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TexLaw
TexLaw, Attorney
Category: Legal
Satisfied Customers: 4021
Experience:  Lead trial/International commercial attorney licensed 11 yrs
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I hurt my lower back at work. Since I am the general Manager

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I hurt my lower back at work. Since I am the general Manager of my business it is frowned upon for me to file a claim on myself. i had also been threatened recently of losing my job by a new superior. I honestly thought it would go away after seeing my doctor and getting treated. After the 3rd visit to my personal doctor in three weeks, she ordered an MRI to be done. This was when I realized that this could be serious and filed a workers comp claim with my employer. I was terminated from my job 3 days later for just cause under an unrelated incident. I filed the claim within 30 days which is the law in my state. After reviewing the MRI, my personal doctor referred me to a neurosurgeon who specializes in lower back injuries. She said there was definitely damage in that area. I have also retained an attorney. I know I did not use the panel of physicians posted, but I thought it would go away after seeing my personal doctor. Now the Employers insurance company is taking their time with the whole process and is trying to dispute the claim. My doctor says I am unable to work, and I cannot go out and search for a new job in my field under my current condition.
Submitted: 2 years ago.
Category: Legal
Expert:  TexLaw replied 2 years ago.
Hi,

Thank you for contacting us. From my read of your question you want an opinion as to what the outcome of your case might be.

You state that you filed the workers compensation claim within 30 days. As long as this was in 30 days of the date of the injury, then you don't have any issues there. The next question will be whether it is a compensable injury. This analysis will look to see if there is any history of back injury in your medical records or any other cause of the injury other than your work. If you have a specific incident in which you felt something happen to you at work, then you don't have any issues there either. If there isn't a specific incident you can point to which caused your injury, then the insurance carrier may attempt to dispute. However, if your job involves lifting, etc., then you shouldn't have a hard time establishing that the injury occurred at work.

If you pass these first hurdles, then your medical care should be provided for in the end. This process may take a while and your lawyer may have to press the insurance carrier to accept the claim and pay the medical benefits due.

The fact that you were terminated prior to your reporting of the claim does not affect the fact that if you are told by your doctor that you cannot work, then you are entitled to benefits. The benefits will be determined by a calculation of your average weekly wage, which will be determined by what you were earning before you were terminated, but will not exceed $500 per week.

Please let me know if this answers your question, or if you need further information.

-ZDN
Expert:  TexLaw replied 2 years ago.
Hi,

I see that you have rated my answer poorly. First I think it is only fair to let you know that rating me poorly results only in the website keeping your money and not paying me for my work.

That being said, what I'm really concerned about is making sure you get the service you paid for. I've told you some information about your workers compensation claim. However, but the poor rating it appears that I did not answer the question you wanted. Can you please clarify what kind of information you are looking for or the exact question you need answered? I'd be happy to provide you with further information and analysis.

I look forward to hearing back from you.

-ZDN
Customer: replied 2 years ago.

Sorry, Zachary


I had heard all the info you had given me already from my attorney. I was hoping you might give me something additional that i hadn't heard.


I do have a followup question. My doctor has done everything she can do at this point. I have had an MRI done and it shows there is something there pinching my nerve in lower back area. She has referred me to a neurosurgeon for further treatment, and I have been waiting now two weeks for this insurance company to approve me to go see this new doctor. I have had to go to emergency room due to unbearable pain and they are still taking there time with this. I was told by my attorney they have 21 days from first day of work missed, which I guess would be the day after I was terminated from my job. The neurosurgeon that my doctor referred me to says they are saying they are not on the panel of physicians, but they are not giving me any other options either. What would you do to get thisprocess moving quicker as an attorney ?

Expert:  TexLaw replied 2 years ago.
First of all, let me say that I've helped clients with back injuries like the one you are going through for years and understand the tremendous effect it has on you. Because it is an injury that people can't "see" they have a hard time understanding the insane amount of pain that a pinched nerve, sciatica and radiculitis causes and how it completely disrupts your life. I'm very sorry that you are going through this.

The delay in approval is caused by the fact that your doctor has referred you to a neurosurgeon who is not on the panel. When this happens, the employer and insurer get to review the matter and may dispute the choice of doctor.

You have two options to speed up the receipt of medical benefits. The first is to ask that your referring doctor send you to a neurosurgeon or orthopedic surgeon who is on the panel of doctors. At this point in your treatment, the next step is usually an epidural steroid injection to reduce the swelling of the damaged tissue which is putting pressure on your nerve and causing pain. A neurosurgeon is not necessary to provide such treatment, so it may be possible to get a specialist who IS on the panel to do this for you without the need for delay. The second option is to stick with your doctor's recommendation and ask for an expedited hearing to get the neurosurgeon visit approved so you can get treatment from him ASAP.

Since you have an attorney handling the claim, the attorney will have to do this for you. The attorney can call the board and request an expedited resolution hearing with an administrative law judge to have the matter resolved.

Please let me know if you need further information.
-ZDN
Customer: replied 2 years ago.

Thank you Zachary,


your answer was helpful and I will ensure I give you an excellent rating.


Last question, as far as my income. Of course I am unable to work or seek employment presently due to this injury. My doctor signed a note that says no work. What is the maximum amount of time can they hold off paying me weekly benefits ? I know there is the 21 day stipulation, which would be Aug. 21st, but can they prolong this further ? I need income to help support my family and pay bills.

Expert:  TexLaw replied 2 years ago.
Unfortunately, they can dispute the right to income benefits for an extended amount of time by disputing your doctors finding of inability to work. Now, I'm not saying that is what is going on here. However, you should inform your attorney there that in addition to seeking an expedited decision on the medical treatment, you also want an expedited decision on income benefits.

-ZDN
TexLaw, Attorney
Category: Legal
Satisfied Customers: 4021
Experience: Lead trial/International commercial attorney licensed 11 yrs
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