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  • jdubs71
    Senior Member
    • Feb 2013
    • 690

    OJI Advice

    I'm hoping I can get some advice from those who have experienced a work related injury and had to deal with workers comp insurance companies.

    I will try to keep this as short as possible so here goes;

    In 2012 I had an on the job injury (torn meniscus) I went to rehab for three weeks and had an MRI which showed a tear. I was one of the lucky few where the tear actually fell back into place causing the pain and most of the swelling to go away. After a few months the orthopedic made his recommendation that I will need future medical, but my injury was considered permanent stationary.

    Fast forward to 2014, 2.5 years after the injury and I'm still symptom free for the most part. I have days where my knee is sore, but it comes and goes. I now work for a different agency, but they knew what they were getting when I was hired. I passed the physical exam, but there is documentation of the preexisting injury.

    I received some paper work recently from the workers comp insurance person assigned to my case. This person explained that due to the time that has passed since my injury and the fact that I have not needed any further medical treatment, they want to close my case with future medical in the event i need to have surgery as indicated by the orthopedic. I asked what would happen if I refused to sign the paperwork to close the case and was told by the insurance person that by law the case has to be settled/closed. Since the case is still open if I were to need surgery tomorrow the medical expenses would be paid and I would receive 4850 pay, if the case is closed by the time i need surgery the medical will be covered however I would have to use my own time and would not get 4850 pay. To me its a no brainier to leave it open and not sign anything.

    In my opinion they tried to pull a fast one by sending the paperwork requesting I sign and return it, because when I talked to them in person and said I didn't feel comfortable signing they asked If I would be interested in a settlement to close the case to which I said no.

    So my question is does anybody know if there is a law that states the case has to be closed by a certain date? I tried calling the workers compensation appeal board, but they have not called me back yet. Also, would my current agency be responsible for doing anything if it involves an injury from my previous agency? Any advice would be much appreciated, sorry for the long post.
    Last edited by jdubs71; 11-03-2014, 9:49 PM.
    "Common sense is not so common"
  • #2
    Samuelx
    Senior Member
    • Apr 2010
    • 1558

    Hey Jdubs, I recommend looking into getting legal representation (LE work comp specialists). Good luck with your situation!

    Comment

    • #3
      jdubs71
      Senior Member
      • Feb 2013
      • 690

      Originally posted by Samuelx
      Hey Jdubs, I recommend looking into getting legal representation (LE work comp specialists). Good luck with your situation!
      Thats what I was thinking after my conversation with the insurance person. I'm hoping the information and assistance personnel from the workers comp appeal board will have some advice too. its kind of a unique situation and I don't want to get screwed in the end.
      Last edited by jdubs71; 11-04-2014, 6:24 AM.
      "Common sense is not so common"

      Comment

      • #4
        003
        Veteran Member
        • Jul 2010
        • 3436




        You need an attorney; call these folks. One of the very best legal firms in Southern California. They specialize in Police and Fire.

        Comment

        • #5
          rcslotcar
          Senior Member
          • Jul 2014
          • 1100

          Get an Attorney, you know the insurance company "IS NOT" looking out for you. You never know if you have a fall or get into fight in 5-10 years that re injures you knee.

          Comment

          • #6
            jdubs71
            Senior Member
            • Feb 2013
            • 690

            Good advice, i think I will call an attorney. Thanks for the contact info 003
            "Common sense is not so common"

            Comment

            • #7
              gmbat
              Junior Member
              • Oct 2013
              • 22

              I'm not an LEO, I teach and coach. I had a similar WC situation with a back injury sustained while coaching. Bad enough to act up on occasion, not bad enough for surgery, YET. When WC tried to settle and close my case, my Dr. wrote a letter to the effect that the case needs to remain open due to the likelihood that surgery will need to be performed at some point. I see him for an exam every 6 months to satisfy WC's "treatment" requirement. It pisses me off that taxpayer money is wasted on unneeded office visits, but we couldn't find a way around this. This has worked for 25 years. My medical will also cover expenses if / when I need surgery, but I want the WC coverage for the time off from work for recovery and PT after surgery, rather than having to use my accumulated sick days. Plus, taking a cash settlement and then having my district's insurance cover all the expenses would be double dipping and not the right thing to do.

              If you have access to legal counsel, take advantage of it. I didn't (my district is non-union), but didn't need it in my situation. Good luck. By the way, I've had 6 knee surgeries from my rugby days. If they scope you to clean up the meniscus, it's a cakewalk.

              Comment

              • #8
                TrailerparkTrash
                Veteran Member
                • Oct 2005
                • 4249

                Putting aside your WC case, NOBODY on earth can force anyone to sign anything. It's NOT, nor has it been ever a "crime" to refuse to sign any document. Even refusing to sign a traffic ticket is NOT a "crime." It causes other problems, but you will never be charged for not signing something.
                sigpic

                It`s funny to me to see how angry an atheist is over a God they don`t believe in.` -Jack Hibbs

                -ΙΧΘΥΣ <><

                Comment

                • #9
                  jdubs71
                  Senior Member
                  • Feb 2013
                  • 690

                  Originally posted by TrailerparkTrash
                  Putting aside your WC case, NOBODY on earth can force anyone to sign anything. It's NOT, nor has it been ever a "crime" to refuse to sign any document. Even refusing to sign a traffic ticket is NOT a "crime." It causes other problems, but you will never be charged for not signing something.
                  I know insurance companies just like to try and bully people around. I'm not trying to get more than its worth, I just want whats fair. I have a few calls in, but nothing yet.
                  "Common sense is not so common"

                  Comment

                  • #10
                    retired
                    Administrator
                    CGN Contributor - Lifetime
                    • Sep 2007
                    • 9409

                    I, like the others, advise you obtain the representation of a worker's comp. atty. asap. Unlike 003, I recommend a different law firm that not only numerous leos use, but also firemen. In fact, it was a fire Capt. in my patrol area that recommended this group and I have been satisfied with their work for over 30yrs.



                    I did use the other firm for my first case and decided not to do so in the future. If you wish more info on that, pm me.

                    Due to several injuries and numerous surgeries, I unfortunately have had a lot of experience in dealing with WC issues and I still do as I write this. As a matter of fact, a couple of years ago, I was advised by a Lt. on the dept. that I had the distinction of having the worse problems in dealing with WC and the Utilization Review company of any active or retired leo on the dept. A distinction I did not want.

                    So you know, once the law went into effect in 2005, that Utilization Review companies would be the norm, most decisions as to meds and procedures were taken away from WC workers. The UC companies have medical personnel (doctors, nurses) who review the reports written by a patient's doctor. They approve or deny the requests by the doctors for the patients.

                    A new layer of review went into effect in Jan. of this year IIRC. It is called the IMR (Independent Medical Review). Basically, if the UR company denies a procedure or medicine request made by a patient's doctor, the patient can appeal that decision to the IMR. If the IMR agrees with the Utilization Review company, there is no appeal from that decision. The patient is SOL.

                    Per my atty. (the firm I listed), prior to May, there were approximately 10K appeals monthly in Ca. In May, that jumped to 20K per month. The denial rate was at 80% which obviously means only 20% of the patients who appealed the denial of the UR company had that decision overruled.

                    Additionally, due to the large numbers of patients who appeal, it takes a very long time (don't know how long since I'm in the process now) for a decision. During the interim, the patient may be without medication or unable to receive any procedure (s) his doctor may believe is/are necessary.

                    For years, statewide, many people abused the system and it cost employers and insurance companies millions of dollars. I personally know of two who did that and both were arrested for Grand Theft and WC fraud. One was in the jail I worked at when I was a sgt. I am glad they were, because they screwed things up for people like me who were genuinely injured.

                    I like to describe this as the pendulum being all the way to one side. I surmise those who passed the law that brought the UC companies into the picture, thought the pendulum would now go to the middle, with both the patients and the insurance companies getting a fair shake. Unfortunately, that didn't happen and the pendulum has swung to the other end of the spectrum to the detriment of the injured party.

                    Don't sign anything until you hire a good WC atty. and I think one of the best is the firm I listed.

                    Good luck.

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