Self Insure Workers Comp – Don’t get Hurt

Workers Comp insurance, who is this suppose to protect? I thought it was for the worker, but I have found out there are many ways for a company to get out of paying you, or paying for medical needs.

I know this is not something new, but it needs to be fixed. I am not sure how regular workers comp insurance works, as the companies I have worked for only had self insure plans.

The regular workers comp insurance has to be better. When I pulled a Hazmat Tanker a few years ago, I stopped at a truck only parking spot one night on my way to Akron, Ohio to do a DOT required walk around. This was before they changed the ruling on the walk around for hazardous material. It was dark, and I had my flash light and got out and proceeded to go around the drivers side of the truck and trailer.

When I got to the rear of the trailer, I started around the right corner of the tank, and there was a pot hole, I didn’t see. I stepped in this hole, and went down on my right knee, hard. I finally got up and was in terrible pain, shined my light down on my knee and had ripped my pants and my knee was bleeding. I tried to walk on it, but it was really stiff, and sore.

So I made my way back to the truck and climbed back in, and got in the sleeper and removed my pants, so I could (doctor) myself. We carried a first aid kit on all of our trucks, and I got in the kit got my antiseptic wipes and bandages and cleaned the wound, and bandaged it. I then proceeded to call my companies terminal manager, and report it. He took the report and asked if I could go ahead and work or if I needed to go to the hospital. I felt I could continue, but I told him when I got back to the terminal the next day I was probably go have it checked out.

He agreed, and I continued on with the load. I delivered it the next morning, having to hobble around the truck and them drive back to the terminal five hours away. I made it back and went to the health clinic, to have it checked out. They labeled it a knee sprain and contusion of the knee cap, and put a brace on it and me on crutches, and put me off work, for three days. If it was not better return to the clinic, on the third day.

Well, three days went and I returned to the clinic as I could still barely walk on it, and they placed me off work for a week (7 days more). This now meant I qualified for worker comp payments, you have to be off work for seven days straight in order to receive compensation. This went on for three weeks, and one day while getting out of the shower, I felt a snap in my knee like a rubber band and the pain eased considerably.

I went to the Dr. and told them it just felt better and they examined it, and immediately put me back to work. By this time I had decided it was a time for a change of scenery and I was moving. My company wouldn’t be able to accommodate me with work, where I was moving to. So I took the release to them and put my two weeks notice in. After explaining to my terminal manager what I was planning, he mentioned work was slow for a time being and if I wanted to just go ahead and do it I could, and they would make sure it looked as if I had taken my two weeks.

Well, this went on and I got another job, and so forth, but I was having problems now. It hurt to go up and down stairs and also climbing ladders. I got in touch with a lawyer, and he told me to start going to a doctor. I did and the doctor wanted to do a MRI after x-rays didn’t show anything. This is where the (fun) begins. It was like I was robbing the company, they denied every request till finally we had to go before a hearing officer, and then I was approved for the MRI.

The kicker here is, a company has so many days to either except a claim or deny it. My company waited the whole allotted time, before putting in the denial’s. Then my lawyer would have to appeal it, this also takes so many days, then we would have to have a hearing with the BWC. This went on back and forth until they finally gave me the approved MRI. The MRI showed a large effusion in the knee joint. I was sent to a specialist, who confirmed the injury was the cause, and wanted to drain it, and give me cortisone shots.

Company would deny it, we would appeal and would have to go to a hearing. This went on back and forth until they would accept it. The specialist said I had a condition called: Chondromalacia Patella of the right knee. Well. this is NOT a knee sprain as had been an accepted claim by my company, this was a “new claim”, and THEY REFUSED it, said I had healed from my sprain.

Well, to edit this story down I have skipped four years, this happened in 2004, and yesterday I just had my first hearing to have them accept the “new claim”. When my lawyer put in the required form for motion to add this “new claim” my ex- companies lawyers requested I go to a “IME Doctor” Independant Medical Examiner, in other words a doctor they hire to write a report why you have healed and they should NOT have to accept this “new claim”.

So I went to the doctor, and she saw me for 15 minutes, and wrote a four page report saying my injury was due to my age! What? My age? I was 34 at the time, now I am 39. Anyway, that was there defense yesterday at the hearing. I will receive the determination of the hearing in the mail. There defense was, that I had ONLY seen this specialist one time, and it was due to my age according to their doctor. Funny, I ONLY saw there doctor ONE time, and for ONLY 15 minutes.

The point of this long story was to show, how easy it is for a company with self insure workers comp insurance to screw you. If the BWC had been handling this claim, after my injury they would have had the MRI done and proceeded on, it would not have taken five years! I have no doubt the injury probably has healed, in five years, BUT it did NOT heal right. So I guess I will have to dig in for another LONG battle. Good luck out there and stay safe!

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