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R

RaySirEKS

Guest
Im from California

Well, here is my story. Sorry might be a tad long.
I injured my back in Sep. '03 carrying doors at work while twisting. I told my supervisor and went home for the day. I did a little lighter work for the next couple days, but still carrying doors. I didn't know about Work Comp and my employer didn't bother to tell me either. So I decided I would wait until my health benefits kicked in to see a doctor, but that was three months away. Finally in Nov. '03 I couldn't wait for a Doc, my leg was going numb, my back hurt like hell and I could barely walk. I asked my work if there was anyone I could see. They still didn't tell me about Work Comp and sent me to a Chiropractor, on their dime and didn't report it to Work Comp. I told the Chiro my left leg hurt and was going numb, my back hurt and I could barely walk. He said I could do "light" duty, yea right, and proceeded to "adjust my back and have me lift weights with my back. After almost three weeks my back hurt even more than before and his "final diagnosis" was that I had a malformed vertebrae that was a birth defect so I am prone to a weak back. I thought this sounded like a load of B.S. so I told my work to send me to a real doctor. At this point they finally told me about Work Comp and sent me to their Work Comp Doctor. After a few weeks of P.T. I told the doctor my symptoms kept getting worse until he finally agreed to an MRI. The MRI showed a rupture in L4-L5 and this particular doctor failed to diagnose a degenerative disc in L5-S1 that my next Doctor said was quite apparent. And at that point my Work Comp adjuster told me that the second doctor reported I said I was improving, wich was a complete lie. That is when I changed to DR#3. Anyways now I am waiting for approval of a fusion of L5-S1.

My Question is this:
Do I have a case against the Chiro for making such a ridiculous diagnosis, or for adjusting my back in the face of such a bad injury? Or do I have a case on different grounds?
Second, is the second doctor liable for lying to the insurance company about me saying I was improving, and failing to diagnose the degenerative disc wich was quite obvious?

Thanks for anyone's time... by the way I'm in California and I have a newborn that all of this is affecting quite a bit, I'm only 25 and my life is being ruined by these people.
 


ellencee

Senior Member
RaySirEKS
You need a worker's comp attorney. If what you say is true and you did not know about worker's comp, then I wonder on which planet or in which solar system you have been living all of your life. If the treating chiropractor didn't ask you who was paying for the job-related injury, worker's comp?, then at least you had company wherever you were.

If your employer did not have worker's comp information posted in the employee lounge, clock-in area, bathroom, or in some commonly visited place (by employees), then I believe they are in violation of the rules and regs of worker's comp. If you were not given a form to complete when you reported your injury and if the company attempted to pay the medical bills and not use worker's comp insurance, then they may have accepted total responsibility.

I can not imagine your neglecting your own personal health and ability to seek treatment in an ER or personal physician's office and deferring all decisions about your treatment to your employer. Another learning opportunity for me, I suppose.

Anyway--get an attorney ASAP and get some additional treatment options other than a spinal fusion. You are far too young to give up flexibility in that region without at least considering other options if other options are medically advisable and available.

EC
 
R

RaySirEKS

Guest
ellencee said:
You need a worker's comp attorney. If what you say is true and you did not know about worker's comp, then I wonder on which planet or in which solar system you have been living all of your life. If the treating chiropractor didn't ask you who was paying for the job-related injury, worker's comp?, then at least you had company wherever you were.
First of all, I'm not a moron. So please do not respond to a legitimate question with a condesending tone. I appreciate the time people take here to answer questions so I will try and clarify.
I did not know of WorkComp rights, ie rules, regulations, and what qualifies. I had heard of WorkComp, but I had never been through the process. I think since you have heard, seen, and been through the law side of it you might be
forgetting that when someone is ignorant to a certain set of laws it is confusing. And second, the Chiro was paid directly by my work, as stated in my previous post. I was never asked who was to be billed. My old job sent a few dozen people there, I'm assuming not through WorkComp to keep their premium down.
ellencee said:
If your employer did not have worker's comp information posted in the employee lounge, clock-in area, bathroom, or in some commonly visited place (by employees), then I believe they are in violation of the rules and regs of worker's comp. If you were not given a form to complete when you reported your injury and if the company attempted to pay the medical bills and not use worker's comp insurance, then they may have accepted total responsibility
I worked in the field, there are no "employee lounge, clock-in area, bathroom, or in some commonly visited place" so no signs. I was given a form to complete, but it was not filed until after I told them I wanted to see an MD. That was three weeks after I reported my injury.
They didn't accept full responsibility because I am on WorkComp. The only doctor not paid by WorkComp was the Chiro.
ellencee said:
I can not imagine your neglecting your own personal health and ability to seek treatment in an ER or personal physician's office and deferring all decisions about your treatment to your employer. Another learning opportunity for me, I suppose.
Easy to say when you probably never have to worry about medical bills. If you understood what I typed, I said I didn't have health benefits. That means that an ER visit or a MD visit would be a huge bill I couldn't afford, especially with a baby on the way. Besides if you know anything about disk injuries, sometimes the full effect of the damage doesn't show up for weeks. My pain didn't get unbearable until almost a month later. Reduce yourself to poverty level and then say you would go to the ER!
ellencee said:
Anyway--get an attorney ASAP and get some additional treatment options other than a spinal fusion. You are far too young to give up flexibility in that region without at least considering other options if other options are medically advisable and available.
I have a Work Comp attorney. And he deals with Work Comp only, my question was nothing related to Work Comp. "Do I have a case against the Chiro for making such a ridiculous diagnosis, or for adjusting my back in the face of such a bad injury? Or do I have a case on different grounds?
Second, is the second doctor liable for lying to the insurance company about me saying I was improving, and failing to diagnose the degenerative disc wich was quite obvious? " that was my question. Finally don't assume I'm uneducated, I would never consider such a procedure unless it was a last option. I have had to endure, so far, almost nine months of this. Including getting my spine "adjusted" by a quack, a second pro-insurance quack writing in his report that I said the pain was deminishing when I never said that, actually quite the opposite. Having to go through two MRI's, a CT-Myleogram (ever had one, extremely painfull), a discogram (again hurts like the dickins), a series of epidural steroids (not pleasant either), a spinal leak causing excruciating headaches, a blood patch, getting an ulcer from the meds, and a couple months of physical therapy. After going through all that only to have the insurance company persistantly deny appropriate testing and deny any adequete care. So please do not tell me to seek additional treatment after what these gluttonous greedy companies have put me through. Sorry one more point, if you knew where L5-S1 was on the spine, you would know that I would be back walking in a matter of days and that my age would help me recover very quickly. Besides, a fusion in that region would cause me no loss of flexibilty at all.

Thank you for your time, however if anyone could help me with the qustion I posed I would much appreciate it, rather than useless banter.
 
R

RaySirEKS

Guest
ellencee said:
You don't have a case. A medmal claim requires a plaintiff that the jury would like.

EC
Listen, I'm not trying to get in a pissing contest. You tried to make me sound like an idiot, but you did not have all the information so don't assume. You did not try and answer my question the first time so I am going to defend myself. You now answered my question with not a legal answer but a very petty attempt at an insult. please do not post any farther in this thread unless you have some constructive input.
P.S. I'm not sure why you are very offensive in your posts, but I am trying to ask a legitimate question and gave you no reason to even start this pissing contest.
 
R

RaySirEKS

Guest
Besides, you assume I am unlikable, again you assume. Please do not fill in what is reality with what is in your head.
 

ellencee

Senior Member
Well, like it or not, I'm about the only poster who regularly evaluates the medical information and after finding substantiating proof (in case it's needed), answers posters who want to know if what happened to them was medically an act of negligence that resulted in significant damages.

And, since you feel obliged to offend me and insult my knowledge of the spine and of medical care and the treatments and outcomes expected, I think you justify your opinion of my opinion of you--that being of course, that you are a moron.

Initially, my opinion was that you were the victim of unscrupulous employers and naive about your medical options. That opinion is now null and void.

Therefore, I shall not render an opinion on the medical care aspect of your post.

EC
 
R

RaySirEKS

Guest
Listen, I apologize for coming off offensive. I have had to put up with a lot of crap from my former employer and the insurance company lately and am a little on edge and defensive. The insurance company is trying to prolong things as long as possible to smoke me out, in my opinion, and I am just trying to protect my family.
 

ellencee

Senior Member
RaySirEKS
I accept and appreciate your apology and will take a closer look at your care that was provided and will post my professional opinion.

EC
 

ellencee

Senior Member
RaySirEKS
I injured my back in Sep. '03 carrying doors at work while twisting. I told my supervisor and went home for the day. I did a little lighter work for the next couple days, but still carrying doors. I didn't know about Work Comp and my employer didn't bother to tell me either. So I decided I would wait until my health benefits kicked in to see a doctor, but that was three months away. Finally in Nov. '03 I couldn't wait for a Doc, my leg was going numb, my back hurt like hell and I could barely walk. I asked my work if there was anyone I could see. They still didn't tell me about Work Comp and sent me to a Chiropractor, on their dime and didn't report it to Work Comp. I told the Chiro my left leg hurt and was going numb, my back hurt and I could barely walk. He said I could do "light" duty, yea right, and proceeded to "adjust my back and have me lift weights with my back. After almost three weeks my back hurt even more than before and his "final diagnosis" was that I had a malformed vertebrae that was a birth defect so I am prone to a weak back.
I'm using the above description of events as your presenting history to the chiropractor and as the chiropractor's diagnosis and plan of care. Your description of events does not include any diagnostic test such as x-ray evaluation of your spine. If x-rays were made, the films will be of significance in evaluating your claim of malpractice. The films will either show a malformation of the disc(s) and as such should have been referred to an MD for further evaluation or the films will provide a baseline that can be used to show that improper treatment caused further damage.

I am providing you with a link to California's laws on the practice of chiropractic medicine and paragraph of text from the site that I used in forming my opinion on chiropractic professional negligence. Even though it does appear that the chiropractor was negligent in failing to refer you to an orthopedic physician, it is questionable as to whether or not you suffered significant damages that would not have occurred but for the act of negligence by the chiropractor. It certainly would be beneficial to your claim for you to have x-rays from the time of the injury and x-rays at the time of your evaluation/diagnosis by the chiropractor. Being able to show that the chiropractic treatment caused further damage to the disc would show significant damage due to negligence. I believe, however, that you presented to the chiropractor with signs and symptoms of a herniated lumbar disc and as such, required prompt medical intervention with diagnostic evaluation (myelogram, CT or MRI, Electromyograhy) and with initial management through supportive measures, pharmacotherapy, and certainly without working for 4 to 6 weeks.

2.1 DETERMINING APPROPRIATE CASE MANAGEMENT
To ascertain the nature of the patient's problem and respond appropriately so as to secure the optimal care for the patent. Inherent in this concept is the obligation to consult with or refer to other health care providers before, during or after the rendering of chiropractic care, if in his/her professional opinion, it is appropriate and in the best interest of the patient.
Second doctor:

After almost three weeks my back hurt even more than before and his "final diagnosis" was that I had a malformed vertebrae that was a birth defect so I am prone to a weak back. I thought this sounded like a load of B.S. so I told my work to send me to a real doctor. At this point they finally told me about Work Comp and sent me to their Work Comp Doctor. After a few weeks of P.T. I told the doctor my symptoms kept getting worse until he finally agreed to an MRI. The MRI showed a rupture in L4-L5 and this particular doctor failed to diagnose a degenerative disc in L5-S1 that my next Doctor said was quite apparent.
I don't think I need to go into a detailed explanation on this part: If the MD actually started physical therapy without first obtaining diagnostic x-rays, then the MD was negligent in failing to diagnose and prescribe treatment based on diagnostic findings and beginning a regimen of treatment that could cause further damage to the spine. Whether or not this MD is responsible for causing significant damages that would not have occurred but for this act of negligence is a question that must be answered in the affirmative for you to have a viable claim of medmal against this physician.

The physical findings of a malformed vertebra(e) or degenerative disc is not of significant impact or relevance to the outcome of your injury or your claim(s) of medical malpractice. Whether or not you have a claim of malpractice against the chiropractor and the first MD depends on whether or not it can be proved that more likely than not, you suffered significant damages that would not have occurred without these acts of negligence. In other words, you're going to have to prove that your symptoms became significantly worse once you sought and received treatment and that your injury was treatable with supportive measures vs surgical intervention.

From your description of events, it seems you are one of those patients that every intervention results in disasterous outcome. For your sake, I hope you can lose the bad karma before you enter into surgical intervention and recovery. Having a positive outlook and anticipating positive outcomes has been shown to improve the patient's response to treatment and improve the outcome. I strongly encourage you to start thinking positively before you proceed further into treatment.

Best wishes,
EC
 
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ellencee

Senior Member
RaySirEKS
The issue of your employer's failure to be forthcoming about Worker's Comp insurance and failure to provide you with the opportunity for prompt medical evaluation and treatment is the part of your post that concerns me. I believe it is in this interval, the time between the injury and the first visit to the chiropractor, in which your condition was significantly damaged. I believe it is more likely than not that immediate medical intervention would have prevented further damage to the spine and prevented the need for surgical intervention; therefore, I believe the chiropractor and the first MD can be found to have caused no significant damages that would not otherwise have occurred.

I read that California requires all employers to have WC insurance, but I did not read that employers are required to use it. Maybe I overlooked that requirement or didn't find it or maybe it is implied as a duty for the employer to immediately report on-the-job injuries to WC and to provide the opportunity for immediate medical assessment and treatment. I don't know.

I do know that when an employee files a worker's comp claim and proceeds under worker's comp, the employee can not sue the employer for damages/injury; that's the employer's benefit from having WC and what keeps lawsuits from financially collapsing employers/companies.

I'd appreciate a response from one of the attorneys on this site and a clarification of the employer's liability in your situation.

--another thought--When your employer sent you to a chiropractor instead of to a physician or to the ER, who made that decision? It suggests that someone was practicing medicine without a license (by diagnosing your condition and developing a plan of care).

Thanks,
EC
 
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kat30s

Member
Hi - I am not a lawyer, but I do work for a doctor in California and am familiar with work comp law - If an employee is injured on the job, and reports it to his supervisor, the employer is obligated to file a work comp claim. They cannot just send an employee to a doctor "on their dime." If the treating physician is aware it is a work related injury, and fails to report the injury, then the physician can be fined. If the proper procedures are taken, and the employer files their claim, then they have what's called "medical control" for a minimum of 30 days, and can send the injured worker to who ever they want, usually a doctor on their "payroll" so to speak. After 30 days, the employee has the option to go wherever they want. Too many employers try to get out of filing a work comp claim, because it causes their rates to go up, and in CA, work comp insurance is very expensive. Dr's also would rather get paid right away for their services than wait 60 days for payment, or even longer if the employer fights the claim. But, CA is really cracking down on these practices. I hope some of this info is helpful.
 
R

RaySirEKS

Guest
Thank you all for your opinions and input. This has been a horrible experience, especially as a young married man starting off a family in San Diego (one of the most expensive places to live).
The Chiro did take X-rays, very poor ones at that, and his finding of my malformed vertebrae was formed by a small line in the film that looked like a hair. It was very suspicious looking to me that is why I did not trust his opinion. In no other films of my back had I seen this either. And definitly did not show up in the MRI's or CT-Myleogram. After that diagnosis he did not refer me to anyone else, all he said is that I need to join a gym and work out for the rest of my life. Then he had me push weights, wich I always told him hurt. He actually had me push weight s from the first visit to the last.

And yes, for the first 30 days, the employer has the right to choose the treating physician. After that 30 days was over, that is wahen I changed doctors. At that point I still was not represented believing I would be cared for to the fullest extent. I believe most people are inherently good, but insurance aren't some of those people. They tried denying tests that would prove the extent of the disc damage and that is when I got a lawyer.

No, I never asked to see a Chiro, that was the choice of the "Office Manager". She sent a lot of employees to that Chiro. In his Office there is a board of people who referred clients and the number of referrals, and there is my ex-companies name with about 50 referrals. Hmm I wonder how many other injuries weren't reported.

Here are some of the sources I have found in my research:
1. Src: http://www.dir.ca.gov/DWC/basics.htm
When an employer becomes aware of an on-the-job injury, the employer is expected to begin the process of providing the injured worker the benefits to which he or she is entitled under the law. The benefits are paid by either the employer (if the employer is authorized to self-insure) or the employer's insurer.
2. Src: http://www.dir.ca.gov/DWC/faqs.html
Q. This is a family business and I’d like to pay the doctor cash.
Is that OK?

A. No, it is illegal for an employer to pay medical bills directly.
You must file a claim form (DWC form 1) with your claims administrator
for all injuries that require more than first aid.
3. Src: http://www.dir.ca.gov/DWC/erguide.pdf pg 21
The pre-designated physician
Usually the employer chooses the primary treating physician for the first
30 days after an injury is reported. However, if before an injury the employee
had notified the employer in writing of a personal physician who previously directed the employee’s medical treatment and has the employee’s medical records, that employee can be treated by the pre-designated physician from the date of the injury. This physician must be a medical doctor or osteopath. If the employee wants to be seen by some other kind of doctor, for example, a chiropractor the injured employee may ask to change doctors after the initial visit.
5. Src: http://www.dir.ca.gov/DWC/erguide.pdf pg 21
Your employee comes to you and says, I’m injured, or I’m feeling sick, and it might be work-related. Your first concern is to see that your employee gets medical treatment right away. Send the employee to the clinic or doctor you or your insurance company chose ahead of time.
6. Src: http://www.dir.ca.gov/DWC/erguide.pdf pg 22
If your insurer didn’t give you employee claim forms or injured worker pamphlets, ask for them at once. According to the law, an employer has to give or send by first class mail an employee claim form to the injured employee within just one working day of finding out about the on-the-job injury. The employer has up to five working days to provide the injured worker pamphlet, which describes workers compensation benefits, employee rights and responsibilities, important timelines and where an employee can get more information on the workers compensation system.
http://www.dir.ca.gov/t8/9882.html
§9882. Written Notice to Injured Employees; Pamphlet Contents.
(a) Within five working days of notice or knowledge of any injury, the employer shall advise the employee of the compensation to which he or she may be entitled and the rights, benefits, and obligations under the workers' compensation law.
(b) The advice shall be in writing, in non-technical terms available in both English and Spanish, and shall include the following information:
(1) An explanation of an injured employee's rights to medical care and to select or change the treating physician.
(2) An explanation of an injured employee's rights to indemnity payments for disability or death, including information on the amount and frequency of such payments.
(3) An explanation of the nature and availability of vocation rehabilitation services.
(4) An explanation of the employee's protections against discrimination because of a work injury.
(5) An explanation of the procedures for claiming compensation, time limits for filing a claim, and methods to resolve disputes, including the employee's right to consult and Information and Assistance Officer or an attorney.
(6) Where further information may be obtained, including an explanation of services available from an Information and Assistance Officer.
NOTE: Authority cited: Sections 133, 138.3, 138.4, 139.6, and 5402, Labor Code. Reference: Sections 132(a), 139.5, 3600, 4600, 4601, 4650, 4658, 4700, 4701, 4702, 4703, 4401-4411 and 5400-5412, Labor Code.

California labor code ref.
3209.6. The inclusion of chiropractors in Sections 3209.3 and 3209.5 does not imply any right or entitle any chiropractor to represent, advertise, or hold himself out as a physician.

3209.7. Treatment of injuries at the expense of the employer may also include, either in addition to or in place of medical, surgical, and hospital services, as specified in Section 3209.5, any other form of therapy, treatment, or healing practice agreed upon voluntarily in writing, between the employee and his employer. Such agreement may be entered into at any time after employment and shall be in a form.

6409.1. (a) Every employer shall file a complete report of every occupational injury or occupational illness, as defined in subdivision (b) of Section 6409, to each employee which results in lost time beyond the date of the injury or illness, or which requires medical treatment beyond first aid, with the Department of Industrial Relations, through its Division of Labor Statistics and Research or, if an insured employer, with the insurer, on a form prescribed for that purpose by the Division of Labor Statistics and Research. A report shall be filed concerning each injury and illness which has, or is alleged to have, arisen out of and in the course of employment, within five days after the employer obtains knowledge of the injury or illness. Each report of occupational injury or occupational illness shall indicate the social security number of the injured employee. In the case of an insured employer, the insurer shall file.

6409. (a) Every physician as defined in Section 3209.3 who attends any injured employee shall file a complete report of every occupational injury or occupational illness to the employee with the employer, or if insured, with the employer's insurer, on forms prescribed for that purpose by the Division of Labor Statistics and Research.

http://www.dir.ca.gov/t8/9785.html
§9785. Reporting Duties of the Primary Treating Physician.:
(e)(1) Within 5 working days following initial examination, a primary treating physician shall submit a written report to the claims administrator on the form entitled “Doctor's First Report of Occupational Injury or Illness,” Form DLSR 5021. Emergency and urgent care physicians shall also submit a Form DLSR 5021 to the claims administrator following the initial visit to the treatment facility. On line 24 of the Doctor's First Report, or on the reverse side of the form, the physician shall (A) list methods, frequency, and duration of planned treatment(s), (B) specify planned consultations or referrals, surgery or hospitalization and (C) specify the type, frequency and duration of planned physical medicine services (e.g., physical therapy, manipulation, acupuncture).


Sorry a bit long, but very informative. These are things my employer and/or chiro failed to do. It's very sad that even though these people violated/broke the law I can take ant legal action against the company.
The way I see it, companies pay insurance companies to to protect them from lawsuits, and insurance companies use the law to make injured people suffer even more than they already have to ultimately give up on a claim. Or stretch out a claim for so long, by the time someone gets treatment and recieves a settlement the debt the have gotten in or the money they lost in not working is not worth it. And the new California WorkComp laws just make it worse.

Well if you guys have any more advise it would be appreciated. Thanx
Oh yea, by the way. The company I worked for had me paint their truck while I was on restrictive duty violating my restrictions and had me do all types of things they knew I shouldn't do. All because they knew I had a baby coming and I needed a job.
 
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