Stopping benefits after 14 years of treatment for an industrial injury?
I fell into a hole in the floor 14 years ago while working as an insulator, hyperflexing my neck, back, and lumbar regions. This affects my central nervous system. My diagnosis is cervical spinal stenosis, lumbar spinal stenosis, somatic dysfunction of my cranial, cervical, thoracic, and lumbar spine, and fibromyalgia from nerves that fire even when I sleep.
This causes muscle cramps, headaches, a sleep disorder, and the claw hand syndrome. I settled with the insurance company with a 5 percent impairment rating and medical coverage for as long as I live with this industrial accident.
Last year, the insurance company representing my claim sent me to two doctors in another state to cancel my benefits. This was after the IME doctor of their choice agreed with my treating doctor's conservative treatment plan to help me avoid surgery in the near future.
The insurance company in the Compromise and Release agreement stated that I may have been injured more severely than a neck and shoulder sprain. They had films showing a lumbar injury when this was written. My injury is aggravated from not having the regular medical treatment to keep me healthy controlling TMJ (Temporomandibular Joint) headaches, and waking up every hour on the hour when I try to sleep.
I will be getting a new MRI and nerve conduction studies in a few weeks, along with letters from my doctors about causation and specific injured body parts. I also hope to get the apportionment questions answered.
I can not find a lawyer to represent me, so I will be requesting the Workers' Compensation office here in Alaska reopen my case and answer questions of apportionment and causation.
What should I ask the board to consider when looking at my case? I will be requesting a Second Independent Medical Evaluation (SIME). I realized if I don't ask I will not be heard or evaluated properly. I need to get my benefits back. Thank you for your answer.
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ANSWER for "Stopping benefits after 14 years of treatment for an industrial injury?":
Convincing the board to reopen your claim will be difficult. Compromise and Release agreements normally resolve a worker's entire claim. This includes past, present and future medical and therapy treatment. The exception is if a worker can prove the Compromise and Settlement agreement was fraudulent.
To have any chance of convincing the board to reopen your claim will require the SIME physician to conclude your present pain would likely not have occurred if the board had authorized the previously required medical and therapy treatment.
Ask the physician not to equivocate in his or her medical narrative. The more specific the physician is, the better chance you will have of convincing the board to reopen your claim.
If you are unable to convince the SIME physician to conclude your present injuries would not have occurred if you had the medical treatment your previous injury required, ask to be seen by another SIME physician. You have that right.
The above is general information. Laws change frequently, and across jurisdictions. You should get a personalized case evaluation from an attorney licensed in your state. Find a local attorney to give you a free case review here, or call (888) 647-2490.
Best of luck,
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