Workers Comp Help
Torn Meniscus After Falling At Work
Aloha.
In Jan 1996 I had a fall at my place of work (I was trying to avoid someone getting hit on the head) I dove to catch the item and during the course of action injured my left knee. I heard the crack immediately it happened.
I suffered pain and swelling for a couple of hours and then went to the Doctor in the emergency room where they removed fluid from the knee (this was done twice) I was then sent home and told to rest the leg and ice it and take a easy. after several visits I was sent to a ortho who after examining me advised that a operation was best. This took place in November, all went well and pt was ordered at the very first visit I made it clear there was still a lot of pain and in fact after several weeks and there still was no improvement and I still could not complete many of the exercises instructed to do by the pt assisting me.
I went back several months later for a follow up and told the ortho/surgeon of the status he kind of just fluffed it off, by saying lose weight! I was sent to another ortho for a independent evaluation, who after examining me said I had 4 % disability in the knee!
I learned to avoid things like going down stairs where my knee would lock up, or run and I learned to live with the slight pain. Until 2000 when my job required me to walk longer distances and the pain returned with a vengeance. I began taking prescribed pain pills and Celebrex which did help for a time, however this was only a short term reprieve from pain so I went back to see the original ortho to ask then to look at the knee again! This was the start of a nightmare
I was told that the case was under workers comp since this was from a old injury and they would not treat me (unless I was willing to pay them directly) was very unhappy since I had been covered by my own insurance and a secondary on my husbands. I was so upset that after 2 visits and getting no where I had a fit and forced the facility to perform a MRI which clearly revealed a tear below the original injury now keep in mind after the first injury I was never given a x-ray prior or post the operation.
The Doctor advised that a second surgery could relieve the terrible pain, however he was unwilling to schedule a operation since it was workers comp. Now here is the cruncher the facility is where I had signed up as my HMO and therefore under my own policy would normally be treated for free. I was then told to contact the company that had covered the original operation to find that they no longer cover the company that I work for since there had been a merger and we were now officially under a new company. This did not however change our individual coverage.
The company whom I work for after several months forced the ins company to reopen the case, after 5 months! I was finally sent to a independent Doctor not a Ortho for a evaluation who in turn agreed that surgery was in fact the only solution and he was adamant that it be asap. This took place Jan 02 I was later verbally advised that the ins co had denied my claim to have surgery! As of this date nothing was given in writing and on the 8th of August 2001 I will have a hearing with workers comp.
In the meantime not wanting to lose my job I continued to work and endure by taking additional pain pills to perform my duties.
As of last week all was well until I nearly had a head on collision driving home from work (too many pain pills) and Celebrex! The following day went to see another Doctor, who agreed that my knee was in bad shape and in fact the right knee was also from my favoring the right knee. He immediately ordered me off the Celebrex and changed the pain pills and gave me a shot in the knee!!
At this time I am off work, per the Doctor and awaiting to apply for TDI and awaiting my results from the hearing and then hopefully will be able to have the operation. as my HMO says once your case is officially denied then we can step up and cover the costs! This has been over 12months of fighting to get treatment!
Update
The day prior to my workers comp hearing I received a 30 page document showing the results of the independent evalution which had taken place on 2/02/2001 that my original insurance handling workmens comp case had set up!I t took them 8 months to the day to get the info to me and 24 hours prior to my hearing with Hawaii workers comp/industrial board. of course it had some of the facts but many areas where biased in favor of the Insurance Co. There was little to do about refuting any of the contents with such a short amount of time.
On the same day I had to see my current Doctor treating me for a second shot in the right knee (which is now giving acute pain) from favoring the right for such a long time. Basically the hearing was postponed this will allow me to get more back up data!
What a drama! this really sucks the life blood from you! I feel no recourse but to try and obtain a lawyer! I also contacted my hmo directly again and asked if there was anyway they would make a allowance and approve the surgery and wait on the final outcome the answer was no! They must have a denial letter from the company insurance carrier (that initially handled my initial injury) they also speak volumes about weight actually they are calling it obesity for the primary reason for the original injury that took place on 1/16/96 where i was on the job.
This is really a hard time and its a catch 22 with me in the middle.