workmans comp

quarterhorse · 03-13-2002, 07:42 PM

I fell off a bridge at work may 19, 2001 and suffered a complete t-10 spinal cord injury.Workmans comp has gave me a weekly check and sent me to rehab in ga,and now i am at home doing rehab 3 times a week at a local facility.What i would like to know is if anyone can help me to find our about home modifications. Our case worker came out with a contractor in july and they said that it would cost $65,000 to fix up our old farm house with a roll in shower and exit door in the bedroom and ramps a covered garage and stuff like that, i told them that i would rather have a new house trailer than put the money into this old house. So our case worker has been looking into that, she keeps changing the housetrailer places that we are supposed to be looking at, going from one type to another, and i think now they are just giving us the runaround. Don't they have to do something about home modifications?I will be home in this unacessable house sence Aug. 1 and if it wasn't for my wife i would not be able to even leave it. I am trying to keep from getting a lawyer because i would like to settle for the check i am recieving now and would hate for a lawyer to get part of it.

Emi2 · 03-13-2002, 09:09 PM

I'm on WCB but I'm from Canada so I'm not sure but all I can say is I wouldn't settle because you will end up with less. WCB is paying for all my equipment, supplies, meds, modifications (when Ui get a place), a van, caregivers, plus mydisability pension. Its a sweet deal for a shitty situation.

"Each moment in time we have it all, even when we think we don't."
--Melody Beattie, writer and counselor

SCI-Nurse · 03-14-2002, 08:07 AM

I am moving this topic to the LIFE forum as the content is more appropriate for there and you are likely to get more responses.

I can say that if you are trying to do any Worker's Comp case without an expert WC attorney, get one now. The case manager for your case may not really be your advocate, since they are employed by the insurance company.

(KLD)

Free · 03-14-2002, 10:14 AM

As suggested, see a W/C attorney asap. W/C is only required to provide items that are a medical necessity. The definition is very subjective. Their decisions will ultimately be determined by cost-effectiveness. This is the case you must make for any service. Do you have any plans of returning to employment? If so, they might be more liberal with you as your eventual return to work would limit their payments to you. If this is your interest, contact the state Vocational Rehabilitation office nearest you.

Ben Rolfe · 03-14-2002, 10:57 AM

Worker's comp. laws vary from state to state and sometimes from industry to industry, you definatly need a lawyer to navigate this mindfield. The sole purbose of the WC case worker is to screw you out of any sense of human decency you have, while making you kiss their pimply butt in groviling appreciation. These lowlifes are not your friends, but scum of the earth who will lie through smiling lips.
you might want to check with your state's protection and advocacy system, and with the disability affairs agency. Such groups will be better able to advise you on where to get help in your area.

Mur · 03-14-2002, 12:14 PM

Are there any unordinary things that have been paid for through WC for you? Just wondering!
Mike~

mk99 · 03-14-2002, 12:34 PM

No lawyer -> you get 100% of NOTHING
With lawyer -> you get 80% of SOMETHING

Get a really good lawyer, fire your case manager immediately and bring on a case manager that represents your interests, not the insurance company/employer.

shacha · 03-14-2002, 01:07 PM

my husband was also hurt at work weare in fla. i can only tell you our experiane. he is 8 yrs.post and we have never ad a lawyer, they have been really good abut paying fr anything we say that we need, we have a nurse case anager i help cordinate appointments and such, hey have done some mods on the house, and we re building now and they are going to help out with that. they still pay his income (% of) plus hs medical and Rx. they ar talking about settling now. I have a friend who lives in fla. also he worked for home depot and hey were doing ok dealing with the w/c people until he hired a lawyer. i would not sign anything withot a lawyer looking it over first. sometimes you just have to call and tell them to stop screwing around or you will hire a lawyer. your state insurance commissioner sould have a basic out line on worker comp. benefits, call them and ask. if you are in fla i will try to answer any more questions you hve if i can. good luck.

jjs · 03-15-2002, 07:58 AM

My husband was injured under workers comp almost 3 years ago. The owner of the company he worked for is a really good friend of the family. So we didn't want to get a lawyer either. After going through a few issues with the insurance company and getting no where, we hired an attorney. That was the best decision we made. He does not take any of our WC wages (because he didn't help us get it), just parts of our settlements. He is an awesome attorney who really knows about the WC laws. He helped us figure out what the insurance company has to pay for and what they don't. He tells us that there are four portions of a WC case that can be settles. They do not have to settle all of them at the same time. As a matter of fact, they should all be looked at and settled seperately. 1)vehicle 2)housing mods 3)wages 4)medical. Always save medical for last and only settle that portion if you have been injured for a long time or have become very stable. My husband has not had any medical complications since his injury, except UTI's, but we would not even think about settling medical. It's way too early. You don't know what the future holds. Our attorney told us to not even think about medical for like another 5 years or so. Then he said to proceed with extreme caution. The first thing we settled was our housing modifications. We had an inaccessible house and needed to either move or modify our house. We had our own contractor come out and give us a price for the modifications. Our insurance co did not want to mess around with paying the contractor bills, so we settled for a lump sum, which was close to what our contractor had quoted us. Our attorney took 10% (because he knew we really needed the money) and the rest was ours to do with what we wanted. We used it for a down payment on a new ranch house. Just two weeks ago, we settled the wages portion of my husbands case with a lump sum. Our attorney only took 15% on that. I know it sucks that they have to take money, but we would have never been where we are without him. He knew the ins and outs of the WC system. He has also helped us with getting reimbursed for money we spent on experimental therapy, he helped with having our private aide get paid in a timely manner and all without getting any money for it. He also told us that in our state (PA), WC does not have to pay for a van but they have to pay for mods. That is what our insurance company has been telling us for the past 2 years. Well yesterday, we picked up our 2002 Grand Caravan IMS conversion van. Fully paid by WC!! Goes to show you that not all insurance companies get angry when you hire an attorney. As a matter of fact, our insurance company kept pushing us to hire one because they knew that it is expected and that you really do need one to navigate the WC laws. I have to say, our insurance company has been good to us. BTW, my husbands ex-boss is still a family friend and after we explained to him that the attorney was not to sue or threaten, but just to help us get what we need and know the laws, he understood completely.

And do not for a second think your case manager is there to help you. They act like they are, but it is an act. They are looking out for the interests of the insurance company. We still have a case manager, but we rarely speak with her and we try not to tell her anything unless it is absolutely necessary. Everything we tell her goes directly to our insurance co. She loves to pretend that she really cares about us and then she finds out little bits of info that is none of her business and she runs back to the insurance co and tells them everything. Not that we have anything to hide, but I feel like our new house or vacations or whatever is none of the insurance companies or the case managers business. I hate people who butt into what we have left of a personal life. Learn to handle as much as you can on your own or who to talk to at your insurance comapany so you do not have to go through your case manager. I know my husbands adjustor and I call her regularly if I need something. Case in point, one time we were trying to get my husband into a gym at the rehab. Our case manager kept telling us she was trying to take care of getting the insurance company to approve it but the insurance company was arguing that we didn't need the gym membership. For weeks we went back and forth with her until finally I called our adjustor myself and she said that she didn't know anything about the gym. Then the adjustor told me to set it up that it was approved. We wasted weeks relying on our case manager to get an approval and all along she was running us in circles because she hadn't even talked with the adjustor for an approval.

03-13-2002, 07:42 PM	#1
quarterhorse Junior Member Join Date: Aug 2001 Posts: 9	workmans comp I fell off a bridge at work may 19, 2001 and suffered a complete t-10 spinal cord injury.Workmans comp has gave me a weekly check and sent me to rehab in ga,and now i am at home doing rehab 3 times a week at a local facility.What i would like to know is if anyone can help me to find our about home modifications. Our case worker came out with a contractor in july and they said that it would cost $65,000 to fix up our old farm house with a roll in shower and exit door in the bedroom and ramps a covered garage and stuff like that, i told them that i would rather have a new house trailer than put the money into this old house. So our case worker has been looking into that, she keeps changing the housetrailer places that we are supposed to be looking at, going from one type to another, and i think now they are just giving us the runaround. Don't they have to do something about home modifications?I will be home in this unacessable house sence Aug. 1 and if it wasn't for my wife i would not be able to even leave it. I am trying to keep from getting a lawyer because i would like to settle for the check i am recieving now and would hate for a lawyer to get part of it.

03-14-2002, 08:07 AM	#3
SCI-Nurse Moderator Join Date: Jul 2001 Location: USA Posts: 41,301	Moving topic I am moving this topic to the LIFE forum as the content is more appropriate for there and you are likely to get more responses. I can say that if you are trying to do any Worker's Comp case without an expert WC attorney, get one now. The case manager for your case may not really be your advocate, since they are employed by the insurance company. (KLD)

03-14-2002, 10:14 AM	#4
Free Senior Member Join Date: Oct 2001 Posts: 191	Worker's Comp As suggested, see a W/C attorney asap. W/C is only required to provide items that are a medical necessity. The definition is very subjective. Their decisions will ultimately be determined by cost-effectiveness. This is the case you must make for any service. Do you have any plans of returning to employment? If so, they might be more liberal with you as your eventual return to work would limit their payments to you. If this is your interest, contact the state Vocational Rehabilitation office nearest you.

03-14-2002, 10:57 AM	#5
Ben Rolfe Senior Member Join Date: Jan 2002 Location: PHOENIX, AZ Posts: 303	Debbie, Worker's comp. laws vary from state to state and sometimes from industry to industry, you definatly need a lawyer to navigate this mindfield. The sole purbose of the WC case worker is to screw you out of any sense of human decency you have, while making you kiss their pimply butt in groviling appreciation. These lowlifes are not your friends, but scum of the earth who will lie through smiling lips. you might want to check with your state's protection and advocacy system, and with the disability affairs agency. Such groups will be better able to advise you on where to get help in your area.

03-14-2002, 12:14 PM	#6
Mur Member Join Date: Mar 2002 Location: Wisconsin USA Posts: 70	workers' comp. stuff Are there any unordinary things that have been paid for through WC for you? Just wondering! Mike~

03-13-2002, 09:09 PM	#2
Emi2 Senior Member Join Date: Jan 2002 Location: Canada Posts: 3,205	I'm on WCB but I'm from Canada so I'm not sure but all I can say is I wouldn't settle because you will end up with less. WCB is paying for all my equipment, supplies, meds, modifications (when Ui get a place), a van, caregivers, plus mydisability pension. Its a sweet deal for a shitty situation. "Each moment in time we have it all, even when we think we don't." --Melody Beattie, writer and counselor

03-14-2002, 12:34 PM	#7
mk99 Senior Member Join Date: Jul 2001 Location: toronto, canada Posts: 3,494	The $ break down like this: No lawyer -> you get 100% of NOTHING With lawyer -> you get 80% of SOMETHING Get a really good lawyer, fire your case manager immediately and bring on a case manager that represents your interests, not the insurance company/employer.

03-14-2002, 01:07 PM	#8
shacha Senior Member Join Date: Feb 2002 Location: bonita springs, fl Posts: 147	w/c lawyer? my husband was also hurt at work weare in fla. i can only tell you our experiane. he is 8 yrs.post and we have never ad a lawyer, they have been really good abut paying fr anything we say that we need, we have a nurse case anager i help cordinate appointments and such, hey have done some mods on the house, and we re building now and they are going to help out with that. they still pay his income (% of) plus hs medical and Rx. they ar talking about settling now. I have a friend who lives in fla. also he worked for home depot and hey were doing ok dealing with the w/c people until he hired a lawyer. i would not sign anything withot a lawyer looking it over first. sometimes you just have to call and tell them to stop screwing around or you will hire a lawyer. your state insurance commissioner sould have a basic out line on worker comp. benefits, call them and ask. if you are in fla i will try to answer any more questions you hve if i can. good luck.

03-15-2002, 07:58 AM	#9
jjs Senior Member Join Date: Aug 2001 Posts: 121	My husband was injured under workers comp almost 3 years ago. The owner of the company he worked for is a really good friend of the family. So we didn't want to get a lawyer either. After going through a few issues with the insurance company and getting no where, we hired an attorney. That was the best decision we made. He does not take any of our WC wages (because he didn't help us get it), just parts of our settlements. He is an awesome attorney who really knows about the WC laws. He helped us figure out what the insurance company has to pay for and what they don't. He tells us that there are four portions of a WC case that can be settles. They do not have to settle all of them at the same time. As a matter of fact, they should all be looked at and settled seperately. 1)vehicle 2)housing mods 3)wages 4)medical. Always save medical for last and only settle that portion if you have been injured for a long time or have become very stable. My husband has not had any medical complications since his injury, except UTI's, but we would not even think about settling medical. It's way too early. You don't know what the future holds. Our attorney told us to not even think about medical for like another 5 years or so. Then he said to proceed with extreme caution. The first thing we settled was our housing modifications. We had an inaccessible house and needed to either move or modify our house. We had our own contractor come out and give us a price for the modifications. Our insurance co did not want to mess around with paying the contractor bills, so we settled for a lump sum, which was close to what our contractor had quoted us. Our attorney took 10% (because he knew we really needed the money) and the rest was ours to do with what we wanted. We used it for a down payment on a new ranch house. Just two weeks ago, we settled the wages portion of my husbands case with a lump sum. Our attorney only took 15% on that. I know it sucks that they have to take money, but we would have never been where we are without him. He knew the ins and outs of the WC system. He has also helped us with getting reimbursed for money we spent on experimental therapy, he helped with having our private aide get paid in a timely manner and all without getting any money for it. He also told us that in our state (PA), WC does not have to pay for a van but they have to pay for mods. That is what our insurance company has been telling us for the past 2 years. Well yesterday, we picked up our 2002 Grand Caravan IMS conversion van. Fully paid by WC!! Goes to show you that not all insurance companies get angry when you hire an attorney. As a matter of fact, our insurance company kept pushing us to hire one because they knew that it is expected and that you really do need one to navigate the WC laws. I have to say, our insurance company has been good to us. BTW, my husbands ex-boss is still a family friend and after we explained to him that the attorney was not to sue or threaten, but just to help us get what we need and know the laws, he understood completely. And do not for a second think your case manager is there to help you. They act like they are, but it is an act. They are looking out for the interests of the insurance company. We still have a case manager, but we rarely speak with her and we try not to tell her anything unless it is absolutely necessary. Everything we tell her goes directly to our insurance co. She loves to pretend that she really cares about us and then she finds out little bits of info that is none of her business and she runs back to the insurance co and tells them everything. Not that we have anything to hide, but I feel like our new house or vacations or whatever is none of the insurance companies or the case managers business. I hate people who butt into what we have left of a personal life. Learn to handle as much as you can on your own or who to talk to at your insurance comapany so you do not have to go through your case manager. I know my husbands adjustor and I call her regularly if I need something. Case in point, one time we were trying to get my husband into a gym at the rehab. Our case manager kept telling us she was trying to take care of getting the insurance company to approve it but the insurance company was arguing that we didn't need the gym membership. For weeks we went back and forth with her until finally I called our adjustor myself and she said that she didn't know anything about the gym. Then the adjustor told me to set it up that it was approved. We wasted weeks relying on our case manager to get an approval and all along she was running us in circles because she hadn't even talked with the adjustor for an approval.

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