I was injured on the job and was initially diagnosed with a shoulder strain, however, after two months of physical therapy my doc decided it was time for an MRI.
Another month passed and the doc reviewed the MRI with me, revealing that I had a torn rotator cuff.
My doc prescribed another twelve weeks of therapy (two six week sessions) before I decided to get a second opinion. My new doctor reviewed the MRI and told me that surgery should have been done immediately. He showed that there are issues with my neck that we will have to discuss after the shoulder heals. During surgery, my doc repaired the rotator cuff and a labrum tear (that he found during surgery).
It’s now nine months later and my shoulder is feeling much better; however, I have continuous pain in my neck and between my shoulder blades.
My doc sent me to a spine specialist and I learned that I have a herniated disc, one disc is tilting to the right, and a severe nerve compression. The doctor prescribed 8 weeks of therapy and an epidural steroid shot in the neck.
I forwarded all the related documents to my WC adjuster, followed by an email ten days later reminding him that I need an approval. His response is listed below…
“I reviewed the initial treating medical records and the statement you provided to me at the beginning of the claim. I did not locate any mention of the neck being injured. I will contact for further explanation and will let you know of the response. Thank you.”
I have no history of neck pain and I was unaware of additional problems until surgery was performed and months of physical therapy had been prescribed. How can I be expected to report this in an interview that took place nearly sixteen months ago? Can they refuse to provide benefits because I didn’t report the injury immediately? Thanks for any info.
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.
You may be overreacting. The response from the claims adjuster does not even imply coverage for your neck injury will be denied. On the contrary, it appears the adjuster just wants to review your recent medical records to be sure the neck injury was related to the initial injury.
To be eligible for treatment and related compensation, an injury must be linked to the work injury event which set the treatment in motion. From the facts you present, there appears to be a clear link between your initial injury and subsequent neck pain.
Once obtained, the adjuster will review your medical records. After doing so it is quite likely coverage for your neck injury and required treatment will be approved.
Learn more here: Pre-existing Conditions
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 with your claim.
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