I Wish I Knew Then What I Know Now! My Year-Long Struggle with Workers' Comp
My Year-Long Struggle with Workers' Comp. This is the final part in a four-part series of me telling my story. The story of my year-long struggle navigating the Workers' Comp system.
Catching you up
My story began In May 2017 when I sustained a work-related injury while pulling a patient. You may wish to read the first three articles in this series:
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With the Holidays over, I began determined plan to get some answers from Cindy, my WC caseworker. I called at least once a day to request some feedback on the approval process for my surgery.
Apparently, Cindy was having some difficulty answering her voicemails. Granted, while I started out nice, the more she ignored me, the less nice I became.
After the fifth day, I decided to pursue another course of action. I contacted a lawyer, told the paralegal about my situation, and requested a consultation.
This was a difficult decision because of the way I was raised, my personal ethics, and loyalty to my healthcare system. But enough was enough!
I also called Cindy's supervisor. It went straight to voicemail, but I left a message, anyway. To my surprise the supervisor called me back within the hour.
I told her of my inability to reach my case worker over the last several weeks. We also discussed the overall lack of professionalism on Cindy's part. She lied to me on several occasions.
The supervisor apologized in behalf of Cindy, and assured me that Cindy would be contacting me by the end of the day.
This is how I left the conversation, "I have been very patient with this system up until now. My patience and understanding is at an end. So, YOU tell me what I have to do to get this surgery approved:
- Do I need to contact an attorney?
- Do I need to call the my Congressional Representative?
- Do I need to call the Insurance Bureau?
- Do I need to call the Department of Insurance?
Because if I don't start getting some answers so I can move on with my life, that is what I will do. I have all of their numbers."
The supervisor insisted that I did NOT need to do any of those things. Hmph
The Day of the Consultation
The morning of my consultation, a week after my phone call with the WC supervisor, I was in the shower when Cindy finally returned my call.
"Hi Lisa, this is Cindy, I'm so sorry we haven't been able to connect! I expect to get an answer regarding your surgery in two days time at the most."
I was nervous. The one other time when I needed a lawyer was during my divorce. I really didn't know what to expect.
I sat nervously in the waiting room with all my documentation. As I was looking around the room, I saw all sorts of awards that my attorney won as an advocate for WC victims.
My attorney's name is Dennis Palso. He only practices two types of law. First, Worker's Compensation. And second, Social Security.
If you have read this entire series, you will notice I have not mentioned anybody's full names. The reason for this is twofold. The purpose of this story is not to slander any one person, but simply to tell my story so that others can read a first-hand account.
Dennis Palso is the one exception. He has advocated for me, when I was unable to speak for my self. He is a wonderful attorney, very down to earth and an easy person to discuss my case.
I mention his name, as a sort of non-paid endorsement, in case you are in the Tampa Bay area and require the services of a Workers' Comp attorney.
Right away, Amber, the paralegal, put me right at ease as she welcomed me to the conference room. We began by going over my entire case.
Then after a while Dennis joined us at the table. He was not what I expected in a good way. He seemed like a "normal" guy who happened to also be a lawyer. He did not talk down to me, and took the time to answer all of my questions.
Towards the end of the consultation he asked me, "What is that you truly want?"
"The surgery. I want to have the surgery so I can get my life back, return to work, and not be in pain."
"Amber and I can help you. And you will never have to speak to your case manager again. From now on all communication will go through this office."
I signed the contract then and there.
Facing My Depression
In January, we now had insurance coverage through John's (my husband) employer. I needed a new primary care physician, as mine was retiring.
A few of my nurse friends recommended their physician. So I called the office to make an appointment with a female internal medicine physician.
Depression is a major disease process. To learn more read this article for information on depression and treatment options.
My new doctor
I told my new doctor everything. My case. My inability to sleep. The incessant pain. And of course, about my worsening depression. I felt very comfortable telling her my story. And for the first time, maybe ever, I was completely honest.
I was in over my head, and despite my intelligence and knowledge, I was not going to get through this without some help.
She was so understanding! She started me on an entire new medicine regimen. Better pain management and an antidepressant. Finally, someone was doing something to help me!
My Struggle with Workers' Comp: February
By February I was feeling better. I was sleeping at least eight hours a night. Finally. My pain was tolerable. I set to the task of finishing my Masters. At this point, that was the only thing I could really control, anyway.
As the weeks went by, my depression symptoms were improving. I was spending less and less time cooped up in the bedroom.
February 27th is my birthday. John and I "celebrated" by getting our taxes done and going to brunch.
We came home after and I made a call to Amber to see if any of WC's documentation had arrived yet.
She said I must have ESP because she was just getting ready to call me. "I am afraid I have some bad news for you." she said.
Gulp. "Bad news?" What now?
"We just got notification that Workers' Comp is denying your entire claim."
"What does that mean?" I asked.
"It means that, after their review of your case, they are denying any further treatment and your bi-weekly payments will stop effective yesterday."
"On what basis?"
"They are claiming a pre-existing condition."
I completely lost my shit. After all of this time of dealing with this process, I couldn't believe what I was hearing.
Amber continued. "We don't know why at this point. Dennis filed an immediate motion for supportive documentation exclusively for their denial."
I immediately associated the denial as a recourse for retaining an attorney. Interestingly, Amber told me that no. WC had retained counsel two weeks before I filed my case against them.
Happy Birthday, me!
So much for the antidepressant! I was practically inconsolable for the rest of the day. I was a good person, always trying to do the right thing. How could this be happening to me?
Instead of climbing back into my shell, I began making phone calls. I called everyone that I knew, asking for prayers, and just telling my story.
I had hit emotional bottom, but speaking to people who love me truly helped.
No Longer a Victim
About a week later, a realization came over me that would dictate my mood and action over the next several weeks. I was no longer a victim!
I realized that I had been a victim of an antiquated bureaucracy for the previous 9 months! This realization empowered me. I no longer had to play by their rules.
On one of my better days, John asked me to accompany him to take Mallory, my step-daughter, to an appointment. I agreed, it would do me good to get out of the house for a while.
On route, John noticed somebody following us. My husband is very detailed oriented, and he does not miss much!
In this case, a grey truck was very aggressively following us. We would change lanes, then the truck would change lanes. The truck ran through a red light, just to continue his tail.
We arrived at Mallory's destination. The truck went by. Then again and again. Three times that truck drove by very slowly. I sat in the truck while John walked Mallory to the building.
The truck pulled into the post office across the street. John took pictures, and began speaking French.
I knew it was a possibility, but I didn't expect how invasive this felt. Being tracked like a common criminal.
I was followed at least three other occasions, that I know of. I decided that following me would have to be the most boring job in the world, because I hardly left the house.
Continuation of My Case March-May
I received notification that I was required to attend a deposition where the WC lawyer would obtain my sworn statement. By this time I had a mediation scheduled for May and a court date of July 31.
I Got My Masters and Started a Blog!
I completed my Masters on march 22nd, two weeks shy of one year. I met my goal!
But then what was I going to do? I couldn't go back to work, I couldn't get surgery. So I started a blog. I was very passionate about helping others attain their educational goals. And I had been secretly looking into the whole blog scene for years.
This is my very first blog post: Nurseways: Paths in Nursing Education Inaugural Post
As part of preparing for court, WC requested an Independent medical exam or IME.
In preparation for this visit, I went to Dennis' office to fill out the paperwork, and go over what this visit meant.
The purpose of the IME is to gather a professional medical opinion about the case. This person would also testify in court as an expert witness.
The physician that conducted my IME exam was no younger than 80 years-old. His demeanor was friendly (probably because he charged $1,500 for these visits.). Dr. IME no longer practiced, his sole revenue was offering "expert" opinions.
Next came my deposition. This was held in St. Petersburg, around 20 miles from my home. During this process I would be sworn in and the opposing attorney would ask me questions about my medical history and anything pertaining to the case.
Dennis called me the evening before the deposition to explain the process and give me some advice.
- Answer ONLY what they ask of you.
- Don't expand on your answers. Keep it simple
- Be honest
- It's okay to say you don't know something.
Afterwards, Dennis said I did well. But he mentioned that I like to talk! Duh.
The Night Before the mediation
My husband and I talked a lot about the mediation and the court date. Dennis told me that he didn't expect much to happen during the mediation. It was more of a formality.
He also said that at some point WC may offer the option to settle the case. Early on John and I as a couple had already decided that we wanted them to be accountable for their actions.
We wanted this to go before the judge. This was never about money for us. It was about getting better and getting on with my life.
The initial part of the mediation entailed meeting everybody present. There was me, John, Dennis, the mediator, the opposing counsel, the WC supervisor, and the WC coordinator for the health system.
After the introductions, both attorneys read statements. Then, we all settled in to our prospective corners so the
battle mediation could begin.
If you know anything about negotiating, one of the tenets is that the first person to make an offer will be the loser.
In this case, because we initiated the suit we were required to go first! We, Dennis, John and I, came up with, in my opinion, that was fair offer.
I calculated the amount of back and future pay, the cost of the surgery, and my attorney's fees. That number came to roughly $110,000.
I know it sounds like a lot of money, but keep in mind I would also have to pay for the surgery from that amount.
The mediator came back in the room, with a grim expression. "They were floored.", she said. "They are offering $1,000." Really?
Dennis told us not to get upset with that number because the opposing counsel was doing a "dog and pony show" to impress the others in their room.
It didn't matter where either of us started. What mattered was where we ended. The mediation would result in either an agreement from both parties or no agreement in which we would appear before the judge in July.
The Mediation Seesaw
We went back and forth. We would come down $5,000, they would rebut by coming up $500.00. Back and forth just like a seesaw.
After about the seventh attempt to reach an agreement. I was wiped out, physically and emotionally. It felt like I my integrity was on the table.
I know it was all business to them, but for me it was my life on the line. I was ready to walk and take my chances.
John saw things a little differently. The financial strain of being the sole provider was weighing on him. And he was concerned about my wellbeing. The constant pain and emotional strain I endured over the past year.
If you have read this entire series, you may remember me writing about my interest in getting a breast reduction surgery.
While I had never been diagnosed with a herniated disc, some of the symptoms I reported were similar to my current symptoms. Not the main ones of radiculopathy, the numbness and tingling going down my right arm to my fingers.
And while I tried to be honest, I had filled out 15 different forms relating to my condition and past medical history.
Some forms asked questions in one way and others would ask in a totally different way. When I answered those questions, it was not my attempt to hide anything. I ALWAYS explained to the physicians about my history.
Here is the thing. I have no control what someone documents. Period.
Secondly, the doctor who agreed that I needed surgery, DR. P, according to the opposing counsel, was going to redact and recant his documentation.
The choice came down to this. I could continue to negotiate a settlement or take my chance before the court.
The settlement would be a binding agreement, no backsies. But it would all be over, this case that cost me so much.
If I appeared before the judge, I would have a fifty-chance of winning. Like Red or Black on a roulette wheel. If I won the case, they would pay for my surgery, and would continue to pay me bi-weekly, as well as the back pay.
But if I lost, I would get nothing. Not only that, I would still have to pay Dennis plus pay all WC's costs associated with my case.
At the end of the day, we chose to settle. One in the hand is better than two in the bush. The final settlement came to $17,500. From this I have to pay Dennis 25%, as per our agreement.
As part of the settlement, I had to resign my position, which somehow hurt me more than any of the rest of this messed up situation.
The good news, I have copies of their "proof" that my symptoms were as a result of degenerative disc disease and a pre-existing condition.
I can now be an active participant in MY OWN care, which is the very heart of patient-centered care, a paradigm that I have spent an entire career advancing.
Finally, I am able to speak. I was so afraid to talk about my situation, because of the repercussions to my case, I said nothing.
Now I am liberated. I am free to speak. To tell my story. If I can help just one person to know they are not alone, it would please me tremendously.
Disclaimer: I am not a lawyer. The advice given within my post is a collection of my thoughts and opinions as a Workers' Comp survivor. If you are a victim of a work-related injury, you should seek advice from a lawyer familiar with Workers' Comp Law.
Here is what I have learned during this past year.
- Take time to write down your entire medical history. Include any surgeries, procedures, medications, and treatments. Write down the dates, clinicians, and facilities. Keep this with you at ALL times! My suggestion would be to have this somewhere on your phone, so it is easily accessed at all times.
- You do NOT have to sign a paper that grants WC access to your ENTIRE medical record. (I did not know this.) Of course they have a right to certain parts of your medical record, such as previous surgeries, x-rays, etc. that is related to your current condition. Consult an attorney before signing away your record.
- Be completely honest when filling out paper work. You will fill out a plethora of forms. Take a picture on your phone so you will answer the questions EXACTLY the same way.
- Your Workers' Comp case manager is NOT your friend! I was very naive. My case worker was extremely nice, and she assured me that she had my back and best interests in mind. That is total bull****. The sole purpose of Workers' Comp is to save your employer money. They will deny appropriate care, just to save a buck.
- The physicians treating your injury through Workers' Comp belong to Workers' Comp. My twenty-five year history as a nurse worked against me. I didn't know about the dark underbelly of Workers' Comp. I thought physicians operated under the Hippocratic Oath. My mistake.
- You will NEVER become rich through a Workers'Comp Claim! Money was never my goal. I don't know about other states, but in Florida, there is no provision for "pain and suffering". They don't care if you can no longer pay your bills, lose your car, or lose your home. Workers' Comp entire purpose is to get your case off their books as quickly as they can.
- Hire an attorney who specializes in Workers' Comp in your state. I don't recommend hiring an attorney who performs an entire menu of services. You want and NEED someone who is well versed in WC law!
- Be prepared to put your entire life on hold while you wait for a resolution. In my case, I truly thought I would have some initial treatment and be on my way. It didn't turn out that way. As a result, I was nearly a prisoner in my own home, shackled by pain and depression that ensued.
- Think carefully BEFORE you file a Workers' Comp claim. Now I am not suggesting that you lie. Far from it. But if there is anything in your past history that is similar to your current injury, or if you have symptoms that were made WORSE by your claim, think long and hard about filing a claim.
- Start an Emergency Fund! My husband I did have some savings, and we were fortunate. As we were BOTH in school last year, we got an unexpected tax-return and he gets a yearly bonus.
If you enjoyed this series, you may also enjoy this article by NURSEBORN.COM, Nurse Interrupted, A Story of Lyme Disease
In my heart of hearts I would NEVER wish anybody to go through the struggle, the humiliation, of a Workers' Comp case. I had two reasons for sharing my story. First, I want people to hear a real-life story about the entire process from someone who has been there. And second, I wanted to tell my story, the good the bad, and the ugly. ~Lisa
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