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Archive | Disability

Money isn’t everything – Don’t let your insurer short your medical bills

One of the most common reasons injured workers contact me is because their doctor is asking for specific treatment and the self-insured employer refuses to pay. Obviously if the treatment is for a non-industrially-related condition, this would make sense. Sadly, these self-insurers play games and offer faulty excuses to get out of paying for the treatment of related conditions as well; a rather deceitful attempt to wiggle out of the deal struck in 1911 between legislators, businesses and labor leaders, most of whom represented the mammoth lumber industry which employed three-quarters of Washington’s workers at the turn of the 20th century.

History class aside, the purpose of the Industrial Insurance Act was and is to provide “sure and certain relief for workers, injured in their work…” To that end, the legislature has created a penalties provision to hold self-insured employers accountable for making timely payments of monetary benefits including time-loss payments and permanent partial disability awards. Unfortunately, this legislative protection has only been offered for monetary benefits and not medical or vocational benefits.

Thankfully the Board of Industrial Insurance Appeals, or BIIA, has recently addressed this issue. In the 2012 BIIA decision, In Re: Coston, the term “benefit” was broadened to include both monetary and medical benefits as well.

This is a fantastic tool which all injured worker representatives should be using to stop self-insured employers from delaying or refusing to pay for necessary treatment for industrially-related injuries and conditions.

If you have a question about benefits, need to protest a decision or you’re unsure about the next steps in your claim, call us at (509) 228-7011 or use our contact form  to set up a free consultation.

System Shutdown

WRITTEN BY RICH BYERS | JULY 2015

Growing up the only child of parents who never graduated high school, both spending nearly three decades as custodians for state colleges, I may have read an article like this one and thought that people are just whiners. On the backs of my parents I had food and clothes, a warm place to live and even got to do some extra-curricular activities like Little League. It was certainly not free of financial struggles, but in one way it was idyllic; through the efforts of my parents “I had it better than they did.”

I put myself through private college and then law school, mostly holding fast to that blue-collar-conservative ideology of working for what you get and not expecting anything more (even studying corporate law) until one day I got a call from my dad. His career had just ended.

He had been an often-promoted and exemplary employee for the State of Washington for over 30 years, a Vietnam-era veteran, and a great role model for me – teaching me that you get what you work for, and that’s that. Then, after over thirty years of heavy labor work, he was injured and his doctor told him he couldn’t return.

He suffered through physical pain, depression, a loss of identity as a contributing member of society, and the realization that a decades-long chapter of his life was now over – one which he hadn’t planned on ending so abruptly. To make things worse, this man who had never had a major claim for worker’s compensation was being met at every turn with a vicious fight from the Department of Labor and Industries. Not the American dream we like to imagine.

I changed the course of my study and my life and became a worker’s compensation attorney. I see everyday the degradation of our system of benefits for injured workers, and articles like this one only ring home the truth – we are experiencing a massive reduction in benefits and a general shift in thinking for workplace injuries. Bottom-line thinking is leaving injured workers – the vast majority of whom only want to return to work as soon as possible – often fighting for years just to receive treatment while their doctors are left grasping at straws to figure out why the very treatment that could get them back to work is being withheld.

This problem is multi-faceted like any other, but the shift of medical decision making from doctors to insurers is inexcusably running afoul of the intent of our Industrial Insurance Act. An injured worker’s sole source of remedy is L&I, to take the power away from doctors and place it in the hands of retro groups and employers who only care about their insurance rates is bordering on the criminal.

My dad’s experience changed my life. How has your life been touched by our failing worker’s comp system?

Blast from the past

Are you experiencing aggravation from a pre-existing injury (aka “lighting up)?

Unless you’re under 25 years old (and maybe still then) you probably have some old injury or complaint from your past. If you’re lucky, the sore neck from that fender bender, or injured knee from a brutal high school soccer game years ago, or other accident – will not come back to bother you.

Unfortunately, people with pre-existing injuries have to work just like the rest of us, and all too often, a workplace injury or repeated exposure can aggravate those injuries. Insurance companies (like the Department of L&I) often try to point the finger at old injuries to avoid coverage.

Here’s what you need to remember if that happens to you in an L&I claim: If an injury or repetitive use of a joint aggravates, lights up, or makes active a latent or quiescent infirmity or weakened physical condition, then the resulting disability is to be attributed to the injury, and not to the preexisting physical condition. More simply stated, if your workplace injury, occupational exposure, or repetitive joint use at work makes an old condition worse, the Industrial Insurance Act likely affords you L&I coverage.

If you’re having trouble getting treatment or L&I claim allowance because you have had some previous injury, call Carlisle & Byers for a free consultation.

 

 

Quiz: industrial injury vs. occupational disease – what’s the difference?

Say you’re having back pain. Would that be considered an industrial injury or occupational disease?

Let’s start with injury – RCW 51.08.100 says “injury” means a sudden and tangible happening, of a traumatic nature, producing an immediate or prompt result, and occurring from without, and such physical conditions as result therefrom. Confused yet? In sum, an injury is what results when something sudden happens and you have symptoms immediately or shortly thereafter, i.e. a fall from a ladder, broken bone, etc.

How is injury different than occupational disease? RCW 51.08.140 says “occupational disease” means such disease or infection as arises naturally and proximately out of employment under the mandatory or elective adoption provisions of this title. This one is a little easier to read, but still not abundantly clear. In basic terms, an occupational disease happens over time from continuous exposure in the workplace, i.e. repetitive motion leading to joint damage, asbestosis, carpal tunnel, etc.

So, whether you’ve been injured or are suffering from symptoms related to exposure at work, go see your doctor, then call Carlisle & Byers for a free consultation.

Regular time loss checks are key

Being on time loss or “total temporary disability” payments is stressful enough because it’s less than you made while you were working. Having the Department withhold your check because your paperwork isn’t current makes it worse.

Once your doctor certifies that you are presently medically unable to work, he or she will submit an activity prescription form. The rest is up to you, but it’s pretty easy.

1) Fill out the “Affidavit of Time Loss” form your claim manager sent you, and return it to the Department.
2) Fill out each and every “Worker Verification” form your claim manager sends you and return the forms to the Department. They will likely come approximately once a month.

Although they look like bland, meaningless forms, if you fail to do either of these things, your claim manager will stop paying you time loss.

The forms can be downloaded from the Department’s website.

Low Back Low-Down

You just lifted something you have lifted a thousand times over, but this time it’s different. You feel a twinge in your back. (“Twinge”, what a strange word to describe pain. In my mind a twinge is a feeling that is slightly uncomfortable, sometimes electric or like a rubber band spring. Instead, they should call it “AHHHHHHH!”). You rotate your back, stretch it a bit like you have learned to do when your back gets tired and attempt getting back to work, but your back just isn’t what it used to be.

So, you do what everyone does. You finish your shift, go home and ice your back while taking Ibuprofen or some other form of self-medication. In the morning, your back is sorer and you are worse off. After trying to make it through the next shift, you realize you can’t do it. You tell your foreman and go to the ER/Urgent Care office.

Now what?

You have found yourself with one of the hardest industrial injuries to get doctors and worse, claim managers to understand – soft tissue injuries. A soft tissue injury is an injury of the muscle, tendon, or ligament, which makes the affected area inflamed. X-rays show no broken bones and the injuries are not so severe that an MRI would show rips or tears in the tendons or ligaments. Even though there is no evidence of pain on the MRI or X-ray, it is still stopping you from work, and has the ability to floor you when you catch it just right.

So how do you inform the doctor about your pain in an engaging way so that more action will be taken than you receiving a prescription for pain pills and an anti-inflammatory?

BE SPECIFIC

One example I hear and read often is “my whole back is killing me” or “it’s my low back, doc, it just hurts.” Those statements are correct, and would be perfect to say if you were at a barbeque, standing with a beer in one hand explaining to your buddy why you can’t play bocce ball every weekend in the summer like you have in the past. Unfortunately, the doctor’s office is not a barbecue, you have no beer, and the pain still exists. During a visit, you will only have three to five minutes with a doctor to describe your injury and pain. The doctor may already be distracted that she/he is behind schedule and be hoping to make up lost time on you by finding a “quick-fix.”

Being generic will allow the doctor to pigeonhole your injury into the first diagnosis he/she can think of and be able to move on to the next patient without much work or dictation. SO BE SPECIFIC!

Have a two to three sentence explanation of the injury ready-to-go. Follow that with two to three sentences about what motions, actions, or job requirements make this injury worse. DO NOT ASK TO BE TAKEN OFF WORK. Your doctor should ask a follow-up question from the information you provided. Finally, you need to be able to point to where the painful areas are and describe the type of pain you feel there. This forces the doctor to engage you and your case. The doctor will see your calluses, your scars from work and realize you are a human being.

Another benefit of having a well thought-out plan for informing your doctor of the specific pain you are experiencing, is that the doctor will document it. Instead of your injury being “lower back pain”, it will be documented as “pain up to the ribcage portion of the back and down through the right butt cheek,” for example.

This should help ensure you have the best possible outcome in your claim.

If you would like to discuss your claim, free of charge, please call our office and we will set up a time to meet.