Let me tell you the story of a 19 year old college student who worked at her state school in the recreation department to supplement her income and to lessen her tuition burden. While at work an errantly thrown football hit her in her right eye, teraing her retina and blinding her in that eye. She got a few months of TTD. She returned to work at a different employer. Indemnity compensation stopped. She continued to see her doctors at Bascomb Palmer Eye Hospital for follow up to her unsuccessful retinal tear surgery. She reached a point in time 2 years after her accident but had not yet been rated. Loss of eyesight in one eye would normally provide a 24% PIR. She was never found to be at MMI. But she made a little mistake. She let 13 months go by without going back to Bascom Palmer after more than 2 years had run from her date of injury. When she showed up for her appointment one month late, she was told the adjsuter at the Division of Risk Management said,"Sorry, tough luck, the SOL has run, you are on your own". Up to this point the injured young lady had asked to be reimbursed for a pair of glasses, ignored. She had asked for reimbursement for a head brace that she had to wear early on, ignored.
I filed a PFB for her. I hoped some wiser individual would make the decision on this one. That the Division of Risk Management of the State of Florida, the one headed by the CFO, would see (no pun intended) the error of their ways. No such luck. SOL has run. No rimbursements. No more treatment. No rating (even though the "Guides" require at least a year go by after stabilization before a rating can be given).
If someone reading this knows the CFO, bring this to her attention. This is just wrong. The Division will lose this case at trial or on appeal. They did this young lady wrong. The adjuster should have arranged an appointment for a rating. A rating the adjuster knew claimant was entitled to, and the money that it represented. The adjuster should have set appointments for the follow up care less than a year from the prior appointment. The adjuster should not have denied the reimbursments that were requested and ignored. She lost her eyesight in one eye. She was 19 years old. She gets free counseling for PTSD and the fear of total blindness. Is this abuse of the SOL by the Division of Risk Management or not?
Thursday, September 4, 2008
WHY DID NANCY HAVE TO DIE?
Nancy worked as a manager for one of those big box stores. The fire supression system was chronically broken. If the alarm tripped falsely, in a short time the sprinker system would begin to ruin the merchandise, including over a million dollars worth of frozen items. Nancy was aware of the problem. On the day of her accident the alarm tripped, another false alarm. Nancy ran to shut off the system. To avoid the loss to her employer. She stumbled and tore her plantar fascia.
As management she sought medical care but continued to work. The workers' compensation medical scheme failed her. She got worse not better. Soon she had to use the stores handicapped carts to get around. Then she had to stop working. Chronic Regional Pain Syndrome (CRPS) had started in her leg. Pain, swelling, hot, cold, discoloration, shiny skin. Her orthopedic diagnosed CRPS. She was sent to a neurologist. Same diagnosis. She went to a pain management doctor. Same diagnosis. She sought care with an expert in CRPS. Same diagnosis. She was on drugs for the pain, for the depression that developed, for the back pain that started when she couldn't walk on both legs. He doctors recommended a spinal cord stimulator (SCS). Her CRPS had spread to her other leg. Eventually it spread to both arms.
It was about this time that her 104 weeks of temporary disability ran out. Her compensation carrier accepted her as permanently totally disabled. But the carrier denied authorizaton for the SCS. Soon thereafter Nancy was referred to the carriers Independent Medical Examiner (IME). The IME was asked, did Nancy have CRPS? Did she need a SCS? Was she at MMI? Did she have a permanent impairment rating? (PIR). The IME orthopedic, whom I shall call Dr. Whore, reported that Nancy was at MMI, that she had a plantar fascitis, recovered, and a 2% PIR. He opined she did not have CRPS and didn't need a SCS. Nancy's benefits were terminated. She had been overpaid!
It was of no consequence that Nancy's 5 other authorized doctors all diagnosed CRPS. It was of no consequence that a SCS was recommended to try to get Nancy off narcotic medications. It was of no consequence that Nancy was told not to work by her authorized neurologist and pain management doctors. Benefits andminstratively accepted could be cut off at any time.
The petition was filed to get the SCS and PTD restored. But Nancy started going down hill. The drugs, the lack of income, except for her SSDI, the depression. She lost 50 pounds. She started to use a wheechair. The carrier denied her doctor's prescription for a lightweight chair. Finally her hearing was set. The carrier asked for an EMA evaluation. Another delay. But she had her EMA evaluation. He agreed with her authorized doctors. Nancy had CRPS. He disagreed with the need for a SCS, but that was not one of the issues he was asked to review. He gave restrictions and limitations. The hearing was held. Not before the JCC assigned to the case, but before a JCC from another district who didn't know Dr. Whore. A JCC who was considered as conservative as they get. He did his own order. 40 plus pages. He considered all the negatives that were applicable to the claimant. He ruled that notwithstanding those negatives, claimant was entitled to PTD benefits. He didn't believe Dr. Whore. The issue of the SCS was not ripe for adjudicaiton at that time. Carrier appealed. Benefits continued to be withheld.
The appeal is still pending a decision. While the appeal was pending Nancy, age 53, passed away. Why did she have to die so young? More next time.
As management she sought medical care but continued to work. The workers' compensation medical scheme failed her. She got worse not better. Soon she had to use the stores handicapped carts to get around. Then she had to stop working. Chronic Regional Pain Syndrome (CRPS) had started in her leg. Pain, swelling, hot, cold, discoloration, shiny skin. Her orthopedic diagnosed CRPS. She was sent to a neurologist. Same diagnosis. She went to a pain management doctor. Same diagnosis. She sought care with an expert in CRPS. Same diagnosis. She was on drugs for the pain, for the depression that developed, for the back pain that started when she couldn't walk on both legs. He doctors recommended a spinal cord stimulator (SCS). Her CRPS had spread to her other leg. Eventually it spread to both arms.
It was about this time that her 104 weeks of temporary disability ran out. Her compensation carrier accepted her as permanently totally disabled. But the carrier denied authorizaton for the SCS. Soon thereafter Nancy was referred to the carriers Independent Medical Examiner (IME). The IME was asked, did Nancy have CRPS? Did she need a SCS? Was she at MMI? Did she have a permanent impairment rating? (PIR). The IME orthopedic, whom I shall call Dr. Whore, reported that Nancy was at MMI, that she had a plantar fascitis, recovered, and a 2% PIR. He opined she did not have CRPS and didn't need a SCS. Nancy's benefits were terminated. She had been overpaid!
It was of no consequence that Nancy's 5 other authorized doctors all diagnosed CRPS. It was of no consequence that a SCS was recommended to try to get Nancy off narcotic medications. It was of no consequence that Nancy was told not to work by her authorized neurologist and pain management doctors. Benefits andminstratively accepted could be cut off at any time.
The petition was filed to get the SCS and PTD restored. But Nancy started going down hill. The drugs, the lack of income, except for her SSDI, the depression. She lost 50 pounds. She started to use a wheechair. The carrier denied her doctor's prescription for a lightweight chair. Finally her hearing was set. The carrier asked for an EMA evaluation. Another delay. But she had her EMA evaluation. He agreed with her authorized doctors. Nancy had CRPS. He disagreed with the need for a SCS, but that was not one of the issues he was asked to review. He gave restrictions and limitations. The hearing was held. Not before the JCC assigned to the case, but before a JCC from another district who didn't know Dr. Whore. A JCC who was considered as conservative as they get. He did his own order. 40 plus pages. He considered all the negatives that were applicable to the claimant. He ruled that notwithstanding those negatives, claimant was entitled to PTD benefits. He didn't believe Dr. Whore. The issue of the SCS was not ripe for adjudicaiton at that time. Carrier appealed. Benefits continued to be withheld.
The appeal is still pending a decision. While the appeal was pending Nancy, age 53, passed away. Why did she have to die so young? More next time.
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