CP Lawyers... please help

[Fire Me Boy!]

Any of our lawyers here willing to talk to me about a workers compensation issue?

[Baby Lee]

MO, IL, KS?

[Fire Me Boy!]

Missouri. Sorry, should have included that. It's been a rough day.

[Baby Lee]

Missouri. Sorry, should have included that. It's been a rough day.
Is this a guessing game? :p

[Sure-Oz]

So what happend if i may ask?

[KCFalcon59]

Fire Me Boy, Fired?!!

[Fire Me Boy!]

I'd rather do this through PM.

Long (very) story short, wife had a pretty major knee injury in Feb. 2006 that required surgery. Hasn't been to a doctor in over a year. No problems.

Just recently, knee started bother her again all the time. Crunching noise is back in her knee, little fluid pocket there, too.

She has done nothing to cause the injury to reappear.

Workers' comp is saying she was cleared a long time ago, they're not responsible... wanna talk it over, here's a lawyer's phone number.

I have lots of questions, beginning with "Can they do that?"

She's not saying she needs another surgery. She's saying she needs to see a doctor.

[Skyy God]

Pm me. I've done plaintiff's comp before and currently do defense.

[Fire Me Boy!]

Pm me. I've done plaintiff's comp before and currently do defense.
You got it.

[Baby Lee]

I'd rather do this through PM.

Long (very) story short, wife had a pretty major knee injury in Feb. 2006 that required surgery. Hasn't been to a doctor in over a year. No problems.

Just recently, knee started bother her again all the time. Crunching noise is back in her knee, little fluid pocket there, too.

She has done nothing to cause the injury to reappear.

Workers' comp is saying she was cleared a long time ago, they're not responsible... wanna talk it over, here's a lawyer's phone number.

I have lots of questions, beginning with "Can they do that?"

She's not saying she needs another surgery. She's saying she needs to see a doctor.
They can certainly take the position that present pathology is not work related. Likewise you can assert your position that it is. If their position is as it appears it is, you need to get a claim on file, and decide if you want to incur the expense [20% of what you recoup in PPD, plus expenses] of representation to press the matter.
You should know, regardless of the present need for medical, a surgically repaired knee injured in a work accident is entitled to 15-20% permanent disability, up to $9,500-12,000, depending on you wife's average weekly wage.
If you get the employer to continue to provide treatment, they'll continue to have the right to chose your treatment provider. You have the right to choose treatment at you own expense, or submit it to group insurance, and hash out recoupment of medical expenses in the settlement of the claim.

[Baby Lee]

Pm me. I've done plaintiff's comp before and currently do defense.
You do MO, too?

[Fire Me Boy!]

They can certainly take the position that present pathology is not work related. Likewise you can assert your position that it is. If their position is as it appears it is, you need to get a claim on file, and decide if you want to incur the expense [20% of what you recoup in PPD, plus expenses] of representation to press the matter.
You should know, regardless of the present need for medical, a surgically repaired knee injured in a work accident is entitled to 15-20% permanent disability, up to $9,500-12,000, depending on you wife's average weekly wage.
If you get the employer to continue to provide treatment, they'll continue to have the right to chose your treatment provider. You have the right to choose treatment at you own expense, or submit it to group insurance, and hash out recoupment of medical expenses in the settlement of the claim.
That 15-20 percent disability you're talking about, is that in writing somewhere? The original settlement we received was for 5 percent. The doctor rated her at 0 percent disability over a year ago, despite her being there telling him she had recurring pain in her knee.

He just kept saying, "Well, there's no reason you should be. It'll go away."

And for the most part, it did go away, until now.

[Baby Lee]

That 15-20 percent disability you're talking about, is that in writing somewhere? The original settlement we received was for 5 percent. The doctor rated her at 0 percent disability over a year ago, despite her being there telling him she had recurring pain in her knee.

He just kept saying, "Well, there's no reason you should be. It'll go away."

And for the most part, it did go away, until now.
No, that's a rule of thumb for settlement of surgically repaired extremities without undue complications, represented by counsel. It's based on a history of what the ALJ's commonly award if the matter proceeds to hearing.
So you signed a settlement contract?
That changes a lot.
If you are not alleging a new work injury and are saying that this is from the original injury, they're gonna stand on the assertion that the ALJ told you at the time of authorizing settlement that this settled the claim. You're gonna have to hoe the road of alleging a 'change in condition' related to the original injury, but not contemplated at the time of settlement.

[Fire Me Boy!]

No, that's a rule of thumb for settlement of surgically repaired extremities without undue complications, represented by counsel. It's based on a history of what the ALJ's commonly award if the matter proceeds to hearing.
So you signed a settlement contract?
That changes a lot.
If you are not alleging a new work injury and are saying that this is from the original injury, they're gonna stand on the assertion that the ALJ told you at the time of authorizing settlement that this settled the claim. You're gonna have to hoe the road of alleging a 'change in condition' related to the original injury, but not contemplated at the time of settlement.
No. No settlements have been signed. Offered, yes, refused, yes.

We offered a counter settlement (for abou $10K), but they refused that.

[Baby Lee]

No. No settlements have been signed. Offered, yes, refused, yes.

We offered a counter settlement (for abou $10K), but they refused that.
Ah, the settlement OFFER you received, not the settlement you received.
Sounds like they're playing hardball, even lowballing your PPD [5% is a joke, even conservatively treated [ie, physical therapy/cortisone injections only] strains resulting in time off are going for 7.5 nowadays]. I'd suggest representation, particularly if you envision that she is going to need additional disability time off in the near future [whether due to the condition untreated, or in recouperation from additional treatment].
Your big three in WC is medical, time off [Temporary Total Disability], and permanancy [Permanent Partial Disability]. The first one, if they remain in the control of the employer/insurer, should not even cross your radar [they get the invoices and pay them]. The last two are tax free. You should get TTD from the time you are unable to work until a doctor either releases you to full duty, or to light duty that the employer can AND DOES accomodate. You should get PPD commensurate with what other similarly situated employees receive, varying depending on one's wage rate, not by percentage of disability.

Since you mentioned that the injury occurred in February of 2006, I'd get to filing a claim, as the statute runs 2 years from the date of loss. However, that's just being overly safe, as there is an alternate statute of limitations of 2 years after the last payment of medical relating to the injury [ie, if they hadn't paid the invoice for her surgery until today, you'd have 2 full years from today].

If you don't mind my asking, was this an acute or repetitive trauma. ie, did she slip and fall with immediate pain, or did it arise over time due to job duties.

And if your wife makes more that $650 a week average, then the 10K is eminently fair for a surgically repaired knee, about 16% PPD.

[Fire Me Boy!]

Ah, the settlement OFFER you received, not the settlement you received.
Sounds like they're playing hardball, even lowballing your PPD [5% is a joke, even conservatively treated [ie, physical therapy/cortisone injections only] strains resulting in time off are going for 7.5 nowadays]. I'd suggest representation, particularly if you envision that she is going to need additional disability time off in the near future [whether due to the condition untreated, or in recouperation from additional treatment].
Your big three in WC is medical, time off [Temporary Total Disability], and permanancy [Permanent Partial Disability]. The first one, if they remain in the control of the employer/insurer, should not even cross your radar [they get the invoices and pay them]. The last two are tax free. You should get TTD from the time you are unable to work until a doctor either releases you to full duty, or to light duty that the employer can AND DOES accomodate. You should get PPD commensurate with what other similarly situated employees receive, varying depending on one's wage rate, not by percentage of disability.
Sorry, I knew it was the offer... why didn't you? :p

Thanks for the information...

[Skyy God]

So can they do that?

What kind of recourse do I have?

And if I decided to fight in court, I'm assuming I'd need a lawyer... but until then is the medical cost up to us? And if it is, and an appeal were granted, would we be reimbursed for the cost of medical care?

The people at the insurance place indicated to her some time ago that if she were to go to her own doctor she'd forfeit the right to a settlement and all costs would be up to her... I think that's BS.

BL covered this pretty thoroughly, but there's a few other areas to consider.

1) If this was a repetitive-type injury, I'd strongly suggest hiring a lawyer. For reasons I won't get in to, they're more complicated cases.

2) How long has it been since she stopped treating? It's pretty customary to send a claimant back for treatment within 6 months of being released by the comp doctor and for the insurers to balk if it's outside that time frame.

3) In Missouri, the attorneys fees are 25% plus expenses, compared to 20% in IL.

4) The "forfeit the right to a settlement" line is ridiculous and frankly makes me mad. I'd request that they provide a second opinion regarding the need for further treatment. If they refuse, your options are to obtain one on your own or hire an attorney.

[trndobrd]

Comp issues aside, nothing happened to reinjure the knee and less than a year later she has grinding and fluid build up. Am I detecting the aroma of Med Mal?

[Fire Me Boy!]

BL covered this pretty thoroughly, but there's a few other areas to consider.

1) If this was a repetitive-type injury, I'd strongly suggest hiring a lawyer. For reasons I won't get in to, they're more complicated cases.

2) How long has it been since she stopped treating? It's pretty customary to send a claimant back for treatment within 6 months of being released by the comp doctor and for the insurers to balk if it's outside that time frame.

3) In Missouri, the attorneys fees are 25% plus expenses, compared to 20% in IL.

4) The "forfeit the right to a settlement" line is ridiculous and frankly makes me mad. I'd request that they provide a second opinion regarding the need for further treatment. If they refuse, your options are to obtain one on your own or hire an attorney.
1) Not a repetitive type injury... one-time deal.

2) She was in constant contact with her doc from Feb. 2006 to July 2006, with surgery, physical therapy, etc. In July 2006, they cleared her to work fully. Since then, nothing. No follow-ups.

When they sent the offer to settle, they said they'd send her back to the doctor to get a follow-up. That never happened. A few weeks later we got the offer, which we declined.

Now this.

4) For getting a second opinion... how do you go about that? Just call the insurance place and tell them we'd like them to send her for a second opinion for further treatment?