New to WC from PA

[weezle735]

Hi Everyone. Sorry this is probably going to be a long read.....
My name is Jenn and I live in northwest PA. I am a Teachers Assistant for PA Pre-K Counts through our local county Head Start Program.
I had an accident at work on 4/12/10 where I tripped over the leg of a physical therapy swing, I did not fall completely but I did twist awkwardly on my way down and caught myself. The swing is located in the hallway of the school building I work in. It does not belong to the company I work for it belongs to an early intervention program and if you ask me should not have been there because it did pose a hazard not only to those walking past it but in a case of emergency it was blocking a doorway. Many times we have found our children tripping over the leg or wanting to play on it and running face first into it......Anyway......
This accident happened at 11:20am on that day and I continued my work day with no issues. The next morning however I woke up to find I was unable to stand straight and was having pain in my back. I went to work as scheduled and reported everything to my supervisor that morning. After work I went to the main office (HR office) and filled out the incident report/ WC report and received my list of specified doctors. I made appointment with one of the doctors, just the family practice one, for a couple days later. Wednesday I wake up (accident was on Mon.) and I am having even more difficulties moving. I go to work but by 9:30 - 10:00 my legs are beginning to go numb and I decide to prevent further injury to myself I am going to leave work and go to E.R. Emergency room dr. gave me rest of that day and next day off. I called and reported this to work. Went to scheduled appt. with listed dr. and he orders off work for week, pain meds, muscle relaxers, and anti inflam meds. Reported that to work. Follow up next week nothing has changed meds barely work. He orders CAT scan and off work till results from scan are in. Reported that to work. Follow up appt for scan results and found out that I have 3 herniated discs at L3-4, L4-5, L5-S1 with thinning of thecal sac at L4-5 and hypertrophic facet changes bilaterally at L5-S1. All without significant canal stenosis or neural foraminal narrowing. Pain I am having however suggest nerve impingment. Pain in back and stabbing pains down right leg mostly but also left leg now and then, to top of calf. as well as weakness and numbness in thighs. Dr. wants me to continue with pain meds (duh) and in a week go see a dr. to talk about epidural shots and physical therapy. and then a week after that dr. apt follow up with him again and no work till at least 5/13/10 after follow up. Reported that to work as well. Dr. has faxed everything to the ins company.
Today I open mailbox to find a letter from ins. company. Denial of workers compeNsation claim due to "other good cause" which states - UPON RECEIPT OF MEDICAL DOCUMENTATION THIS CLAIM WILL BE RE-EVALUATED FOR COMPENSABILITY.
This whole time I have been wondering if I should get a lawyer just to make sure that I am getting everything I am entitled to. I dont know what to do next.
I dont really want to do the epidural shots yet, I think they are trying to rush me back to work by just blocking the pain, I am afraid that I may hurt myself more in the long run because I dont feel it so I am going to do more then I should. Can I refuse to do the shots ? and still get paid ?
How long do they have now that the denied me before they have to make the next decision ? the first on they had 21 days and now thats over can they take thier good ol time ?
I am lost. I hope someone has taken the time to read through my story and can help me in anyway. I love my job and do wish to return but I wanna be good enough to do so and dont wanna ruin my career by going back to soon and getting hurt more..
I am sooooooo lost. Sorry

[jayne]

ahhhhhhh you are in luck one of our members is a Pa.WC lawyer....Timothy Belt will be along soon or you can PM him...welcome to the forum

[weezle735]

Thank Goodness ! I am starting to lose my mind as to what I am to do next if anything. I have so many questions.

[weezle735]

Does anyone have any advice ?
I am just going to look for an attorney. I am part of my union and I have numerous benefits that I am concerned about losing.
Do I need to file FMLA so that my job is protected or is it protected already ? I heard that they cannot fire you when you are off for a work related injury.
IDK too many questions and sooo far very few answers.

[1171]

Yes you need to file for FMLA to protect your job.
try the state bar for a work comp specialist
http://www.pabar.org/

[inpainokla]

hi and welcome to the forum..the epidural shots are just a conservative approach to your treatment not all herniations require surgery if the e.s.i can get the swelling down and get the herniation off the nerve your pain should go away..i also herniated my disk l-4 through s-1...my dr started off with the e.s.i's had 3 in total in a 2 month period...with no improvement he oredered a discogram which found tears in the disk that eventually led to a 2 level fusion..all of this within a year 4 e.s.i's discogram 2 level fusion and hardware removal and now going to have another e.s.i in june...i guess what im trying to say the injections are a starting point if they work for you and keep you from having to have surgery then i would think that it would be a good thing..i really dont understand the physical therapy as my dr was totally against it saying it will make the herniations worse..if your worried at all your always entitled to a second oppinion..

[Timothy Belt]

The sad reality is that now that they have denied your claim, they do not have to do anything else. In fact, they do not even have to pay for your medical. The ball is now in your court, and the only way to assure this matter moves forward is to file a Claim Petition.

I would agree that a good lawyer would be helpful at this point. I may know someone in your area, so feel free to contact me directly if you have any questions.

Workers' compensation does not provide any job security in PA. However, your union contract might, and you should talk to your union representative about this issue.

[weezle735]

I have an appointment tomorrow at 2p.m with an attorney. He is suppose to be a really good one. Everyone who I know has had an injury has gone to him. Also when I called and told them who I worked for the secretary kinda laughed and said oh yea we are familiar with them, we have a couple cases now. So if they are familiar with the company I am dealing with then I feel a little comfort.
I e-mailed my HR person and told her I wanted to file for FMLA just to be covered and sent an e-mail to union pres. to see what he suggests.
I feel a little relief knowing that things are still rolling and I am not just sitting here wondering what next.
Tomorrow - Lawyer
Wed - ESI shot
Next Wed - Follow up to see how ESI shot went.

And hopefully within that time a check from Insurance Comp. for wages. lol

[weezle735]

update
Went to lawyer appointment and filed for petition against the denial letter. Been receiving calls from WC about what is suppose to come out of my checks such as child support. Gave them information about child support. And today the caseworker for WC called and asked questions about when Dr appointments are and w/ who. She also stated that the case is coming along and she is starting to receive all the necessary paperwork. The lawyer said that when they denied me due to "good Cause - not enough information yet" that was were they messed up said they should have just given me temporary payments until all information was received. So he said that we have a great case based on all the information and documentation that I have kept.
Now the ESI - the doctor did a physical exam asking me to lift my toe and not let him push it down, did ok on the left side but he had to redo it three time on the right. Then I couldnt walk on tip toes, or lift my leg when he was pushing on it. Basically everything he did hurt.
Went in and had the ESI done under floriscope, that went ok. Rest of the day I started having muscle spasms in my back and couldnt get comfortable. Last night I couldnt sleep cause of the pain and today my calf muscle is spasming and my hip and thigh are sooo weak and TONS of pain. I am going to be calling to find out if I can up my pain meds at all.
I go next wed for follow up with other dr. to see how things are going.
I have to go back in 2 weeks for another shot.
So from now I am just praying that everything goes smoothly. Hoping that this shot starts working and I get some relief.

[Regrets]

Did You Retain the Attorney You Spoke to as Your Attorney for Your Case? If so, any and All Calls should be Directed to Your Attorney, and that is a Good Thing, that Way They can't Trick You into Saying Something Wrong. Some Say an Attorney Slows Things Down a Bit, but Mine has been Great and Very Timely. Best of Luck with Your Case, I Hope Surgery can be found not to be needed, and Other Care Helps Your Back. I have Failed Back Surgery and it's No Fun! But don't let that Stop You if it's absolutely Needed, a lot of Back Surgeries are Very Successful, and many Return to Work. Mr.Belt is a Great Source for You, and will give You Fair and True Answers. Best of Luck, and Please Check with Your Attorney on Whom These Phone Calls You have been Receiving should be going to, You or Them.