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Worker`s Compensation/Knee injury at work, out of work no income

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Question
Tore medial and lateral meniscus of right knee at work, have had 6 surgeries and1 knee replacement. Switched doctors in the middle per WC as they were concerned with physician negligent. Knee needs to be replaced again. Injury happened on June 16 2011 at work, slipped on oil and twisted right knee. Was terminated on January 21 2014 due to not being able to work. Had reaction to the antibiotics on surgery #6, which was to be 2nd knee replacement, coded, heart stopped, kidney failure, lung failure, liver failure and was revived in the operating room and spent 3 days in ICU. Now have heart issues after the reaction to the antibiotics (ancef) and had to have a stent put in an artery. Can not have knee surgery until cleared by heart doctor. My job was terminated after 20 years (Vice President/Chief Technical Officer).  I can not work due to my knee so can not get unemployment. Can not get workman compensation compensation because the heart is not covered. I have a WC claim and they pay the doc bills but compensation was denied due to the heart issue, the claim is for the knee. Would not have a heart issue if not for the knee. I have had zero income since 1/21/14. We are losing everything! Have no money to pay for utilities, bills, or food. There must be something I can do, the injury was work related. This does not seem fair and I need help badly, we have already filed bankruptcy, chapter 7. That stopped the phone calls but does not help to pay bills or buy food. I need help, very desperate and do not know where to turn to. Losing everything and feel everything is caving in on me and am very depressed. Been going on for almost 3 years, 6 surgeries, almost killed me (heart stopped) lost job and am losing everything we have. I will be lucky if I survive this.

Answer
Hey Steve and thanks for writing,

I am so very sorry to read about your work-related injury, it’s unbelievable what you’ve been through! I would strongly recommend that you consult with a Labor Lawyer tomorrow if possible.

When you look at settling, the things you need to consider are:
-lost wages during your time off, (past and future if you can no longer work in your field),
-any expenses you incurred due to the injury (Physician visits, Chiropractors, Physio Therapists, Transportation to/from any of the above; Medical Supplies like bandages, braces, crutches, pain medication including pills and ointments; Fees for filling out forms for you or from the doctors); Postage and/or Fax expenses,
-any lost benefits (Vacation Days, Stat Holidays or Stat Pay, Medical-Dental coverage, etc),
-any costs you may incur upon return to work (time off or cost of making up any education or in-services you may have missed; any training you may need to do prior to returning to work),
-if you will be doing a Graduated Return to Work Program [most people do this if they've been off more than 30 days and/or need to have restricted duties (ie: lifting, hours of work, etc)] then Workers Comp [WC] should pay for the difference. A very common scenario is: if you normally work 8-hrs/day, 5-days/wk, you could return doing 4-hrs/day, 3-days/wk x 1 week; then 4-hrs/day, 5-days/wk x 2 weeks; then 6-hrs/day, 5 days/wk x 2 weeks; then 8-hrs/day, 5-days/wk IF TOLERATED and WC will pay the difference until you are working F/T hours again,
-Pain & Suffering (although this may be harder to prove and may be impossible to get without a lawyer – this is usually reserved for severe injuries where the employer can be proved to be liable); in your case it seems clear to me that the heart issues are directly caused by the effects of the work-related injury,

Unfortunately Worker's Comp is like all other Insurance Companies - it is in THEIR best interest to drag things out as long as possible, and usually they hold most of the cards and have the laws on their side. Sadly, this can cost people their jobs, and sometimes their families due to the stress associated with lingering pain and other disabilities; the financial and/or emotional drain can be too much for some people. 60 Minutes did a show a few years back where large insurance company executives admitted there is an unwritten rule to deny most claims initially as they know a good percentage will just give up and not fight the claim.

It is important to be sure you do everything correctly during your claim period and you don't want to miss out on any payments you may be entitled to now or in the future, so I advise that you consult with a lawyer who does WCB cases and find out exactly what your options are, and what you need to do in your state to cover yourself (WCB regulations do vary state to state).

Dealing with WC is one of the most frustrating things we have to do, like most big insurance companies, their number one interest is guarding their own money. I always find it's best to do a little brown-nosing when talking to those people and ask "how can we make this a win-win for both of us and how would you like me to proceed" etc...

Laws do vary state to state, so I always advise people to go online and talk to WC Helpline about what their rights are so you're informed of what you are and are not entitled to with coverage. As for your employer laying you off during your comp leave, the lawyer would have to look at local state laws and your existing employment contract as for whether they can legally lay you off.

Most States have Lawyer Referral Services which will give you the name of a few local lawyers who specialize in your area of concern (Labor Law) and you can usually get an appointment to meet with them for 30 minutes for a nominal fee. You could go and ask some basic questions, exactly like you asked me and hopefully s/he can give you some advice and possibly some resources to help you.

I hope this helps, it may feel like you're constantly hitting a brick wall, but perseverance is necessary whenever you deal with them. Please hang in there Steve, I pray things will improve for you and your family soon.

Sincerely,

Margot

Worker`s Compensation

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Margot RN BScN GNC

Expertise

Please feel free to ask anything, but the more specific you are, the easier it is for me. Please share as many details as you are comfortable doing. I do check my Emails daily Monday through Friday so you should receive an answer within 24 hours on most business days. Thanks.

Experience

I have 15 years experience as a Small Business Owner-Operator; I own a Nursing Agency so often deal with both employee and client injuries. I would be pleased to offer any assistance I can. If I can not answer your question I'll do my best to direct you to an appropriate resource. Thank you.
Experience in the area
20 years of Long Term Care and Community Nursing, specialising in Geriatrics, Gerontology and Palliative Care.

Education/Credentials
Registered Nurse , Certified Gerontological Nurse, Bachelor of Science in Nursing
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