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TexLaw, Attorney
Category: Personal Injury Law
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Experience:  Lead Personal Injury Trial Lawyer
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Hello, I was injured on the job on September 8, 2012. I have

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Hello, I was injured on the job on September 8, 2012. I have a complete tear of the left acl. That week I was scheduled for pto and was told by my manager to go ahead and stay home. On Monday I was able to file a workmans comp claim and they sent me to the local urgent care. The doctor looked at my knee and did a couple of X-rays and told me that it was just sprained. I told her I thought something more was wrong and asked for a MRI. She said ok and requested one to be done through my claim. She told me they I could return to work and work desk work only. When I called and told my risk management this, they said it was up to my manager wether or not I had to use my pto or return to work. Again I called my boss and she told me to stay home. Then finally on Thursday they approved for me to have my MRI done. That is when they realized that it was an acl tear and not a sprain. I was still on desk work only duty and tried to contact my manager to find out if I could come back to work. She never responded so on the following Monday I dragged myself to work in horrible pain and waited for the approval to see an orthepedic surgeon. My manager acted surprised to see me on Monday and then said I could stay if I wanted to. Since I was not told by the doctor to stay home I pushed through till I could get in to see the orthepedic doctor. I had to make many calls to insist the approval and finally they approved it and I was seen on thursday. The knee doctor said that I should not have been walking on my knee and ordered that I have 12 physical therapy appointments over a 4 week period before he would do the surgery due to I did not have enough movement in my knee. So at that point I scheduled physical therapy on that Friday and started. Once I arrived at the spooner physical therapy, I was told that the company sedgewick (the insurance company that my company wells fargo goes through) had only approved 4 visits. So we scheduled the four visits over the next week and during that time I had made many calls to the adjuster and so did the physical therapy office to get more. So needless to say I had to wait an extra week and a half to get the rest approved. This caused me to have to wait even longer in pain to get worked on and to get surgery done. Finally after 4 weeks and not all therapy completed I went back to the doctor to see if my knee was ready. In the mean time Sedgwick forgot to pay me any salary and I was running through all my savings. Needless to say I have been very stressed. Finally after many attempts sedgewick sent me a check 2 weeks after my 1st one was due to come in. At the doctors office he said I was ready for surgery however he wanted me to stay off work due to my knee still was filling up with Edima and didn't want me to damage it further. He told me his medical assistant would be contacting me to schedule an appointment. She called me a few days later to apologize that she had been having a very hard time reaching the claims adjuster to get it approved and to hang on. So in the meantime as I am waiting for over a week to get scheduled, I am getting even more stressed. Finally she calls me and tells me they approve it and she wants to schedule. So I schedule an appointment for surgery. Then the next day the claims adjuster calls and tells me he has more questions for me and the surgery is not approved! So he tells me that he needs to ask me about a claim I did back in 2000 for a neck injury and was it associated to my acl tear????? Needless to say he caused me more stress and told me to make sure I don't schedule my surgery until two more weeks do he can assure that it is approved. So over the weekend I got very stressed and awoke with pains in my left side and a really bad headache. My left side felt numb and it really scared me because back in April I had woke up from a stressful night sleep due to work conditions and went to the doctor with similar numbing. She said she thought it was bells palsy but wasn't sure and that she gave me an antibiotic. Then I went to a chiropractor a d be adjusted me a few times and I felt fine. I think I may have slept weird due to the stress. So after this last episode I went to the doctor again. She wants to me to a neurologist and have an MRI done. I don't think that is the issue, but I am going to follow her orders. So now out of no where this case nurse manager from sedgewick calls me and tells me she has been assigned to me. She starts questioning me on how I'm doing and I tell her thinking it's ok. Well now she is demanding that I have this MRI done or she says they will drop my insurance and make me go on short term disability only. I am really stressed and need good advice and need to know what my rights are. Can they do that to me? She is trying to tell me that they will not pay me if there is something wrong! The way I see it is if there is it is because of all this damn stress that they have caused on me. What do I do? Or is there anything I can do?

Thanks for your question and I'm sorry to hear about your situation.

If your ACL tear occurred while you were at work, then the medical treatment should be covered by workers comp. Further, you should be receiving temporary income benefits while you cannot work, especially where you have been allowed to return to work on light duty, but your employer has not made any light duty work available to you.

Since you have filed a workers comp claim, you need to contact the following:
Claims Division
Request for a Hearing
Melinda Poppe, Claims Manager
Email:[email protected]
Phoenix: 800 W Washington St, Phoenix AZ 85007 - Phone: (NNN) NNN-NNNN
Tucson: 2675 East Broadway, Tucson AZ 85716 - Phone: (NNN) NNN-NNNN
FAX (use for either office): (NNN) NNN-NNNN

This is so that you can request a hearing. At the hearing you will tell the judge exactly what is going on and ask that they pay for your surgery and pay you the income benefits you are owed.

Sedgewick is a bad company. It may be a good idea that you call a workers compensation attorney to help you with this. Google "workers compensation attorney" and the name of your city to find a local attorney to help you. They will take your case usually without charging you anything.

It really is as simple as that. Your workplace injury entitles you to payment of medical treatment needed for the injury and income benefits while you cannot work, or if they do not have light duty work for you.

Please let me know if you have further questions.
Customer: replied 4 years ago.
Thank you for your quick response. I understand that they should be paying me, however due to this last doctor visit that I paid out of my pocket and the tingling in my left side, sedgewick is stating that if I I have a new issue, they will stop my benefits until I get that fixed. Can they do that?

They do not have to pay for the tingling in your side unless your doctor shows it to be a complication of your acl tear. I think you are correct in assuming that you have somehow hurt your back or neck by sleeping in an uncomfortable position. So this probably is not going to be related to the work injury closely enough to allow workers comp to pay for the treatment of that injury. If the tingling in your left side is keeping you from going to work, rather than only your knee, then they can transfer it over to disability rather than comp.

However, they cannot stop treatment for your knee, and they cannot stop paying you income benefits if your are unable to work because of your knee. All they can do is not pay for treatment on your back, unless you get a doctor to say it was caused by an at work injury.
Customer: replied 4 years ago.
Can they stop the knee surgeon from doing the surgery if I do not get the MRI done? Let's say the knee surgeon does not require the MRI and he says he can do the surgery without me having that done, can sedgewick force me to have the MRI before they will approve the surgery? Also can sedgewick stop payments of benefits if I choose not to do the MRI?
You are saying that Sedgewick wants you to do an MRI and won't approve the surgery until you have one?

Sedgewick (the "Carrier") has a right to examine you to determine whether or not they agree with your doctor's diagnosis before they approve a surgery. If you choose not to do the MRI, they can attempt to stop your benefits, at which point you will need to have a contested hearing with the workers' comp board to get the benefits restarted. It is probably a good idea to get the MRI done. If the Carrier's doctor examines the MRI and says that it doesn't believe that surgery is needed, it can refuse to approve, at which point you will have to go to a hearing to get an order for them to approve the surgery (based on your doctor's findings that the MRI shows that surgery is needed).
Customer: replied 4 years ago.
Ok I just want to be sure that we are talking about the MRI they are wanting me to do on my head not my knee. The one on my knee is done and shows a complete tear. The one for my head I was going to pay for, but I went to do it earlier this week and panicked inside the machine. So I had my doctor prescribe me a sedative to get it done. The case nurse for sedgewick is saying to me that I have to go back and have it done again. She is saying that the knee surgeon will not operate on my knee until they see my brain is ok. And she also said that if I don't get this done that they will stop my benefits! I told her I think it's just a side effect from sleeping funny. She said it didn't matter. Can they force me to do this MRI? She told me she called the knee surgeon and they said that I have to have the MRI done. I don't think that is the case because when I talked to the knee surgeons office they said they didn't think it was going to be an issue. I truly think that sedgewick is looking for other reasons not to do the surgery and or pay me my benefits. What do you think?
Is Sedgwick offering to pay for the upper body MRI?
Customer: replied 4 years ago.
No they are not!
Then they cannot require you to get the upper body MRI. It is illegal for them to make contingent payment of medical benefits on your payment of a non-related medical procedure. If this is what they have told you, then you need to immediately call and get a hearing date so that you can have order for them to provide the medical benefits.

At this stage, if Sedgwick is threatening to cut off your benefits and claim your disabled due to an unrelated matter and is refusing to pay your income benefits in a timely manner, you MUST contest this by requesting a hearing. I really do think the best thing you can do is get a workers compensation attorney to represent you. There are firms that specialize at this and can maximize your award and speed up the payment process.
Customer: replied 4 years ago.
The case nurse from sedgewick is claiming that the doctor who is doing my surgery will not do the surgery until I find out what is wrong with me. I have tried calling and leaving the doctor messages today and they haven't returned my call to find out if she is telling me the truth. She made me call and reschedule the MRI for tomorrow but I'm not sure I am wanting to go through with it. Do you suggest that I wait until I talk to the knee surgeon?
Yes. If your doctor did not order you to take an MRI, then you don't have to take the MRI. Talk to the knee surgeon first to find out what is going on. If the knee surgeon recommends the MRI, ask why it is required for the knee surgery. If it is required for the knee surgery, then Sedgwick should pay for it, not you.
Customer: replied 4 years ago.
Ok, well my personal doctor that I paid for on last week, said that she wants me to go get the MRI. Not the doctor from sedgewick. I just don't think that I have an issue. But I'm going to try to go in the morning again and try to do the MRI. I think that sedgewick is trying to make me nervous and think that they won't pay if I don't do it. I just made a huge mistake by telling the case nurse that I had tingling in my left arm and she suggested that I go to my doctor. Now it seems like they are digging for reasons not to help me. After I figure out the results from this MRI and go to the neurologist next week, I'm going to call an attorney. This entire thing has been a nightmare and sedgewick is an awful company. They have caused nothing but stress and problems through all of this. Thank you for your advice.
Please let me know if you have any further questions on this subject, and please do not forget to rate me positively so that I might receive compensation for my work.

Best Regards,

Please let me know if you need further information on this issue.

Also, please be aware that although you have made a deposit, the website does not compensate me unless you rate me positively. I spent a significant amount of time with you and hope you show your appreciation by allowing me to receive compensation

I appreciate your business.

TexLaw and other Personal Injury Law Specialists are ready to help you
Customer: replied 4 years ago.



I am going to start where I left off from our last talk. I went and had my mri done and the neuroligist said I was fine and that the tingling was due to me sleeping crooked and cuased a hip misplacement. The insurance company magically lost all the information regarding them telling me I had to have this MRI done. So I went to an attorney and they had me go to a new doctor to get the clearance for surgery from another surgeon. The surgery is scheduled on January 3rd. My question for you is that due to all this time waiting, my fmla has ran out and now my position has been posted at my job. I spoke to my manager about coming back at a part time work to see if I can handle it until I have surgery provided my doctor gave the ok & she said no. So now, I am in a position of me possibly losing my job. I received a letter from my fmla & it reads that my position at my location is no longer protected & once I am well, if it is in within 2 years of the accident, they will give me 90 days to search for a new position within the company. If no one hires me I am out of a job. My question is can they do this? The doctor I am seeing says they can. I don't quite see how this is fair when none of this was my fault & the time the insurance company is taking to get me approved has over ran the length of my fmla coverage.

Customer: replied 4 years ago.

Just so you know, I just saw that I had to hit confirm on the service, I didnt know that..

The company can do that, and unless you are released by your doctor to return to work, then the company does not have to offer you light duty, and they do not have to keep your job position open for you after the FMLA period has expired.

However, you are allowed to continue with temporary income benefits while you have been rated as disabled by a doctor. You really should consider hiring a workers compensation attorney to make sure you are getting all your benefits and to fight for you.

While we can give you advice here, it doesn't replace having actual representation.

TexLaw and other Personal Injury Law Specialists are ready to help you
Customer: replied 4 years ago.
Ok thank you. Yeah we did get an attorney

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