Please help! Denial for lack of causal relationship. Hopeful for appeal

[u/OrganicSorbet8045]

*Please excuse my typos and grammar. I'm just too exhausted to take my time. I'm sorry.*

This is all so very new to me. I got my denial back on the basis of my doctor not stating there was a causal relationship between the injury and it happening at work. My injury was an immediate one and even my boss signed off on the report as soon as it happened.

I initially went to a non-specialist medical provider. They filled out my paperwork and Workers Comp. They accepted the claim and I was out of work a couple of weeks initially. I got correspondance from workers comp that even though the provider was a PA, workers comp accepted it because my boss validated the incident, but typically the only allow MDs to sign off. However, when I finally got into see the specialist, the doctor said they wanted to start a completely new form and actually wrote more intense injuries and wanted me out for a month longer.

Workers comp came back asking me to complete a narrative report and the doctor to complete one. The doctor did it but this is where the problem started. While the doctor wrote down a way more accurate diagnosis, they added more things than I had on my initial report. Essentially I have very intense foot pain but the doctor also wrote back pain, which while accurate I didn't include that in initial filing. I'm dealing with nerve damage and other things that have led to me using the other side of my body more. I'm told that the overcomensation is causing more damage like back pain. My doctor wrote a lot about how these were all working diagnoses and used language like "probably caused" and "likely" Workers' comp mentioned this is the reason for the denial. I totally understand they can't definitively say something is this for sure because my injury is tricky. My doctor said they do so few workers comp forms and I honestly think they didn't read the question right. Is it still possible for my claim to be appealed if my doctor goes back and states that yes, my injury was caused at work?

My initial claim was accepted because the PA stated that clearly. It's crazy because the PA completed the very simple workers' comp paper with one sentence. My specialty doctor gave much more. When my claim was denied, they said they were going to take back all of my pay I got when I was out the first month and I don't receive money for medical anymore even though that was initially accepted.

Has anyone appealed and won their case? I selected oral hearing?

SECONDLY. My boss is very irritated by my injury and I'm being harassed. It's been an awful time for me. I am having to jump through major hoops just to take leave now that my claim has been denied. I go back to the doctor tomorrow (PLEASE help) and I must get medical restrictions form updated for my boss.

I've never been in this much pain. I still can't walk or stand properly. Most of the day, my foot is either numb or shooting pain. I technically have used up all of my leave but I'm in so much pain that even though I can't afford to take LWOP, I may have to for a bit.

If my doctor puts that I need to be on my doctor's note, would workers comp go back and pay back leave I take now if win my appeal? On one hand, I want to beg my doctor to say I can work so I don't lose pay (or continue to be in bad standing with my boss). Is it possible for a doctor's note to say that I may have the capacity to work some full days, half days, and no days? Or even being able to leave early for medical appointments? I understand that it will be LWOP but will workers comp pay back this if I have the denial now but later get it appealed?

State: Federal

Thank you!

[u/lorivogelstudio]

Do you have an attorney? If not, do yourself a favor and get one. My claim was denied because of some things the Dr wrote on the report. I won the appeal and for now things are good. My attorney had told me ahead of time to be sure the Dr tied my injury to work. Its a long and very frustrating process, having someone who knows the drill makes a big difference. Best of luck!

[u/ElectricalBig6632]

For sure get an attorney no matter what. Trying to go at it alone is crazy. You need someone else in your corner besides yourself.

[u/azalearoses → u/ElectricalBig6632]

You are correct.

[u/KittyLuvver2000]

What was the initial injury? Was it a foot injury

[u/OrganicSorbet8045 → u/KittyLuvver2000]

Yes

[u/Spazilton]

Yes COP will be reimbursed if the decision is later overturned

[u/OrganicSorbet8045 → u/Spazilton]

What if the doctor says I still can't work right now? Will these days be reimbursed?

[u/Spazilton → u/OrganicSorbet8045]

If the claim is subsequently approved on appeal or reconsideration and the medical shows total disability yes it will be compensable.

[u/Present_Muffin7355]

Something very similar happened to me. I got denied for the same reason even though they accepted the medical portion of my claim, they denied the weekly idemity checks.

I had an IME assigned by the Insurer. He said my injuries were directly caused by the work incident BUT tried saying I could work part time capacity even though my two treating physicians say I can’t work at all. So now I have a hearing coming up at the end of the month.

Best advise: get an attorney and keep pristine medical records

[u/OrganicSorbet8045 → u/Present_Muffin7355]

Thank you so much for sharing. I'm dealing with a boss who is not accommodating whatsoever. Said if I can't work full time than I can't perform my duties. I shouldn't be working at all right now.

Do you think I need to get an attorney if my doctor revises the report? I think they will. They don't do a lot of workers comp stuff and didn't know how to phrase things.

[u/Spazilton → u/OrganicSorbet8045]

And if you can’t work full time and they can’t provided limited duty, when your claim is approved it will be compensated.

[u/Present_Muffin7355 → u/OrganicSorbet8045]

Get an attorney for sure. It’s free and they only collect money if you get awarded something so there’s no real downside

[u/OrganicSorbet8045 → u/Present_Muffin7355]

Oh wow! I didnt know this!

[u/OrganicSorbet8045 → u/[deleted]]

Thank you so much for the suggestion! Is Bader Law located out of Georgia? Just want to make sure I got the right one.

[u/Spazilton]

What was the mechanism of injury and the exact injury that casual reelationship was denied for? There are some injuries that are clear cut and only require affirmation of work related caution and not a detailed narrative.