work injury and aggravation of condition

[Bummer Knees]

In 2005 I was injured in the classroom while lifting a child from the floor. I had left meniscus surgery 3/06 and right meniscus surgery 2/07. Since the injury I have learned I will need total knee replacements.

My wc treating physican says I have a pre-existing condition of DJD and wc refuses to pay for the replacements. The news of DJD was a suprise to me, I have never recieved medical treatment for my knees.
My personal health insurance also refused to pay saying wc is responsible for treatment of my knees.

I now require the use of a cane for walking and use a scooter for shopping trips. My back in now involved and I am recieving epeidural treatments and physical therapy for a S1 leg/nerve involvement do to an alterted gate.

If an injury effects the aggervation of a pre-existing condition, would this be reconized by work comp?

Bummer Knees

[Still in Limbo]

Bummer, Please excuse my typing if it's bad, I'm having a rough time with my Meds. right now, but in Pa, injury to a pre-existing condition caused by a work related injury would e covered. Sorry I can't type more, Good Luck!!

[Pooh]

Bummer

The thing is how can they prove it was a pre-existing illness. Do you have films from a long time ago showing that you have DJD? (Sorry this is like DDD and one of WC doctors greatest ways to say it's not WC fault.) Now let's say it is DJD and you didn't know about it, which sounds like you didn't and neither did your own PCP - so none of this is documented in your records as far as problems with your knees.

Basically, your side has to prove that you have not had treatment and didn't know of the condition if they are claiming it pre-exisiting - and they will then have to back up the claim that it is pre-exisiting with medical documentation that you have been treated for it.

Now remember this is my opinion - so your attorney would know better - but this was what they tried with me saying that I was given steriods when I wasn't prior to WC and that is what caused my AVN in my shoulder. Their documentation could not back up their claim as my doctors records clearly showed that I had not been given any steriods neither could any of the pharmacy records. (I lost this part of my case because of other reasons not medical) But the Osteoporosis in my lumbar spine that the company knew about as soon as I knew about was documented - so when they said I had DDD - they could not argue with because they knew about the OP and I was still working with no restrictions for a year prior to the injury. So even though I was being treated for OP - they could not contest the claim based on that.

[capricorn]

Hi BK...sorry you are going through this. I am also in PA and out of the 5 injured body parts 3 of them have been injured before at work. Also my cervical injury is listed as an aggravation of pre-existing stenosis. I guess it depends on the state you're in. Best.

CAP

[Timothy Belt]

They can also back up their position with studies from shortly after the injury which show DJD. A degenerative condition takes years to reach a point where it would be visible on a study. The key is that your injury caused a previously asymptomatic condition to become symptomatic or that they underlying degenerative condition was substantially worsened by the injury. Again, I am in PA and basing the above on PA law. Your state may be different.

[Bummer Knees]

I started this thread due to a letter my attorney wrote to my family physician also a D.O. and has treated me for almost 20 years.

My attorney directed three questions to my family physician in hopes that the information received will help in me receiving medical treatment.
(My doctor answered yes to all of the questions)

The letter reads:
There is no dispute to XXX injury to the knees, although the extent of the injuries has become an issue in the case.

1. In your opinion, did the initial work injury to XXX knees, accelerate, aggravate, or intensify the pre-existing degenerative condition in the knees?

2. If the answer to question number 1. Is yes of either or both knees; is XXX in need of referral to a specialist for consideration of knee replacement surgery as a result of the acceleration, aggravation, or intensification of the knee condition form the previous injury?

3. IF the answer to question number 1. is yes, did the altered gait that XXX developed cause an aggravation, acceleration, or intensification of the pre-existing degenerative condition to XXX lower back, and if so is treatment of the lower back needed as a result of aggravation, acceleration, or intensification from the altered gait brought about by the knee injuries?

HISTORY
In 2005 I was injured in the classroom while lifting a child from the floor. I had left meniscus surgery 3/06 and right meniscus surgery 2/07. Since the injury I have learned I will need total knee replacements.

According to the treating wc treating doctor I have DJD and this is being use by work comp as a reason not to provide treatment.

[capricorn]

BK>>>>JMO but i feel in the end this will work fo ryou. You have documentation, your Dr. on your side and always remember that WC will say/do anything to stall and get you to give up. I had something happen to me yesterday that I am still in shock over. Couldn't sleep again last night after finally breaking the cycle after a year of sleepless night. I still cannot believe they do what they do.


CAP

[ksgirl]

Bummer, You are going to be fine! Surely with your dr that has treated you so long, and your attorney, you will be able to get this figured out.
Wishing you the best!

[bagpussinamerica]

I am so sorry that you are having such difficulties in your state. After reading so much here, I am in agreement that wc is probably trying to stall and keep from doing anything at all. My doctor said the same thing to me when she still hadn't received any authorisation for any consutation. It was obvious I was hurt at work and the MRI backed it up, but the wc just want to take their time. Keep your attorney on top of the situation and don't let go. Hang on to that baby like a rabid dog.

[Bummer Knees]

Thank you everyone for your responses.

Timothy, bless you for being on this forum and assisting injured find answers.

Previous to being injured I worked part time 25-30 hours a week as an Early Childhhood Teacher and was on my feet all day doing the duties required of my job, bending, kneeling, squating, and lifting children.

If I had known I had DJD or DDD I would of worked in another profession that would of been easier on my body.

My medical condition is to the point that if I do not recieve medical treatment in the near future, the cane I now use will not be enough supports and I will require the use of a wheel chair or motorized scooter, and I don't want to do that because I am a fighter.