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Worker`s Compensation/Chronic Back Pain

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QUESTION: Nancy,

Back in September 2011, I was injured at work.  My back got so tight at work that while I was working I heard and felt a snap in my upper back and lost all strenght in my right arm.  I felt pain shoot from the area where I felt the snap all the way to my fingertips.

I have was sent to urgent care and had x-rays taken off the area and was told that I sprained my back and that a rib popped out!  I was sent to see a chiropractor for 6 adjustments to try and push the rib back into place.  This was the worst feeling I literally felt and to the point where I wanted to cry.  I was then placed on light duty for 3 weeks and released from light duty as soon as my chiropractor visits had stopped.

About a month and a half later I was injured in the same area of my back and was once again taken to urgent care!  I was told by another company facility that I had sprained my back again and that a rib had popped out.  

I then decided to go to my personal doctor and had x-rays taken and they called me in 3 hours to tell me that I had a fractured rib at the T6 level.  I was sent for physical therapy and given a consult for acupunture in which all of the treatments were unsuccessful.

I have had visits to the chiropractor, acupuncture, electric stimulation, massage therapy and pain management all of which were unsuccessful.  I have been dealing with chronic back pain for over 2 1/2 years now and the doctors did not know where my pain was coming from until recently!

I was referred over to a rheumotolist, which reviewed my x-rays and was able to show me through several views that the rib that I had fractured actually did not heal correctly.  He showed me where the rib is now curved about 2-3 mm away from my spine, which he said is causing me my pain.  He also told me that their is nothing that I can do to fix the problem at this point!  

It is extremely hard for me to do any kind of physical labor at this point.  My previous job was extremely physical working for the electric company climbing up and down poles throughout the day!

My employer right now is looking into whether or not they are going to be able to accomidate me at this point and place me in a (return to work program).  3 doctors have already told me that the injury is now possibly permanent.  

Wouldn't they have to accomidate me if the injury happened at work?

ANSWER: Only the reports from the Comp insurer's MEDICAL PROVIDER NETWORK are admissible as evidence; I cannot tell from this whether the chiropractor to whom you were 'sent' is on the network, or whether any of the three doctors telling you personally your injury is 'now possibly permanent'   are on the network.

You get one final, maximum improvement report from a Primary Treating Physician (never 3) who in on the Medical Provider Network, the "MPN".

If you disagree with that doctor's findings, you get one Panel Qualified Medical Evaluator report.

ONLY THEN does the employer read these reports and check to see whether they have a job opening that matches the permanent work restrictions written in the QME Report and the Treating PHysician's final report.

The employer HAS NO OBLIGATION to make a special new job, or 'accommodation', for you.  If the employer DOES make a permanently-modified new job, the insurer gets to reduce your permanent disability award by 15%, so this is the only incentive for the employer to find a special new job for you.

IF THE employer cannot find a special job matching the new permanent restrictions, then your Permanent Disability award is increased by 15%...that's your only extra compensation for becoming unemployed.

Sadly, you get zero for your pain, and you get zero for 3 different doctors' opinions.   Workers Compensation only awards Permanent Disability, which are the factors of disability resulting from being unable complete 'activities of daily living' such as bathing and meal preparation and laundry.

There is no 'Pain&Suffering" in workers comp.  The system only gives you a little payback for being less competitive in the workforce.

IF the Primary Treating PHysician HAS written the Maximum Medical Improvement report, YOU SHOULD APPLY FOR UNEMPLOYMENT INSURANCE IMMEDIATELY.   This typically forces the employer to tell the State EDD whether you have a new job there or not; and if you wait too long you'll be denied California Unemployment Insurance (the employer has to make contributions from recent paychecks for you to qualify).  

---------- FOLLOW-UP ----------

QUESTION: 2 of the 3 doctors are within the network the other doctor is actually a Veterans Affairs doctor.  They asked for my VA doctors opinion because I have also been getting treated by them for my back injury to try and get treatment from both sides to try and speed the recovery process up.

I understand that their is no such thing as pain and suffering and realize this.  

Now wouldn't the new findings of having an abnormal rib actually prove otherwise and therefore have another diagnosis other than chronic back pain?

All 3 doctors have suggested that the injury is permanent and that their is no way to fix my abnormal rib and that it is going to cause permanent pain and discomfort.  Now, if this is so does this actually qualify as a permanent disability because of my rib fracture?

Answer
In CALIFORNIA workers comp law, only two reports are admissible at trial:   the ONE Primary Treating physician's report, and the Panel QME report.

So, there isn't any "2 or 3 network doctors" ... well, the judge would only look at one report.

IF the Maximum Medical Improvement report of the QME or the MPN Primary Treating PHysician specific states there is 'Whole Person Impairment' resulting from an abnormal rib, there is rateable permanent disability from the rib.

If not, then no.

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Nancy Wallace

Expertise

California injured workers employed by state and private agencies (NOT federal employees) regarding On-The-Job injuries, disability payments, and terminations from being injured on the job (work-related wrongful terminations).

Experience

20+ years in California Workers Compensation law practice in California. Certified Specialist, Workers' Compensation, Board of Legal Specialization, State Bar of California

Organizations
California State Bar Board of Legal Specialization

Publications
Editor, Western State University College of Law newspaper www.Avvo.com www.imhurt.info

Education/Credentials
J.D., Western State University College of Law B.S., cum laude, Cal Poly Pomona

Past/Present Clients
Senior adjuster for one county sent me her husband when they needed caring representation. The injured Employment Development Dept. hearing representative -- who see all applicant's attorneys in the region -- hired me when she got hurt on the job. A Fire Department Chief in Orange County came all the way to San Bernardino for my representation.

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