Workers Comp Help
Slipped on Ice At Work
My story begins in 1997. I am a divorcee who struggled for years to support my son. Child support was something my ex-husband would pay when he felt like it. My son turned 17 that year. He had a car and no longer needed me to take him to sports activities and practices. I felt it was time to do something for myself and in doing that, I would be able to help my son as he entered the "real world" of adulthood.
I decided to go back to school and earn an Associates degree. I chose the computer field as I was one of the many people at the time, who only knew how to turn on the computer and use an application, yet had no knowledge of why it worked or how to do anything other than use that one application. I had devoted my life to working around my son's schedule of activities and now I was going to have the freedom to do what I wanted to do, where and when I wanted to do it.
I was working a very part-time job as a bookkeeper for a small hobbie business, part-time as an "on-call" waitress and bartender at a lovely Inn. I was supposed to start full-time waitressing and bartending at the Inn in March, taking over for a waitress who was moving to Florida to finally be rid of the cold New Hampshire winters. I was self-employed cleaning private homes. I took this on just before the holidays to help in making sure we had a really nice Thanksgiving and Christmas. I had planned on continuing the cleaning into the New Year as there was a larger demand than I had thought possible in the area where I live and I knew that my student loans would become payable soon after graduation.
The New Year bells of 1999 had barely stopped ringing when I went into work at the hobbie business. I was asked to move my car from the side parking area to the front parking area so the plow guy could plow. I happily moved my car out front and headed back inside. It took a few minutes to realize what had happened. My hands stung and I realized that I was on the ground in a twisted heap. I had fallen just outside the front door. I have no recollection of the fall. I only remember my hands stinging and being on the ground.
I tried to get up and pain shot through my knee. I was helped up by a co-worker who said, "I told him, (meaning the owner of the business), he needed to do something about the roof run off. Good thing it's only you, if it were a customer he wouldn't have a business. This way it's only workers comp." When I stood my hip began to hurt. I had pain shooting everywhere from my knee right up to the base of my skull. I was asked if I needed an ambulance and I declined. I said, "knees and elbows hurt like crazy when they get bumped and I am sure this will pass." I finished my work day and headed home.
The pain was worse by then. My knee was swollen up to easlily double it's size. I applied ice and hobbled through the rest of my day and night complaining to my son that my hip, back, and neck hurt too. I couldn't sleep as the pain was so bad. I stayed up all night icing the knee.
The next morning I could hardly walk. I had to limp to get anywhere. Pain shot up and down my leg and the hip shot pain into my lower back and right up my spinal cord. When I sat at the edge of my bed with my legs dangling, it felt like my knee wasn't attached very well. I felt like it was going to fall off if I wasn't careful. Being stubborn, I gave myself one more day to ice and rest the injuries telling myself that I probably stretched some things out that didn't want to be stretched.
I was worse on the third day. I called my boss from the hobbie business and explained to him what had happened. I told him that I needed to be seen by a doctor. I asked him how he wanted to handle it. Did he want this to be billed to Workers' Compensation or did he want to handle this privately? I had been told in the past that employers sometimes handle things privately when there is an injury on the job. He was angry and raised his voice at me. He didn't answer my question except to say, "Of course I have workers compenstion!" He hung up on me.
I couldn't stand the pain anymore so I called my doctor for an appointment. He was booked up and told me to go to the emergency room. I was asked on the intake form about my injuries. I wrote, "injured knee, hip, back, neck from fall at work." I was seen by the on call physician who took ex-rays and examined the knee. He told me that nothing was broken but there was fluid under the knee cap indicating some form of trauma. He reccommended that I see my regular physician in a week.
He recommended icing the knee and to take asprin or non-asprin for pain. I asked about my hip, back, and neck. He told me that it was normal for the hip to hurt as the ball end of the leg probably got jambed into the hip socket and as far as the back and neck pain that I was having that was normal too after a traumatic fall. "Who am I to question?" I thought and went home, made an appointment with my doctor and suffered.
I went to my doctor a week later and he recommended that I see a Orthopedic surgeon as he felt I had torn something in the knee and he felt that there were other injuries inside the knee and the best person to help me with it was a specialist. I inquired about the hip, back, and neck pain. He agreed that it could just be from the impact of the fall and could be aggrevated because of the limping. Ice, asprin, wait it out were the instructions. If fluid kept building under the knee cap he would need to extract it. I hurt so badly and no one seemed to care that the pain was intense. I went home and called the surgeons office to make an appointment.
I was really nervous going to see the surgeon. I didn't want to have surgery. He was very pleasant and gentle to my knee. He took numerous ex-rays and checked out the movement of the knee and put his ear up to it when he moved it. I, of course at the time, thought this was really funny. He then informed me that he suspected that I had a meniscus tear and some internal injury to the knee. He told me he could not tell me how bad the damage was to the knee until he got "in there" to see. I mentioned the hip, back and neck pain to him and he agreed that some could be from impact and some could be from limping. He felt the surgery would stop the limping and then the other things would go away. We scheduled surgery for the week after gradution with the agreement that if things got worse I would come in sooner. It did get worse but I wanted to complete my studies.
I notified my boss at the place where I was injured of the need for surgery. He told me he didn't think I was hurt that bad and that he was sorry that I got hurt. He told me he should have done something about the roof run off years ago. That last comment didn't sink in
for a long time.
I continued to work at the hobbie business, went to classes, and was called in to help out at the Inn on Valentines Day to bartend. I worked my shift and my knee and hip were just killing me the whole time I was standing behind the bar. I worked my shift. The next morning I was in agony. I called the surgeon. He had me come in. He took me out of work at the Inn and told me to stop cleaning explaining to me that I couldn't lift, bend, stoop, squat, or carry anything that weighed more than a pound. Additionally I was not able to stand in one place for any length of time. I was floored as I needed the income from the job at the Inn and cleaning because my job at the hobbie business, an antique auto repair place, was very part-time; about 4 hours a week. I had to tell the owner of the Inn that I would not be able to fill the position for full time work in March. I called my cleaning clients and referred them to others who cleaned locally.
I went in to work at the place where I was injured. In general, as long as I got payroll done every two weeks the owner didn't care when I came in, but I went in weekly to pay bills, enter things into the computer, file, balance the check book etc... The last payroll date was Feburary 4, 1999. I picked up my check and filled out the wage hours form for Workers' Compensation and had the owner sign it.
I went to work the week of Feburary 11th and was surprised to see that the owner had done all of my work for me. He had filed, paid bills, etc.. The only thing left for me to do was to enter the dollar amounts into the computer. That was a five minute job! I thought that maybe it was just a fluke as the owner had never done the bills or payroll since I had been working there.
I went in to do payroll on a Thursday night, the week of February 18th. On Friday morning the owner would come in a sign the checks and give them to the guys. He would leave my check in an envelope locked in a filing cabinet. To my surprise the payroll was done but only for the guys. All of my other work was done as well. The same as the week before. Again there was only about 5 mins work to be done. I did what little bit was there for me to do. When I got home I called my boss at home to ask why he didn't make out a check for me. I got the answering machine and left a message. I gave him the benefit of the doubt and thought that perhaps there was an emergency and he just forgot to write out my check or perhaps he couldn't find my time sheet, even though it had been left in the same spot as always.
The following week I stopped by the shop. There was no mail brought in and that means no work for me to do. I asked one of the guys why there was no mail. I was told that the boss was out of town and he didn't know when he would be back. He further told me that he was not given permission to pick up the mail from the Post Office. I asked about payroll and was told that the owner had written out the next months payroll for the guys and that his accountant would be dropping it off to them.
I was really furious. The owner frequently took trips. We had made arrangements that when he left town he would call me and we would do payroll in advance as the guys were on salary and estimate my hours as they were pretty much the same each week. He knew I expected to be paid each pay period, just as the guys expected to be paid each pay period when he was away. The guys didn't know when he would be back. I left him a note asking that he please write out a check for my hours. My time sheet was stapled to the note.
I continued to go in to work each week on the off chance that the owner had come home and realized or been informed of his neglect toward my pay and left me a check. I went to work for the final time on March 12th. The owner had been back. All of the bills were paid, all of the filing was done. There was no check left for me and my note and time sheet were gone. I looked in the company check book and he had written checks in advance to the guys again. He had emptied the cheekbook of checks, so even if the mail situation had been corrected, I still would not have been able to do my job. I went home and wrote a resignation letter and requested my final paycheck be mailed to me. I mailed it the next morning. Three weeks later my son answered the phone. It was my old boss. He told my son to give me a messege: "Tell her this is rediculous." I am still waiting for my final paycheck but I am glad I didn't hold my breath as it is now December 2002.
The owner of the hobbie business delayed giving the hospital and doctors the policy number and name of his Workers' Compensation Insurer. It wasn't until they threatened to report him to the Labor Department where he could be fined that he gave them the information that they needed. It was now April a full three months after my complaint to the emergency room.
Everyone kept telling me to get a lawyer. I didn't see why I needed a lawyer. After all, isn't it when you get lawyers involved that things get nasty? No, I wasn't going to need one. I thought, "I have a legitimate claim. Just because my old boss is a jerk didn't mean that the Insurance Company wouldn't be fair."
I had the surgery on my knee in June of 1999 right after I graduated with my first degree. A friend called me to ask if I were receiving Workers' Compensation benefits. I told him that I have no idea how it all works but they were paying for my hospital bill and doctors bills. My friend informed me that they needed to pay me some financial compensation. I called my old place of work to ask for the phone number for the insurance company. After numerous messages were left and unanswered I called my doctor's office and was given the name and number of the Insurance Carrier.
They took my information for the bookeeping and work at the Inn. They said they needed a letter from the owner of the Inn stating my wage information. I got one from him and mailed it to them. I called to make sure it had arrived. I was told it had and that my benefit amount would be 279.60 a week but they couldn't consider the income from the cleaning as I had not paid Workers' Compensation Insurance for myself. I could live with it. I was disappointed but I could live with it. I was actually relieved to have any money coming in as I didn't know how I was going to be able to support myself and my son without being able to work. Besides, I told myself,"it's only for a little while."
Things went smoothly for a while with the Insurance Co. I was getting my medical care: physical therapy, medication for pain and inflammation, medical bill were being paid, and my benefits checks were arriving every week on time! "My gosh," I thought," those people who told me to get a lawyer were nuts!" Then the bottom dropped out. The checks stopped coming. I didn't know why. I didn't get a letter in the mail telling me there was a problem or that maybe they were changing to an every two week pay schedule. I tried calling.
I had called numerous times prior to this and had always gotten a call right back or gotten through to the party I needed to speak with, namely my case technician. This time was different. I got bounced around from one extension to the next. I was disconnected. I had to redial and went through the same thing time after time. It took three weeks before I got a live person at the other end of the phone. I asked for my case technician and they told me she no loner was employed there. They of course transfered me to a voice mailbox where I left a very polite messege and requested a call back with some insight as to what was happening with the benefit checks. Three more weeks went by and still no calls were returned. I was at my wits end and flat broke. Tis time my messege was not nice. My message stated that I was going to sue them if I didn't get a call back. I got a call back within fifteen minutes. Now I knew how to get a return phone call.
The person on the other end of the phone was extremely rude. I was told nothing was going on with my checks. She said that my checks were not being held up and that they were being mailed to me. I told her that they were not being sent and informed her that I had notified the Labor Department of this problem and that they wanted me to let them know what the resolution to this problem was. Her toned changed. She told me she would look into it. Gee for checks that were not being held up I got one check for over seven hundred dollars and a second one for over eight hundred dollars. However, this problem became a pattern with them.
It was constant and on going. Sometimes it was only for two weeks other for four or five weeks. Each time I would call and politely ask for a return call there was none. When my patience would run out and I would threaten them with the Labor Department, I would get a return call A.S.A.P. with my checks soon to follow. This went on for eight months.
My knee, back and hip were still giving me so much trouble that my surgeon had not returned me to work. So I decided to put myself through another year of school. I needed to take five courses to get an Accounting degree to go with the business degree I had earned the year before.
The Insurance Company merged with another Insurance Company. I was called by two auditors, one from each company before the merger. I was told by both of them that all of my paperwork was in order. The checks stopped again. I had been sent a post card by this new merged company and asked to call my new case technician. I did. I told her I had received the little card in the mail and I was calling to introduce myself to her and to find out what was going on with my checks. I was told that she was too busy to talk to me and she hung up without saying good-bye, I'll call you back... just hung up. I decided it was time to hire a lawyer.
I did hire a lawyer but take some advice from the person who thought they would never need an attorney: shop around for your attorney. I didn't. The first attorney I spoke with who said they would be happy to represent me, I went with. I call this first attorney a Workers' Compensation Settlist and not a Workers' Compensation Specialist. She did nothing for me. She would not call to find out about my checks. She told me to because she didn't think that they would call her any sooner than they would call me. She wrote my phone number down incorrectly in my file. I pointed that out to her and she never changed it. She wrote my address down wrong. She could not keep my physicians straight. She was a nightmare.
Oh right, I haven't told you about my continued medical problems. The surgery to my knee went well. It was a real mess. They repaired everything they could without giving me a knee replacement. I began physical therapy. It seemed to only aggrevate my knee. It would swell something aweful everytime I would do the exercises which were slow and gradual. I was still limping like crazy, my back, neck, and hips still hurt and the surgeon insisted that the knee was sound but he didn't feel I was anywhere near ready to go back to work.
He decided that he thought I had developed R.S.D. (reflex sympathetic dystrophy), either when I fell or as a result of the surgery. I had never heard of such a thing. Many people haven't. The easiest way to describe R.S.D. is that your pain center has a nervous break down. Although the pain signals from my knee injury should have stopped firing after the surgery and the healing process they didn't.
There are many misconceptions about R.S.D. I have had very educated people tell me that it goes away with physical therapy or that it burns itself out within thirty six months. The fact is that only thirty percent of all people with R.S.D. will ever return to work and even less have a remission. That being said I will return to my story.
My surgeon sent me to a Pain Specialist to confirm diagnosis and for treatment. It was confirmed that I had R.S.D. I was put on very strong medication and began receiving lumbar blocks, shots in the spinal cord to increase blood flow to my knee, every six weeks. The shots helped but not enough. I was taken out of physical therapy because it was aggrevating verses helping and put on a home routine. I was told by my physical therapist and my surgeon to get a stationary bike. I could not afford to purchase one.
I called the Insurance Company and actually got through to a person. I thought maybe there was hope. I explained that I needed to get a stationary bike and that I couldn't afford one. They refused to help me get one and told me that when I could afford to get one to make sure I submitted my receipt with three others so that I could be reimbursed for the average price of a stationary bike not to exceed my purchase price. While I had someone on the phone, I asked about the back, hip, and neck pain that I was having. I explained the situation start to finish about those pains. I told her that even after surgery the pain was getting worse and that I would like to see someone for it. She told me they would not allow me to go and would refuse payment if I did. She told me. "You should have had specialists look at it when I was in the emergency room."
As I had mentioned I decided to take those few courses to earn an additional degree. I was given permission to complete the remainder of my course work on independant study as the medication did not allow me to drive. I was so out of it. I was very lucky to have a good grade point average as I failed my final exam. I still passed graduating second highest in my class. I was lucky.
One night I needed to go through some things that I kept in the basement and asked a friend to come by and help me. I told him I would feed him if they moved the boxes for me. I was making my way down the stairs to my basement where the boxes were kept. The knee I injured and had surgery on, buckled. I fell down the stairs. The stairs are steep and in one respect I was lucky because I could have smashed my head on the stairs or skinned my back or worse, but I landed on my left foot and fell forward and slammed my left knee into the concrete wall at the end of the staircase. I thought that I had actually managed to get away unharmed and then I stood up. I knew immediately that something was wrong. My friend who was behind me on the stairs helped me back upstairs. I removed my shoe where I saw to my horror many bumps sticking up but still under the skin. I had broken my foot on my good leg. I broke 5 bones, one in six places as well as cracking my ankle.
I went to the emergency room. I told the doctor there my story and he wrote it up as Workers' Compensation as I would not have fallen down the stairs if my knee wouldn't have buckled, a complaint I have had since the initial injury. I had to use a wheel chair as my knee would not hold my weight with the use of crutches. I was one week shy of my one year anniversary date for my knee surgery.
My Settlist in the mean time was doing nothing to help me. The Insurance Company began refusing to pay for my medical treatment stating that it was not related to the injury. They paid for some of the doctors visits for my foot and not others, they paid for ex-rays but not the dye used for a nuclear bone scan, etc. I called my attorney and she actually asked me, "what do you expect me to do about it?" I told her that I thought she was supposed to be dealing with the Insurance Company on my behalf. If she did call nothing changed.
The Insurance Company scheduled an I.M.E. for me. It was a month after I broke my foot and I was going to be in a cast for another four. I called my attorney about rescheduleing the I.M.E. She told me to go. She told me that the Insurance Company had hired an attorney and told me his name.
One night while resting after having a block that morning, my phone rang. It was the Insurance Company's attorney! He wanted to know how much money I wanted to settle my claim! I was shocked and furious as I knew he was not allowed to contact me personally but only through my attorney. I told him that he knew I had an attorney and that I had nothing to say to him. The calls persisted for over a week. Each time I would tell them the same thing.
I called my attorney to tell her what had happened and she didn't bother to call me back, but then she might have but dialed the wrong number, the one she never changed on my file. My checks once again were not arriving. I was grumpy from the shots. I was having a very hard time adjusting to the medication as I am the type of person who feels like they are going to mars without a space ship when I take cold medicine. The medication was really effecting my personality and more so the pain was. I was in a cast with a mangled foot. I was very angry and upset.
I decided one night, in all my drugged up wisdom, that I had had it with the Insurance Company and their attorney. I decided to call them. As usual I got a voice mail. I vented all of my frustration and anger at them. I was not polite this time. I told them about their unethical attorney, I told them that I knew by law they can not stop my checks without good cause and without having a hearing. I threatened to sue their butts,(not the word I used),from here to eternity if things didn't straighten out.
I got a call the next morning from the case technician that had hung up on me before. She told me that their attorney had called me a liar. He claimed that no one from his office had ever called me. I was told they were not holding up my checks. A week later I received three checks in the mail. The week after that I got a letter telling me that they were stopping payment of the last check they sent and reducing my benefits to 36.48 a week, claiming that the 279.60 a week that I had been receiving was just an estimate. They were claiming that they had never received the letter from the owner of the Inn. I could not replace that letter. My son had mailed it out for me and forgot to make a copy before mailing it. By this time, over a year later, the Inn had been sold and I had no idea how to get ahold of the old owner. I heard through the rumor mill that they had moved to Jamaica. Great! That helped a lot!
I went to the I.M.E that had been scheduled and the Insurance Company forgot to tell him I was in a wheel chair and in a cast. His office was not wheel chair accessable. Months later when I got his report it was favorable to me agreeing that I did in fact have R.S.D., that the injury to my foot was caused by the knee buckling and that the complaint of knee buckling was well documented. He further went on to say that the pain in my hips, back, and neck were most probably caused in the initial fall and should be treated.
I got home from the I.M.E. and went through my mail. My phone bill was there. The last night the Insurance Company's attorney called me I *69'd the call. Their inside office number, which was not listed, was on my phone bill with a fifty cent fee for giving me that number. I phoned my so called attorney and told her what was going on. She did call the Insurance Company's Attorney. He wrote a letter stating that he was unaware tht anyone in his office had ever called me. He further stated that the day the first call was made was the day he actually had been given the case. How then did I already know who he was? He lied and I still have the proof that he lied. My attoney filed nothing. She called no one. She told me that the Insurance Company's Attorney was such a nice guy that she couldn't bring herself to report him to the Ethic's Committee. I fired her. I was on my own again.
Financially I was ruined. I was about to be sending my son to live with his father as I was going to have to live in my car. I had no money for rent, bills, food, for nothing. My son decided to drop out of full-time classes at the local tech college and go part-time and go to work full time to support us. I did not ask him to do that. He offered and has told me repeatedly that "He knows I would do the very same thing for him." I can not tell you the guilt I have because of this role reversal. I figured I might need a little help from time to time when I was in my retirement years butnot when I was a 38 year old woman and not this kind of help.
I continued to get worse pain wise. My foot healed but I was having R.S.D. pains in my left foot and leg. The R.S.D. had, what I call jumped ship, meaning that it spread to the injury site of my broken foot.
I complained to my pain doctor that the pain was still really bad in my hips, back and neck. The back pain had graduated to full fledged back spasms. He took a back ex-ray to rule out a compression fracture. The Insurance Company refused to pay for the ex-ray. My pain doctor felt that my pain had graduated past the point of what he treats and sent me to see the doctor that taught him all about pain management.
I have been seeing this new doctor since August of 2001. I have a new attorney. The Insurance Company upon learning that I had a new doctor scheduled another I.M.E. with a different doctor this time and requested a hearing at the Labor Department. The day that I went in for the I.M.E. the Insurance Company Attorney canceled the hearing they had requested. I guess this new doctor didn't write them a favorable report.
The Insurance Company has not paid for any of my office visits to my new doctor. it's been over a year. They have not approved any medication changes even though my doctor personally called to tell them that my medication treatment was no longer effective. They have played games with the medications I am on, many should not be stopped suddenly. A month ago they decided that they were no longer going to pay for Neurontin which I have been taking for over two years now. I can not afford to pay for it myself. I went though three weeks of vomiting, diarhea, and severe headaches. This month they decided to pay for it again. This insurance company does not care that they are playing serious games with my health. Any chance I had of a remission from the R.S.D is now lost because of ineffective treatment. R.S.D. has to be treated aggressively to knock it back if it is possible. It has spread.
My new doctor feels that I also developed fibromyalgia when I fell at work as I pass all the tests in the trigger points. It is well noted in my charts that I have been complaining about symptoms since the initial fall.
The Insurance Company scheduled another I.M.E. for the end of October 2002. I did not have transportation that far away as people would miss three quarters of a work day to take me and bring me home. They were notified by my attorney that I didn't have transportation to the appointment due to the distance, a good 55 miles away. They rescheduled at the same place and offered no transportation. My situation didn't change a bit. I still didn't have transportation. They have stopped paying my benefits of 36.48 a week.
I have been doing my own research for my Workers' Compensation case. Please don't ask me to totally trust another attorney. I have the Insurance Company playing with my life and now I am supposed to trust my future life to another attorney. After my last experience, I decided to find case law on my own. I have all of the regs and the statutes. I have every slip opinion regarding Workers' Compensation cases heard here in New Hamshire since 1995. We are soon approaching the time to file for a hearing.
I am also filing a separate civil suit against the Insurance Company. Here in New Hampshire we are not barred from filing suits outside the Workers' Compensation court. The exclusivity rule does not apply if my case meets certain criteria, which it does. I am also filing a separate suit against the owner of the business where I was injured against his property insurance. Again the exclusivity rule in my case does not bar me from filing the additional suits. The owner of the business knew that the roof run off needed to be handled for years. His lack of action created a premeditated act as he knew it was just a matter of time before someone was hurt entering the building. The roof has not been repaired to date.
Regardless of the law suits, my main purpose is to let it be known that Insurance Companys should not be allowed to get away with this kind of treatment. Additionally, I do not feel that it is fair that business owners can hide behind the Workers' Compensation statutes. I can understand a simple, real "accident." In this case it has gone beyond gross neglect both by the business owner and the Insurance Company.
I am still looking for the owner of the Inn.
My future. It's not looking so hot. I will never do the things I once loved to do: water ski, down hill ski, hike, ride motor cycles, play volley ball, tennis, badmiten. I used to love to cook. I was very good at it. Now I can't be on my feet for as long as it takes to prepare the things I once did. I will most likey never be able to pick up my grand children and having them sit on my lap will be out of the question as the pain is too great.
I used to be a vibrant, healthy, independant, go getter and lover of life. Now I spend my days trying to find a way to beat an Insurance Company with a relitively inexperienced attorney and praying for the pain to subside so that I might be able to get the dishes done or the bathroom cleaned.
My life is now trade offs. If I do the dishes I can't clean the bathroom. If I run the vacuum I can't do the laundry. I can't work because of the medication and the pain. There are not many employers who would understand that I have been up all night and finally got enough pain medication into my system to knock me out for a little while, so gee I won't be in today and maybe the next day and who knows. I don't drive very often. Once in a while I will have a good morning and I will put off taking my medication and drive myself to the Post Office or the local market. It is less than a mile away and my body doesn't like being set in any one position for more than a few minutes.
My life is over. I no longer dream. I am now just sustained in a body. I breathe so I live, but life goes on around me and I can not participate.