I'm baaack; A Workers' Comp Dilemma

[HobokenChickenEmergency]

I'll try to keep this short: 4 weeks ago, dh hurt his hand/wrist at work (genius hit himself with a 20oz hammer!). His boss sent him to the doctor the company uses for workers' comp.

In those 4 weeks, he's been given:

5 appointments
2 kinds of pain pills
1 splint
2 Ace bandages
2 gel-cast things
23 X-rays
and NO diagnosis!

They've been saying it's a "possible wrist fracture". Apparently, he hit his hand hard enough for the carpals to ram into the scaphoid bone, fracturing it (original diagnosis). Dh has also seen his x-rays, and it's an OBVIOUS break. Now they want to send him for an MRI in 3 weeks.

The usual treatment of this kind of break is a regular elbow-length cast. I think they're just trying to milk this for all the money it's worth.

The danger is, this type of fracture (scaphoid) has been known to result in a lack of blood to the broken bone, causing the bone to die. This results in surgery to place pins and bone grafts, as well as arthritis and limited mobility forever.

This is not something that needs to be prolonged, and I am starting to get MAD. If it wasn't broken, it wouldn't still be so painful that he can't move it. That in itself should be an indicator, to say nothing of the X-rays themselves.

He saw an actual Orthopedic Surgeon today (same dr's office), and this guy is the one who ordered an MRI because the 23 X-rays are "inconclusive".

What are our options here? Can we seek a second opinion, and still have it covered by Workers' Comp?

I'm about ready to haul him to the ER myself just to avoid further complications, even it means we end up paying out-of-pocket (we are among the glorious uninsured

). My dh works construction--how will he work if he needs surgery for bone grafts because the stupid doctor messed up? Not to mention all the pain he's in.

I am absolutely breathing fire over this, but of course my passive dh won't say anything. He just comes home and gripes to me about incompetent doctors.

BTW: Dh is only making "shop time" AKA $10/ hr while he's unable to use his hand. Usually he gets a percentage of every job he works on. This is causing us HUGE financial problems, because he's netting a whopping $195 a week after deductions now that he can't actually work. Isn't Workers' Comp supposed to be helping out in some way? Neither of us know anything about WC, except what his boss is telling him. I'm not inclined to believe his boss, because he's REALLY upset about having to pay even the medical bills.

Help!

 

[PattiXmas]

What insurance company does your hubby's boss use? I would think that the Workers Comp Claims Adjuster would have contacted your husband and gave him the options. I also think, but not quite sure, that the insurance company should be compensating the difference between the wages he is making now and the wages he was making then.

The best advise I can give you is look up your state's rules regarding Workers' Compensation and/or find out what insurance company your hubby's boss is using. I know that the Claims Adjuster should have been in contact with your husband to discuss the process with him.

Good luck!

 

[Brindlebtch]

That whole situation really doesn't sound on the up and up. He should have been interviewed over the telephone, at least, for worker's comp. I don't think his employer is being honest with him.

 

[pips&peeps]

As long as you have filed a workers comp claim and have a claim number, you should be able to go to whatever doctor you want to.

They usually just bill under the claim number and date of injury.

 

[PattiXmas]

Sometimes they do require that you go to "their" doctor. This is a way that they can control costs. Is the employer a self-insured entity? You mentioned that the employer was mad about paying the doctors' bills. The payments to the doctors, hospitals, etc will not come out of the employer's pocket unless he didn't turn the claim in and is just paying things directly instead of filing a claim. Your husband needs to get the insurance information and the claim number and then call the insurance company direct. I believe the employer has only 24 hours to report a claim. It almost sounds like he opted not to file claim so it doesn't affect his Comp rate. A lot of employers will do this if they feel that the injury isn't "big" enough to turn in.

 

[HobokenChickenEmergency]

SOME good news: They're able to get him in for an MRI today at 4 pm. The Orthopedic called him at work right after he got back from the dr. So that's one thing in our favor.

He doesn't know his claim number for some reason. I told him to ask for it, write it down, and bring it home. I'm sure this is my fault in some fashion, because I handle EVERYTHING here. I think he assumed that either his boss or I would be handling this, too.

He has talked to a claim adjuster on the phone at work a couple times. Anything I know about it is 2nd hand, half-forgottten information.

Dh and I are going to be having a LONG talk about what his responsibilities are. Obviously, I can't manage his work stuff for him. He's a grown man. But he's content to sit back and let me try, and it's infuriating.

I'm also looking at the Workers' Comp website. So far I found out that as long as there's no diagnosis his employer is responsible for everything, even if it's just the doctors dragging their feet. I already knew this, but it's nice to be validated.

As for his tiny paychecks: he IS getting his regular pay (he's supervising, so he still gets a percentage). Turns out his boss's wife is doing payroll now, and she doesn't know the state laws about garnishments. She's taking out more than she's supposed to for child suppport. That's a whole other mess that's going to need straightening out, but at least it's not related to this.

Anyway, I'm going to go finish deciphering the WC law.

Thanks for the advice, you guys!

 

[Brindlebtch]

Good luck!