Visitor Question

Fell again while out on workers’ comp?

Submitted By: A (USA)

I fell at work 4 months ago and hurt a pre-existing lower back injury, plus causing new injuries in my neck, upper back and hip. Today I fell while still out on workers’ comp, due to my back locking and having spasms. My leg is still weak so I could not get my footing and I went down.

Now I feel new pains and don’t know if this is going to be considered a new injury or continue the original workers’ comp case. The fall was caused by the weakness of the original injury. I had an MRI of my lower lumbar, but am still waiting on getting the MRI of my hip, neck and upper back done. I don’t have documented images of these areas, just verbal reports.

My question is, what if I hurt myself more from this fall, while still trying to determine the extent of damage from my first injury? Can they tell me that since I didn’t fall at work this time that it’s not covered, or try to deny this fall?

I’m going to the doctor tomorrow to let them know I fell again, and I’m worried about what’s going to take place. How do I stop them from trying not to accept these new injuries and the further damage to the pre-existing injuries? Thank you.

Disclaimer: Our response is not formal legal advice and does not create an attorney-client relationship. It is generic legal information based on the very limited information provided. Do not rely upon the information in our response, or anywhere else on this site, when deciding the proper course of a legal matter. Always get a personalized case review from a local attorney.

Answer

Dear A,

You are in a difficult position. Workers’ compensation insurance companies are notorious for denying coverage for injuries outside of work, and aggravation of prior injuries. This is not to say your claim for additional coverage will be denied.

While your fall occurred off the job, if your treating physician can convince the insurance company your new injury was the direct result of your on-the-job injury, it will be difficult for the insurance company to deny additional coverage.

Without confirmation from your treating physician about the direct link between the work injury and your new injury, the insurance company will likely deny additional coverage.

Alternately, if your treating physician refuses to make a direct link between your work injury and new injury, you can ask the insurance company to permit you to seek a second opinion from another company approved physician. Moreover, to support the link between injuries you can seek a medical opinion from a private physician.

The more proof you have of a direct link between the injuries, the better your chances are of obtaining additional coverage from the insurance company.

The above is general information. Laws change frequently, and across jurisdictions. You should get a personalized case evaluation from a licensed attorney. Find a local attorney to give you a free case review here , or call (888) 647-2490.

Best of luck,

Published: July 7, 2014

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