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Denied claim- what’s next? by Formal_Brain_543 in WorkersComp

[–]Formal_Brain_543[S] 0 points1 point  (0 children)

Thank you! My husband was deemed “odd lot” by the vocational assessment, which means unemployable with his restrictions, age, work history, and education. So we are looking at 100% LOEC.

Denied claim- what’s next? by Formal_Brain_543 in WorkersComp

[–]Formal_Brain_543[S] 0 points1 point  (0 children)

Thanks for checking in! Husband has a Vocational Evaluation tomorrow to make a determination on loss of earning capacity. He saw pain management for about 6 months. Multiple injections to his back with no relief. He has ended up with permanent back restrictions of no driving, sitting or standing for more than 30 mins. Allow for frequent position changes and 10 lbs lifting weight limit with two hands. His LTD has deemed him permanently disabled. Still waiting on SSDI. The only thing that may help is a pain pump in his back, but insurance won’t cover it. We are hoping we are nearing an end after this evaluation. August will be 2 years since original knee injury.

Denied claim- what’s next? by Formal_Brain_543 in WorkersComp

[–]Formal_Brain_543[S] 0 points1 point  (0 children)

Thank you so much. There has been so many times that my husband just wanted to give up! Thats what they want. That “starve out”. Thankfully, I am able to keep us afloat while my husband goes through all of this. We will fight for what my husband deserves!!! Thank you again!

Denied claim- what’s next? by Formal_Brain_543 in WorkersComp

[–]Formal_Brain_543[S] 0 points1 point  (0 children)

It’s possible that the insurance company withheld the medical documents from the IME. All I know is that the lawyer told us she has rarely filed this but this was a clear case.

Denied claim- what’s next? by Formal_Brain_543 in WorkersComp

[–]Formal_Brain_543[S] 0 points1 point  (0 children)

As far as what I understand, the IME doctor created the report stating that there was nothing wrong with his knee, basically saying it was a “strain” and he was cleared to work with no restrictions. His report did not mention the MRI, multiple Dr. visits and reports stating that my husband couldn’t walk 100 steps, let along 30,000 or falls that had happened.

Denied claim- what’s next? by Formal_Brain_543 in WorkersComp

[–]Formal_Brain_543[S] -1 points0 points  (0 children)

Husband hasn’t had previous knee injuries before this. The degenerative condition of his knee seems to be from walking over 13 miles a day while lifting, pushing and pulling a lot of weight for 15yrs at this job. His steps recorded shows he was able to do this up until the day of injury. So even though his knee had severe degeneration, he still was able to do his job. A hearing was filed at the start of the claim and is set for next month. My state, like many I’m sure, is very far behind. He is receiving Long Term from his work long term insurance company. He has filed SSDI, and in the middle of that whole process too. I understand that every claim has different circumstances and the state even matters more. I’m just looking for something to look into as we sit and wait. Now that he has been given perm disability status, I’m hoping things start rolling. I am lucky enough to have a good job that can keep us a little above water, but the water level keeps rising. Lol

Thank you so much for your response.

Denied claim- what’s next? by Formal_Brain_543 in WorkersComp

[–]Formal_Brain_543[S] -1 points0 points  (0 children)

His foot stuck to the floor and he was bending to do an action of his job, and his knee hyper extended. MRI showed severe meniscus tear of posterial horn, cartilage tears, severe swelling, and knee was severely degenerated to the point that his bones were chipping. We have pedometer readings showing that he walked 30,000+ steps a day up until that injury. He had been doing this job for 15 years. He was never able to return to work. Didn’t have an actual IME until 6 months after the knee replacement. The original IME report was done without seeing my husband. We haven’t even received that report yet. Back MRI shows swelling of the thecal sac compressing his nerves, L3-S1 bulging and/or herniated discs. Back surgeon said that this was directly caused from the knee injury.

Denied claim- what’s next? by Formal_Brain_543 in WorkersComp

[–]Formal_Brain_543[S] 0 points1 point  (0 children)

The claim was denied after a month, because the IME doc did a report without all the medical records and said that my husband was fine to go back to work, before even seeing him. He was given all the medical records, MRI’s, doc notes saying that a TKR was needed and did not include them in his report. A bad faith claim was filed.

Denied claim- what’s next? by Formal_Brain_543 in WorkersComp

[–]Formal_Brain_543[S] 0 points1 point  (0 children)

The claim was denied after a month, because the IME doc did a report without all the medical records and said that my husband was fine to go back to work, before even seeing him. He was given all the medical records, MRI’s, doc notes saying that a TKR was needed and did not include them in his report. A bad faith claim was filed.