In 1996 I had a back injury lifting while doing my job duties. I was 26 years old. It was diagnosed as a herniated disk. I never even missed 1 day of work for the injury, but I continued treatment and physical therapy. Within 3 months I had the insurance company wanting to settle.
I had requested that other than the disability rating payment schedule, I also receive future medical costs. I think the payment schedule gave me about $3400. The disability rating was 8:1.
Of course, I had some issues for about the next 4 years. Pain, sciatica, 5 epidural injections, physical therapy, back brace, a tens unit, etc. I still did not miss work except for a couple sick calls here are there when I had severe back pain.
I went through years of having a “bad back,” which limited my activities and lifestyle. But I dealt with it on my own for 13 years. In 2013 I was having severe pain. I thought “heck with this, I’m going to get an MRI and some treatment to see what’s going on.” I contacted the workers’ comp insurance company to seek payment for these expenses.
The MRI showed the same things: herniated disk, dehydrated disks, now called “Degenerative disk disease.” I went to a pain management dr in town expecting some relief. They basically prescribed me oxycondone and told me to “see how it goes.” I couldn’t function on the oxy, and wouldn’t take it.
About 6 months later I switched to a Dr who was more into physical therapy, massage, electric stimuli, and something I had heard about called a traction table. I was in severe pain and had called in sick about 6 times in a month because of the pain. I asked the Dr to get me better and told him it was a workers’ comp case.
Over 2 weeks they treated me with all of the stuff at their disposal. I was reporting low pain numbers. On my 3rd week the dr office called and said workers’ comp denied the traction table and physical therapy, but they would pay for the prescription nucynta.
So all treatment stopped except meds, and the dr gave me work restrictions: no lifting over 20lbs, only working 4 hours a day, and frequent rest off of feet. So for the next 20 weeks I struggled through work, took lots of nucynta and used my tens unit, back brace, and spent most of my day at home lying down.
I wanted to see a surgeon so I made that appt. The surgeon had a 2 month wait to be seen. Finally, after seeing him he suggested we try a facet injection and radio ablation. Between the dr and the workers’ comp it took 4 weeks for them to deny the facet treatment. So I had it done on my own through my personal insurance. The injection determined that I was not a candidate for ablation.
I am completely out of work now. My short term disability at 100% pay runs out next week. It then drops to 60% and my company says that they will no longer pay my health benefits. So I’m stressed about money now too.
I have asked for an epidural injection through my adjuster. I bet they will deny it.
I’m contemplating going back to work in a wheel chair. I’m still in huge pain and have had no treatment for 5 months. And workers’ comp is denying anything but drugs.
So my question… My award stated future medical, yet they are denying everything. What can I do? Do I need a lawyer? And if so for what? The case was done when I signed the agreement 18 years ago. Also, what do I do about work? The injury was in California but I live in Utah now. Thank you very much for any information you can give.
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.
Section 337 of California’s Code of Civil Procedure establishes a four (4) year statute of limitations for most written contracts. As a result, you really don’t have the basis of a breach of contract claim.
Although we don’t have access to the agreement you signed regarding “future medical,” the agreement very likely contained additional language stating future medical was to be based on the opinion of certain physicians under the employment of the workers’ compensation insurance company.
While you can certainly seek the advice and counsel of a workers’ comp attorney, it’s likely the attorney will have a problem with the contractual obligation, and its statute of limitations. If you choose to seek the advice of an attorney, visit with several before you decide whether or not to proceed. It’s important to have confidence in your attorney.
Gather copies of all your medical records. In your case, the controlling documents will be the agreement you signed. Be sure to bring with you all those documents when you visit with the attorneys. They will be able to give you a better idea of the viability of your claim.
Learn more here: Worker Partial Disability Claims
The above is general information. Laws change frequently, and across jurisdictions. You should get a personalized case evaluation from a licensed attorney.
Best of luck with your claim,
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