WC Meeting This Week

[Eddie_G]

Well this is the week I've been waiting for. My Liberty Mutual Insurance adjuster is meeting with his boss about my case and my DEMAND for ADR. They plan om sending me to ANOTHER independant doctor for evaluation. I hope I have enough paperwork to throw at them. (Thanks to all of you who sent me stuff) It's very hard sometimes when you are one person fighting an entire industry but the people on this board have been very helpful.

I can't wait any longer and I made a tentative appt. with Dr. Mathews (Virginia) in March. If I am not allowed to see a decent out-of-state doctor, I guess I will have to go the lawsuit route. I need to find out if it is OK to sue my employer in NJ. I heard that in NY you cant. Anyway I do plan on suing since my life will NEVER be the same and this is the fault of my employer not salting ice the inside a trailer in disrepair. I have a witness & pictures so I'm like "BRING IT ON!" EVery day they piss me off, the price goes up!

Wish me luck...

...more to follow

[JL]

Eddie, I hope they can get you the medical attention you need. And soon. CT has had at least one Workers Compensation Approved ADR that I am aware. Maybe you could reference this too. Contact me for more information. Let me know how you make out. Bill

[Alastair]

Hi Eddie,
I live in the UK so don't fully understand the WC thing in the USA. However it looks as if you've got a great claim against your employer to get your back fixed at their expense. Good luck with whatever it is you're doing and "Sock it to them Buddy"
Best,
Alastair

[Mariaa]

Eddie,
Good luck. I have lifetime future med benefits and for several years the insurance carrier offered to pay for ADR even tho UR denied the surgery. Now I'm back to square one fighting to get where I was when I wasn't ready/sure about having the surgery!

WC is sending me for another consultation tho this time with someone that is ADR trained however doesn't perform ADR, tho does work closely with referrals to a group that does them.

Honestly I don't know where I will stand in terms of what this person will be rendering decision wise.. hopefully not for multilevel fusion as I'd be going backwards vs. forwards IMHO...

My primary treating physician/OSS wants to do ADR and fusion combo as he feels that will be approved by UR.. I told him I wanted to fight for the multilevel ADR if I was still a candidate which now will have to go back and do the discogram/CT again to see ...

Anyway, good luck~ WC is rather maze like in terms of getting anywhere~ purposefully so..tho I wish you the best and hope you will win in your fight to get ADR.

From what I've read, if you are fighting to get ADR, the surgeon you have chosen must present enough Evidenced Based Medicine (studies) that would bear out that ADR is the surgery that would give optimal results in your case and that it is as good as or better than fusion in terms of results.

Let us know how all goes please~

[luvmysibe]

Eddie,

Best wishes with your pursuit for ADR and WC claims coverage. Based upon my personal experience with WC in CA, you can not sue your employer unless they acted with willfull misconduct and intent to harm. If a third party was involved with your injury they may be sued separately from WC. Do you have legal representation? Now that I am in my settlement phase, I am being represented by an attorney.

Continue to persevere!

Yes, I think luvmysibe raises some good points. You need to consult a workers compensation and/or personal injury attorney. Typically the workers compensation system in the US is a bar to suing your employer. The trade-off was supposed to be greater certainty of benefits, although less in amount, received in a shorter period of time than litigation. In exchange, the employer was supposed to get lower claims, no litigation and a fixed monetary exposure (e.g. their periodic premimums). But there are clever ways around WC laws sometimes. You can decide how well the sysstem is taking care of those that have been harmed.

[Eddie_G]

I just found out that a third party owns the trailer that I was hurt walking in, not my employer. The trailer is typically parked at our loading dock and loaded with junk furniture. I found the name of the company that owns it. Maybe my attorney will find that useful.
Yesterday my attorney told me that the WC judge can make any decision he wants. The more info I can present to the judge, the better. It seems that ADR is past the "experimental" stage but the judge has to have compelling evidence that this procedure will benefit me better than fusion.
Liberty Mutual wants me to have any operations done within NJ. The best ADR doctor in NJ has done only 10. (Maverick) I may take my chances with him if that's all they will offer, but I'll let the judge decide if it comes to that. So far, no answer from Liberty Mutual. I will call today.
If they force me to get fusion, are they going to guarantee my adjacent discs in the future? I think not...
I will NEVER fuse my spine. It's not an option and off the bargaining table. Remember, I'm only 37.

Hey Eddie,
I have no insight to offer, just my support in that you're doing the right thing. Too bad you're having to fight the pain and WC. Stay tough! You can come to Colorado and have my surgeon implant the Maverick. The FDA trials for that disc should be starting up this year, unless there's been another delay.

[Mariaa]

Eddie,
If you and your attorney have the Evidence Based Medicine necessary to present a case for you that offers why ADR would be a better surgery than fusion, hopefully that Judge will take this all into consideration and make a decision based on this info, not what the insurance company wants..

I hear ya re the fusion, I've been holding out for an incredibly long time on that one myself, and when WC offered me the two level surgery w/trial I didn't take advantage of it when I could have. Oh well, I wasn't sure it was the right thing with the right surgeon at the time so I hesitated. And there's that saying about "he who hesitates.." can't remember it but think "he" (she) ends up in the crapper..

Good luck!!!!! Hope you'll have good news for us!

[Nairek]

Eddie,
I know that in NY, there is a 3 year statue of limitations when it comes to personal injury cases. If you can sue a third party for your injuries, check out the staute for NJ to make sure that you don't miss out!
Karin