Why Won’t Workers’ Comp Pay For My Medical Treatment?

It happened in an instant. Our client Jane (not her real name) was going about her regular routine at her job as a chef at a busy Raleigh restaurant. Unbeknownst to her, a worker in the kitchen had spilled a pan of grease on the floor between Jane’s work station and the refrigerator.

Problem was, the other worker had been called by another chef for some quick help and left the grease there, figuring he would be back to clean it up soon. Jane headed for the refrigerator to grab some ingredients. Before she knew it her feet hit the grease and she went airborne. As she fell to the floor, arms flailing, her right wrist slammed onto a steel table and then she landed directly on her bottom. She felt pain all over, but the pain in her arm and wrist was immediate and excruciating.

In that instant, Jane didn’t think about filling out forms, making claims, and dealing with insurance companies. She understandably had one thing in mind: “I am hurting. I just want to get out of here and feel better.” She showed her already swollen wrist to her employer, they wrapped up an exposed cut on her arm and she left to go home.

Jane didn’t sleep all night. By the time morning came her wrist was black, blue, and swollen. She headed to her local Raleigh urgent care. She showed them her arm and they took her back for x-rays. X-rays did not show a fracture, they said, so they gave her pain killers and told her to follow up with an orthopedic doctor if she didn’t feel better.

A few days passed and she didn’t feel any better. In fact, even with the pain killers she felt worse. On top of that, her back and neck were hurting. She called her employer who gave her the name of the “approved” orthopedic doctor she could see for her workplace injury. She immediately made an appointment with the orthopedic doctor. She couldn’t get in to see the orthopedic for days, so she kept taking the pain medicine until her appointment.

Finally, she got to see the orthopedic doctor. She filled out the intake forms, including the fact that she was suffering from wrist and back injuries and headed back for examination. The doctor came in and examined her still swollen and discolored wrist. She mentioned her back pain, but he focused only on the wrist. He sent her for an MRI of her wrist and told her to continue her pain medicine and to come back once the MRI was completed a week later. He made no mention of any further back exam, much less treatment for her back.

As it turned out, Jane had fractured her wrist but the fracture was not picked up on x-ray. The orthopedic doctor met with her and explained how that could happen. She again complained about her back pain. This time, the doctor noted the back pain in her chart. He placed her wrist in a cast and sent her for therapy for her back. After a course of therapy, Jane still suffered back pain so her doctor sent her for an MRI paid for by the insurance carrier. It turned out that she had a bulging disc in her back pressing on her sciatic nerve. The doctor said he wanted to give her epidural steroid shots to reduce the inflammation that was causing her back pain.

At this point, this story should have a happy ending, right? Jane’s wrist was treated and should heal. The doctor sent her for physical therapy on her back and an MRI of her back that showed the source of her back pain and had ordered epidural injections. The workers’ compensation carrier paid for her wrist treatment, physical therapy, and MRI. Jane waited for approval of the injections while she endured her back pain, knowing that she’d soon get the shots that would ease that pain. Obviously, if the very same doctors selected by the insurance company decided she needed more treatment on her back, the workers’ comp insurance company would pay for it, correct? Wrong.

What Jane had not understood was that the Workers’ Comp carrier had filed an answer to her notice of accident with the North Carolina Industrial Commission and accepted her wrist injury but had only agreed to pay for her back treatment without prejudice to their right to decline to accept that injury as part of her claim. Their reasoning was simple. Her employer had not told them she complained about her back, the urgent care had only taken x-rays of her wrist (not her back), and the first note with the orthopedic doctor said nothing about her complaints of back injury.

We are now fighting hard for Jane to get her the treatment she needs and deserves for her back. We’ve filed an emergency medical motion with the Industrial Commission and taken the deposition of her treating orthopedic doctor. We’ll soon have a hearing and believe we’ll be successful in making the Workers’ Comp insurance company pay for that and future treatment for her back. Until then, though, Jane will continue to suffer.

Here’s the lesson to learn from Jane’s case:

• Document ALL of your injuries as soon as possible, including photographs, if possible
• Make sure you note ANY complaints of injury on every intake form at any health care provider you visit
• Make sure any medical personnel you talk to at your treatment makes a note of your injuries
• Don’t be afraid to tell the Doctor that you want to make sure he notes all of your complaints in his record
• Review any paperwork regarding your workers’ compensation claim carefully and note any missing information or other discrepancies that appear in any documents your employer files for itself or on your behalf
• Talk with an experienced workers’ compensation attorney about your claim.

If you have been injured in an on the job accident and have questions or concerns, feel free to call us for a free, no obligation review of your situation.

Talk with a Workers’ Comp Lawyer in Raleigh

Kirk, Kirk, Howell, Cutler & Thomas has experienced workers’ comp lawyers on staff in Raleigh and Wendell, NC. If you or a loved one has been in an accident, give us a call to evaluate your case and assess how your insurance coverage could help. Call (919) 365-6000 or Request a case review today!