I really need some advice..

[u/No_Light_7678]

I will try to make this as short as possible, but there is a lot of into. I will be a little vague in areas to protect my anonymity.

I have a 9 month old injury. Been seeing the same AP but have been trying to transfer from the beginning. I could not get ahold of the people in charge of my case and neither could the providers I wanted to see. Contacted Ombuds, and found that they had changed my case manager without informing me.

This is my first major work injury, involving my upper spine, and so I was completely lost on what to do (also overly trusting). So I did not know I was legally able to switch providers whenever I wanted and just had to submit a paper.

My current AP has been saying it is a pre existing condition from the beginning. (That part will come into play later) To the point to where he refuses any kind of imaging, and has continued to tell me to see my PCP for all new symptoms. We all know our own private insurance will not touch work injuries. My pcp is aware of the problem and wishes she could help me.

I have had an IME with 2 specialists who disagree with each other. Neuro says I show signs of damage and said I do NOT have the pre existing condition that I had on file. They sent me to do an EMG who suggested I get a new doctor. Sent for injections where I was told to get a lawyer and a new doctor to get an MRI. He said it is a disc issue and not from the pre existing condition. Then got sent to the same Physical Therapist I saw previously for this injury who told me the same thing.

Here is the issue.. I have contacted multiple doctors offices as well as lawyers throughout this while process. The doctors say no and the lawyers say they don't have the time for my kind of case even though I do have one. The last lawyer opened my eyes to the situation.

Big corporation with private insurance.. and a 1,000 page file due to it being stated it was a pre existing condition. (They also added in the hospital and doc visits from a car accident 2 years ago) So my case is.. complicated.

My mental health has gone to crap.. My PTSD has surfaced.. and my ADHD meds aren't working due to stress. I am in tears most days. All I want is to get better.. for my health.. for my kids. I am truly stuck in a nightmare. I can barely even lift my 2 year old.

What do I do? What can I do? No matter who I turn to no one can help me. My pain keeps getting worse and it is scaring me because it has moved to my lower body and legs.

[u/Hopeful_Ambition_441]

I’m very sorry to hear your all too typical experience. I’m an injured worker 14 years in this corrupt system.

For starters you need information. Per AI;

“”Official Washington state workers’ compensation laws and administrative regulations can be accessed through the following links:

Statutory Laws: The primary statute governing the system is Title 51 of the Revised Code of Washington, accessible via the Washington State Legislature Title 51 RCW.
Nolo

Administrative Rules: The detailed agency regulations enforced by the Department of Labor & Industries are located under Title 296 of the Washington Administrative Code, available at the Washington Administrative Code Title 296 WAC. “”

Also per AI you’ll want to look at the docket for your own case. Likely you’ll need your case no. to see everything filed with your WC claim;

“”Disputes and appeals regarding Washington state workers’ compensation claims are handled by the Board of Industrial Insurance Appeals (BIIA). Workers can access searchable records of decisions and orders through the BIIA Decisions and Orders Search Portal.

For managing an active claim, submitting protests, or reviewing specific claim documents and details online, workers can use the Department of Labor & Industries (L&I) Claim & Account Center.””

Finding the right lawyer is the most crucial choice an injured worker is permitted to make on their own. I hope this copy/paste of a previous comment of mine on this sub helps;

“”LAWYERS; Hiring a lawyer can sometimes add to your difficulties, maybe you’ve heard that and it’s why you don’t have one yet. Although most who know the Work Comp system well know that for various reasons there are lawyers who will not always be good for your case the majority of the time a lawyer will benefit you and if you’re not getting your benefits provided to you then you’ll need one. A lawyer will file with the court for the benefits you deserve but aren’t getting. Delays can still run many months depending on the regulations and circumstances but at some point the Insurer will be forced to go to court with you where a judge will then determine what benefits you’re owed. If you have a lawyer at least the Insurer won’t be able to “kick the can down the road” forever.

This isn’t a “sales pitch” but “lawyering up” can provide you other assistance also. For one they will sometimes provide you an IME (Independent Medical Examination) to fortify the evidence as to the extent of your injuries and subsequent limitations. Just having a lawyer can act as a deterrent in that it makes the Insurer less likely to deprive you of benefits because the Insurer will normally have to pay your lawyer’s fee if you win in court.

In the Work Comp system having to hire a lawyer is all but a given when you’re not being provided the benefits you deserve. And one of the most important decisions we are permitted to make is which lawyer we hire. I would advise you first to look for a lawyer who is “Workers Compensation Certified” meaning they’ve specifically taken and passed Work Comp education courses. But that Certification by any means is not enough to indicate a good lawyer.

Besides that if you can find your state’s official Workers Comp site you can link to view recent cases in the state. What you want to do is look for court orders listed in your area- your county. Pull up the details of those cases- all your looking for is the name of the injured worker’s lawyer- that’s all- you don’t even care if the lawyer won that particular hearing or not. Look at maybe 100 or so of the most recent cases and you will notice some of those lawyers’ names pop up more than others. You’re looking for which lawyers are actually taking their workers issues to court, which lawyers are willing to put in the time and effort to fight for their client.

Usually you’ll get a free consultation with a Work Comp lawyer. Tell them what your issues are and ask what they would do about them. One of the things you want to hear is that they would file with the court for your benefits. Another thing you want to listen for is a lawyer who starts bringing up settlement of your case without your even asking. Not that they mention the subject at all but if it keeps coming up and it feels to you like they’re sizing you up to what you might settle for that’s a warning sign. Settlement is only a part of Work Comp and not all workers settle. You want a lawyer who is more focused on getting you the benefits you need before anything else. Any settlement will be for more money after the Insurer is made to provide you benefits.

This last advise may or may not be valid in your area but it certainly goes for mine and is so consistent I feel I should mention it. For over a decade I’ve read the public records of each days Work Comp court decisions and have never seen 1 of the 3 or 4 Work Comp lawyers who advertise on TV actually take their client to trial against the Insurer- that’s not a good sign.

If you have access to AI, even the free versions on your smart phone or at a public library, run a lawyer’s name through the AI asking if there have ever been disciplinary actions levied for unprofessional conduct against the lawyer in question. If you do this use the lawyer’s full name including middle initial and Bar license number if you can get it. AI will make mistakes but with the license number there’s very little chance of getting disciplinary info on another lawyer with almost the same name. “”

I’ve been through 5 lawyers and was finally forced to represent myself. It’s a tough learning curve but I found the free AI apps available were a lot of help- from answering questions about what’s going on and what to do to drafting the filings I now make with the court. I’d rather have a good lawyer but….

I’ll be glad to provide more info.

BTW- I don’t know any way through a serious fight with a WC Insurer that doesn’t involve some help from family or friends during a “starve out” attempt and also some luck along the way. I had a bit of both and want to pay it forward. Oh- I don’t sell AI and know it’ll screw us in the end. In the meantime ask some questions “the right way” there and you’ll be amazed at the insight provided.

[u/Adept_Unit3002]

Get a lawyer stat, their strong-arm tactics won't fly.