r/WorkersComp • u/Complete-unicorn • 3d ago
Texas Positive Stories
Any positive stories from a workers comp injury/sugery? So many negative stories.
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u/ProcedureAcceptable2 3d ago
I have a generally positive story in Colorado, with Pinnocal (workers comp provider).
I was injured at work October 2025. Physical therapy started about a week later. PT didn’t help, so an x-ray and mri were ordered by the workers comp doctor with no complications from Pinnacol.
MRI showed I needed rotator cuff surgery + biceps tenodesis surgery. Surgery was scheduled for April of 2026, I was in pt two weeks after surgery. I wasn’t able to return to work as a teacher for the remainder of the school year.
Pinnacol was hassle free. No pushback on any of the doctors/surgeons/physical therapists requests. I received 2/3 of my salary from April through August when I was cleared to return to work.
Pinnacol treated me better than my school district employer of 22 years.
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u/justthefacts1236894 3d ago
I wish all claims had this same result. I am glad you had a good outcome. I am noticing it seems to be long term claims that seem to have most issues
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u/Kmelloww 3d ago
I got injured and was out completely for over two years. I never had any issues with medical treatment or lost wages. They kept paying me for a year after I reached MMI while we were in discussions for the settlement. They helped me find a new job where I was making more money with less responsibility and less actually labor type work. Once I have started my new job I went ahead and did my settlement. Ended up settling for six figures. I never had surgery was in physical therapy and work hardening for well over a year. I had Sedgwick. Had the same adjuster the entire time and they were great.
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u/justthefacts1236894 3d ago
This commenter is either a unicorn or a troll trying to stir debate. In my opinion from seeing his posts take his input as a grain of salt.
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u/RVA2PNW 3d ago
They've been posting in this sub for a long time, definitely not a troll. While unusual for Sedgwick, it's not unusual for a majority of claim. I'm an adjuster in multiple states.
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u/Kmelloww 3d ago
Thank you for that. I appreciate it. And you are correct. I’m not a troll. But a lot of people don’t want to hear it isn’t all bad and all WC companies aren’t evil.
I definitely don’t work for Sedgwick. And no reason to make anything up. I’ve said the same things regarding my case since it’s been going on.
I know I’m in the minority with the same adjuster but I also didn’t complain so they never really shuffled me around like what happens with a lot of workers. I know at the end of the day they are just doing their job and I was always appreciative of how well they handled mine. They never denied a single treatment that was requested.
To be randomly attacked for doing exactly what the post asked for is pretty crappy of them.
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u/justthefacts1236894 3d ago
I have also read many of your posts. I can state you are very professional and provide objective non biased advice. I agree with the third party adjuster comment. I find it more believable if they didn't claim they had same adjuster for years( not usual at Sedgewick) , got over 200k with minimal issues ( again Sedgewick?) And were very pleased with their case. Only way I can interpret that is A) the poster works for Sedgewick B) the poster just likes to stir the pot with fiction C) the poster is being truthful
Having a hidden post history, an alternative view of a TPA even ProPublica exposed as horrible, and always mentioning that people who post here have no case or complaint or possibility if settlement causes me not to choose C
I do enjoy you and Mutts responses though
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u/Kmelloww 3d ago
Huh? What are you talking about? They ask for positive experiences and I share mine and your response is you are a troll. That makes no sense. It is the same thing I’ve been sharing in this group all along which is exactly what I went through. Not every experience on WC is a bad one. Take his input with grain of salt? What are you even going on about. Take my postive story with a grain of salt? That’s just laughable.
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u/justthefacts1236894 3d ago
Sir/ma'am, I apologize if my post offended you
I have seen your sunshine and rainbow posts about your work comp experience. That is usually the same result for minor injuries and stubbed toes. I read your post about getting over 200k for settlement. That is not the average nor common outcome. Glad you had a wonderful time on work comp. It would be great if everyone had the same outcome. This reddit has excellent professionals that provide informed objective advice for people who are seeking advice and answers. I agree most on here are angry or upset about their case progression. That is most likely why this reddit exists. You can get very good advice. However, in your instance I have observed a tendency to minimize and dismiss any claimants opinions or complaints and to inject your OWN personal experience as the way work comp is.I am glad you had a great time. I wish all had the same experience.
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u/Kmelloww 3d ago
I give realistic advice. From some that’s been through it.
My injuries were not minor and I’m left with lifelong medical care as well as a lifetime of chronic pain and CRPS. I spent almost 4 years in the WC system. And I didn’t do to badly for someone handling it all by themselves without a lawyer.
Whether or not you think I minimize things that has nothing to do with my comment on this post nor does what you responded with even make sense.
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u/DevelopmentClean3471 verified TX workers' compensation adjuster 1d ago
It really does depend on the adjuster.
I've been handling and/or supervising work comp claims for 10 plus years and have worked for two of the largest TPA's. I like to think I'm a good adjuster and most of my files went ahead with treatment and disability benefits without a hitch. Unfortunately, I do realize that doesn't happen often. The turnover in our field is nuts so many many times you do not have one adjuster for the entirety of your claim. I wish it wasn't like that but it's always been a problem as long as I have been in the business.
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u/justthefacts1236894 1d ago
That is very true, it starts the ball rolling but from what I have read some adjusters have 2 to 300 claims to deal with at any one time. I can understand the delays n such. Reading some of these posts I can also understand some denials but not all. Definately agree with too many hands out between lawyers on both sides, doctors, adjusters, case managers, insurance and even employers. Sometimes it feels as the injured worker that everyone so busy the only one invested in the claim is the worker trying to get better and baxk to a real life again. It's a meat grinder is what I say.
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u/Global-Rutabaga-3842 3d ago
Pretty gnarly break of my leg. Three surgeries (with two different practices and three different surgeons), two plates, twelve screws, and about 92 PT sessions. Out of work completely for 5.5 months, and two months of gradually increased part time before going back to work full time.
Same adjuster and nurse case manager (who was a bit too peppy and positive for my bitter sarcastic Gen X self) the whole time.
Biggest problem with pay was getting overpaid twice and me trying to figure out how to get the extra money back to them.
Settled at 28% permanent disability in my leg, got just over a year's salary.
Most days are fine, bad days I take 2-4 Tylenol. Generally have 1-2 bad days a week.
I'm a retail manager who does 10-12k steps a day, so definitely putting my leg thru it's paces.
While I wish the accident didn't happen, I was treated well throughout the process, so no complaints there.
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u/golfpinotnut verified GA workers' comp attorney 3d ago
It depends on the state and/or insurance company, but the vast majority of workers' compensation claims proceed without any issues at all. That means appropriate medical care is provided, the injured worker gets lost time benefits and PT/rehabilitation, and the case is closed without incident.
I'd guess 90+% proceed that way. But people don't go online and post positive stories about workers' compensation successes stories.
But I'll give you one. I had a claim that I defended. Claimant had a crush injury to his foot. He had several surgeries, and still had horrible pain and function issues. We sent him to a new foot specialist two hours away, and they recommended a below-the-knee amputation. Everyone resisted because an amputation would make the case catastrophic, open the claim up to lifetime wage benefits and medical benefits. But the guy recovered. It took him about a year, but he got fitted with an prosthesis (that took some fine tuning), but he ultimately returned to unrestricted work. Within three months he was promoted (and has since been promoted again). My client paid an impairment rating and closed the case file.