Q: I have an open workmans comp case that I was still getting seen for. Recently re injured but not at work. Am I covered?
I dislocated my kneecap at work seven months ago. Was cleared to go back to work things have been better but my knee still makes a popping sound so I was going to appointments with an orthopedic monthly and was about to start seeing a PT. Just yesterday I was not at work and my knee popped out of place. Does my workmans comp still cover since my case is still open?
A: You have asked a very important question. If the same knee popped while you were doing your usual and customary activities, there is no reason why a doctor or adjuster should deny this. However, many do. In addition, if any other body part such as the other knee, low back, etc or lower extremity were to sustain injury or trauma due to a abnormal gait or walking crooked due to your injured knee, you need to report that immediately to your doctor and claims adjuster. However, there is a 95% chance they will deny it since they never accept secondary injuries or compensible consequence claims. My advise is that you contact an experienced workers compensation attorney so you get legal protection and legal advise to proceed wth your claims. We have the power to get you to better doctors that will represent you and not the insurance adjusters. We will make sure you get the highest level of benefits for your claim. There is no way you will get any justice on your own against the large, corrupt and powerful insurance companies without a competent Workers Comp attorney. After dealing with adjusters for 30 years, I've learned that they are not on your side. I wish you the best. Good Luck!
A:
Possibly a non-industrial exacerbation of an industrial injury is 'covered' by the Labor Code. It comes down to what the treating physician writes. If the treating physician writes that this event is the result of the initial industrial injury, the carrier will most likely pay for the treatment and any temporary disability required by this exacerbation. BUT if your treating doc is 'in bed' with the insurance company -- if that treating physician only treats what the adjuster tells me he can treat and nothing more -- then the doctor will write the dislocation was due to non-industrial factors and is not the responsibility of the insurer.
THIS IS WHY it is absolutely crucial to have an attorney who gets you to a worker-friendly doctor on the insurer's network...seeing the wrong doctor can end all benefits.
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