP is currently under invrstigstion by the Tennessee Health Department Office of Investigation, TOSHA and the local County State Attorney's office. Also, I have had my insursnce pay for an emergency room visit, 2 doctors visits plus the MRI. Of course, since the MRI was delayed becsuse  of the afore, it makes the MRI results inconclusive as to WHEN the injury occurred. With this new information, my questions are still the same:

1) is this an acceptable practice?

2) does anybody have any case law on this issue?

 

All i have is a smartphone and no access to a law library! I've been unable to work for over 3 months and savings account is running low. No benefits have been paid!

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3 hours ago, rebeldawg36 said:

1) is this an acceptable practice?

 

The way you put it, of course not.

 

3 hours ago, rebeldawg36 said:

2) does anybody have any case law on this issue?

 

Case law won't help you because the reaction will be "Oh, now he's quoting case law. Smirk, smirk." And nothing will change.

 

You need a work comp lawyer. If the first 17 weren't interested, call another 17.

 

Have you talked to the Bureau's ombudsman?

 

https://www.tn.gov/workforce/injuries-at-work/injured-workers/injured-workers/i-need-help--ombudsman-program-.html

 

 

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I've attempted to speak with the ombudsmen on several different occasions and each time I try to ask a question about any of the above, I'm told to call the mediator assigned to my case. The mediator has stated several times that I need to contact an attorney. He's explained to me that Tennessee law only allows an attorney to collect 20% of whatever is awarded and that most attorney's that did do workers comp cases are no longer doing them. By the way, the 17 I was referring to are the ones that contacted me back within 100 miles of my location. 

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Since your medical condition is obviously serious and should result in major amounts of money it is surprising that attorneys specializing in workers comp would not jump at the case.  That leads me to suspect there is a problem with the case that you have not disclosed.  How, exactly, did the injury occur?  Workers comp is responsible for injuries that occur as a result of the employment.  Did your injury occur because of a job related action?

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The injury occurred when a lanyard attached to myself and the equipment that I was operating malfunctioned when I tried to bend over to place a box on a pallet causing something in my lower back to pop. The lanyard was supposed to have had a 6 feet reach before it stopped. The one that malfunctioned acted like a seat belt at about 3 feet and would catch 3 times in a row at the same spot. 

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Your post is rather vague as to who "they" are and what you actually did and when. If "WC" (by which I assume you mean the carrier) cancelled an appointment, they would have had to know about it. No adjuster goes around calling doctor's offices and randomly cancelling appointments, and no doctor would remove an appointment from their calendar because some third party asked them to do so. Same with an MRI if you were using your own insurance and not making a WC claim. Now if you told your doctor that this was a work injury, the doctor might have declined to see you if they do not take WC. Your state does allow the employer to designate medical providers, at least initially. Did you request the panel of doctors from your employer when you filed the claim? If that didn't happen, did you file a petition of benefit determination?

 

I can guarantee we aren't getting the whole story here, either because you are confused or don't think certain happenings are relevant or you are being deliberately misleading. I don't know you so I don't know which camp you fall into but the above poster is correct that for attorneys who handle WC, it is like shooting fish in a barrel and if 17 have turned you down when compensation is guaranteed under statute, something is amiss.

 

https://www.tn.gov/workforce/injuries-at-work/available-resources/redirecr-available-resources/a-beginner-s-guide-to-tn-workers--comp.html

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Despite ElleMD guaranteeing that the entire story wasn't being told, all relevant facts have been told here. I will also say that the mediator assigned to my case has ordered my FORMER employer and workers comp carrier to settle or he's turning the case over to the workers comp courts. Also, I filed a discrimination complaint with the EEOC and found out that I have one hell of a discrimination suit against my former employer. It seems that because of my age and now disability from the work related injury, my former employer denying me medical treatment violated several Federal laws. Everything that I've stated in all my replies fromthe beginning can be backed up by documentation provided by either workers comp, my former employer, the case worker or treating physicians. 

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Since, "You have a good case but it's not something I'm interested in" is code for, "You've got nothing and I want to ease you out of my office quietly",. you'll have to forgive us if we think something is missing from your story anyway. If your case was as good as all that, at least one of those 17 attorneys would be interested.

 

What is the status of your EEOC claim? It makes a difference what I recommend next.

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Except you are mistaken as to how the law works. WC is governed by the state (unless you work in the federal public sector in certain industries such as Energy or railroad or longshoreman, etc.). Any violations of the WC statutes for your state are remedied solely at the state level and within the WC system. It is what is known as an "exclusive remedy". Now there are potentially other actions an employer might take that could violate federal law, but the handling of a WC claim would not be one of them. WC was the "great compromise" and part of that deal is that what happens in WC, stays in WC. This is true in every state. Nothing you have shared would raise the red flag that any federal laws have been violated but again, we don't have the full story. Even if your employer did violate federal law, the EEOC will either mediate the claim, including take it to court on your behalf if all other attempts to resolve it fail (and if this happened a few months ago, you are no where near that point), or give you a "Right to Sue" letter. The letter essentially says they didn't see a clear violation, but you are free to pursue it through the courts on your own. Again, none of this is a quick process and if you were just injured in late September, it would be unusual to the point of being unheard of for you to be through this stage with the EEOC.

 

Further, once you file a claim, your employer is out of the loop. Unless they are fully self-insured and self-administered (extremely rare) it is the carrier, not the employer who approves or denies care. If care is denied when you disagree that it should be, there is a remedy through the WC system, and only there. Contrary to popular belief, it is far from unusual for a contested WC claim to be adjudicated as opposed to settled. Especially at this stage. I've handled thousands of claims and mediators do not order anything. That isn't mediating. Even a judge or hearing officer/commissioner can not order a party to settle. It doesn't work that way. If it doesn't settle then by default it moves to a hearing. This is normal and not something either side would "fear" beyond the cost of litigation.

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18 hours ago, cbg said:

Since, "You have a good case but it's not something I'm interested in" is code for, "You've got nothing and I want to ease you out of my office quietly",. you'll have to forgive us if we think something is missing from your story anyway. If your case was as good as all that, at least one of those 17 attorneys would be interested.

 

What is the status of your EEOC claim? It makes a difference what I recommend next.

As of yesterday, I received my right to sue from the EEOC. I  have multiple grounds of discrimination based on the same information given above plus I was unjustly fired from my job 2 days after filing the Petition for Benefit Determination is not only retaliation and illegal on a state level, it proves discrimination on a Federal level also. My workers comp case is based on not getting medical treatment in a timely manner. I was injured on September 22, 2017, the Environmental Health and Safety manager for the next 2 months refused to allow me to go to the doctor. She went as far as to say, and I quote; "In my professional opinion the only thing the doctor is going to tell you to take ibprophen and to use bio freeze on your back", end quote. I do believe that that constitutes abuse of power by authority figure.

 

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18 hours ago, ElleMD said:

Except you are mistaken as to how the law works. WC is governed by the state (unless you work in the federal public sector in certain industries such as Energy or railroad or longshoreman, etc.). Any violations of the WC statutes for your state are remedied solely at the state level and within the WC system. It is what is known as an "exclusive remedy". Now there are potentially other actions an employer might take that could violate federal law, but the handling of a WC claim would not be one of them. WC was the "great compromise" and part of that deal is that what happens in WC, stays in WC. This is true in every state. Nothing you have shared would raise the red flag that any federal laws have been violated but again, we don't have the full story. Even if your employer did violate federal law, the EEOC will either mediate the claim, including take it to court on your behalf if all other attempts to resolve it fail (and if this happened a few months ago, you are no where near that point), or give you a "Right to Sue" letter. The letter essentially says they didn't see a clear violation, but you are free to pursue it through the courts on your own. Again, none of this is a quick process and if you were just injured in late September, it would be unusual to the point of being unheard of for you to be through this stage with the EEOC.

 

Further, once you file a claim, your employer is out of the loop. Unless they are fully self-insured and self-administered (extremely rare) it is the carrier, not the employer who approves or denies care. If care is denied when you disagree that it should be, there is a remedy through the WC system, and only there. Contrary to popular belief, it is far from unusual for a contested WC claim to be adjudicated as opposed to settled. Especially at this stage. I've handled thousands of claims and mediators do not order anything. That isn't mediating. Even a judge or hearing officer/commissioner can not order a party to settle. It doesn't work that way. If it doesn't settle then by default it moves to a hearing. This is normal and not something either side would "fear" beyond the cost of litigation.

Are you an attorney? You say you've handled thousands of claims but yet you refuse  or cannot answer a simple question. So, here's another question for you, can a worker's comp carrier use a Nurse Practitioner to render a causation opinion? In the state of Tennessee, a nurse practitioner is NOT QUALIFIED TO MAKE A CAUSATION OPINION ! You say the mediator cannot "order" a settlement, this is partially true. When an injured worker has proved beyond a "preponderance of the law" that he has been denied medical treatment,  he can and did state, and I quote, "if parties cannot reach an agreement to settle, I'll have no choice but to turn it over to the Workers Compensation Court "! End quote.

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While I'm usually down for a good debate, I don't think that I should have defend myself here. I came here to have a couple of questions answered. Not to be asked non pertinent questions and have non pertinent remarks made to my questions. For the first 2 months after my reported injury, my EMPLOYER refused to give me medical treatment. End of story! Criminal charges have now been filed against the Environmental Health and Safety manager for abuse of power. This is a felony in Tennessee! After finally seeking medical treatment on my own accord, on 2 different occasions, I was diagnosed with a slipped disc and referred to a specialist for an MRI and treatment. After scheduling an appointment through my insurance, i was contacted by the Case Manager and gave her my history on medical treatment and advised her of my forth coming appointment with the orthopedic surgeon. 2 days later, the case manager called me and advised me that this appointment was cancelled! This was not a workers comp appointment!  5 days later, the case worker said that my "employer" wanted me to see their doctor and emailed me the first panel of doctors. This is 2 and a half months after date of injury and 15 days after diagnosis of a slipped disc. I picked the closest provider to my home because of having a difficulty with driving, sitting, standing or walking. At the time, I was led to believe that I was seeing a licensed doctor instead of a NP. The NP was not concerned with my current condition. Instead, he wrote my problems that I was there to see him on were left knee and left shoulder. Neither condition I was there for. The NP ordered xrays, read them himself and diagnosed me with sciatica and scoliosis. He also tested me for rheumatoid arthritis. The NP said I could return to work immediately  since non of my symptoms were work related. However, the NP scheduled me another appointment for 4 days later. On this visit, the NP again diagnosed me with sciatica and scoliosis, claimed that the causation was age and released me to full duty. When I tried to question the NP about him making a causation opinion, he became threatening, got in my face with his fist balled uo and told me to get the f*** out of his office! From this point, the workers comp carrier refused to offer me any more treatment saying that the NP was fully capable of rendering a causation opinion. On January 2, 2018, I saw my personal doctor and finally got the MRI on my lower back. Diagnosis is slipped, or herniated disc. The workers comp carrier then decided to have me see their doctor who agreed with the diagnosis but said the causation was age and was an aggravation of a 30 year old back injury. This is 3 and a half months after initial injury. No further treatment has been offered. Now, I filed a Petition for Benefit Determination and my former employer fired me 2 days after filing the Petition for Benefit Determination. I do believe that's called retaliation! I do believe that my questions of is this an acceptable practice of denying medical treatment and does anybody have any case law are plain, cut and dried questions. Every aspect of my case has been submitted to the mediator and his first concern was that Tennessee law requires a 51% or more causation opinion of injury being work related being met. When I filed the Petition for Benefit Determination, it was clear that I was NOT going to allow a NP to issue a Causation Opinion. If you remove the NP from the equation, as the mediator has stricken the NP's opinion from the record,  there is a clear intent by the employer and workers comp carrier to deny me medical treatment. 

 

Everything stated above is documented with the Division of Workers Compensation Court and in the records filed in my case!

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A right to sue letter is essentially the EEOC saying, "We're not taking this one on - you're on your own". You now have 90 days in which to file suit, after which time you are forever barred from doing so. Note that this refers only to those issues under the EEOC's jurisdiction, which does NOT include any workers comp issues.


So unless you're planning to handle the discrimination claim pro se, which is not a good idea since your employer will have attorneys, you need to pick up the pace and start dialing. Do not send emails or texts; attorneys will  much more inclined to ignore unsolicited cyber messages than they will a phone call.

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4 hours ago, cbg said:

A right to sue letter is essentially the EEOC saying, "We're not taking this one on - you're on your own". You now have 90 days in which to file suit, after which time you are forever barred from doing so. Note that this refers only to those issues under the EEOC's jurisdiction, which does NOT include any workers comp issues.


So unless you're planning to handle the discrimination claim pro se, which is not a good idea since your employer will have attorneys, you need to pick up the pace and start dialing. Do not send emails or texts; attorneys will  much more inclined to ignore unsolicited cyber messages than they will a phone call.

The EEOC complaint is simple. No need to waste money on something that is already proven. The reason given for the Right to Sue letter was because my former employer refused to try to settle. But thats beside the point. I asked 3 questions that have yet to be answered. Instead, the ones that have answered have insinuated that I'm lying, not telling the whole story or some other bs remark. I have yet to get a straight forward answer. 

 

BTW, I'm very law literate. Shocks me to see so many answers on "law" site that are so far off mark!

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29 minutes ago, cbg said:

Then I, at least, won't trouble you with any more answers that do not suit your expectations of what a message board can do for you.

 

Have a good day.

If your answer or remarks were pertinent to the questions asked, I would welcome them. However, you have not answered my questions! The reason that I needed the case law was not to quote them, but instead, to have a better understanding of the process and time frame of what is considered acceptable medical care. Due to the worker's comp carrier's attorney, I do not need this information. It appears from the record that he's more concerned with justice than he is with who is paying his bill. The reason I say this is because said attorney did not have to state in his position statement that a NP is NOT qualified to render a causation opinion and he further agreed that medical treatment had been "unnecessarily delayed"! I do not know if this was a slip or if said attorney is use to representing the injured instead of the carrier. This I cannot answer nor do I intend to try.  However, i do think that if responses to specifically asked questions are kept on task, that there would be alot more communication from alot more members. Just my opinion!

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