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Amputation, Prosthetic Devices, and Joint Replacement in L&I Claims. How to Make the Best of a Difficult Situation

Seriously Injured Workers Have a Right to be Considered for These L&I Benefits:

L&I Procedure and Paperwork –Understand L&I Claims if You Want a Good Result.

Insist on Your Rights. Don’t let L&I and Self Insured Employers use IME Doctors to Ruin your Claim.

Catastrophic workplace injury claims are medically complicated, especially if the injury leads to amputation or serious loss of function. The need for a prosthetic limb, or a joint replacement may be obvious, but L&I and their IME doctors may not see it that way. Prosthetics and joint replacment, especially first class state of the art devices are expensive and are often contested by L&I. L&I will use IME doctors to get out of paying for expensive medical procedures, hospitalization, medication, and on-going lifetime medical care. See IME for more information

Prosthetic devices, artificial limbs, and joint replacement – get the best for your situation.

Amputations are one of the costliest injuries in the workers’ compensation system. Injured workers who suffer amputations or require amputation as a result of a work-related injury will need surgery, hospitalization, medications home health care, multiple medical providers, and may benefit from prosthetic limbs.

As new technologies, manufacturing techniques, and materials have evolved, artifical joints and prosthetic devices have improved. However, these advancements come at a price that L&I may not want to pay. You have a right to functional and practical state of the art prosthetic devices. This is a basic right if this medical treatment is found to be necessary and proper. Rely on your medical experts to advocate for good equipment for you.

Many medical specialties are involved after an amputation or a need for joint replacement.  Medical rehabilitation is primarily coordinated by a physiatrist as part of an inter-disciplinary team consisting of physiatrist, prosthetic, nurses, physical therapist, and occupational therapists.

If you will need a prosthetic, you should get a prosthetist, a specialized prosthetic provider, involved as soon as possible. They can work with your medical team to have the prosthetic and associated care and treatment approved. Delays in authorization can lengthen the amount of time it takes to return to work, and waiting for a prosthetic can negatively impact your prognosis and the effectiveness of the prosthetic.

How Do You Like Being  an Amputee? Got a Good Nickname? Stumpy? Lefty?

Amputation affects each person differently. Some people get over it quickly. Others will be affected more profoundly. Anger, feelings of worthlessness, and depression are natural consequences of a catastrophic injury. These things hurt. There is something you can do about it.

Mental health treatment is a logical and natural remedy for the effects of a catastrophic injury.  Good mental health treatment can cure depression and brighten your outlook. The most difficult thing about having mental health concerns is allowing yourself to admit you have a mental health conern. Get over it. Stop denying the problem and do something to help yourself because:

Mental health treatment is good for you in three ways.  

  1. Mental health treatment is good for you. Psychiatrist, psychologist, and counselors are professionals. Find a good one and get some help. Your are not a freak. You are not going crazy.  Help is available
  2. Mental health treatment significantly increases the value of your L&I and third party claim.  Depression, anxiety, and PTSD are impairments worth money. If you have any of these conditions you may have money coming. Don’t throw your money away by being a tough guy and pretending you don’t have mental health concerns.
  3. Group meetings with fellow amputees is incredibly helpful. These support groups can give you a helping hand to a new normal. Skip the self pity. Get help. Get better. Make your life great again.

What About Ongoing Prosthetic Care?

L&I has rules about ongoing medical care. To their credit once they agree to accept their responsibility for a prosthetic device or joint replacement, L&I will be fair with ongoing lifetime medical treatment for the accepted condition.

What About Medical Complications Affecting Other Body Parts?

Replace a knee and it will affect how you walk. This can cause other medical problems in the hip, the injured limb, or the other leg. As obvious as that is, L&I takes the position that if it wasn’t part of the original injury, then it’s not part of the claim. This is wrong thinking.

Don’t let them get away with that.

The key is a solid medical opinion showing the causal connection between the original injury and the current need for additional treatment. Don’t let their IME doctors shut down or preclude necessary treatment.

The attending physician runs the show. If your attending doctor is strong in the face of IME and L&I pressure, you have a chance. If your doctor is weak, so is your claim.

What About the Future, After Medical Care Reaches Maximum Medical Improvement (MMI)?

The L&I claim moves to a different phase. Next is the question of employability. Can you return to work and hold down a job. Are you are qualified to do so? Many amputees return to good jobs in the work force.  See vocational rehabilitation.

After that comes settlement of your claim. What’s it going to be for you? A good permanent partial disability award? A lifetime pension? A lump of coal?  It will make a difference. Learn about these benefits here L&I Settlement

Phantom Pain

Don’t be fooled by its name. Phantom pain is real, and for some amputees it’s a serious concern. Medical treatment is available. If you have phantom pain, get your doctor to refer you for medical treatment.

How to Deal with Pain Without Becoming an Addict.

Be smart here. Some doctors will be careful with how they manage your pain. Others not so much. Some patients have additive personalities and could easily get hooked on pain drugs, others don’t . Understand your personality type and how powerful these addictive drugs are. Have discussions with your doctors. Be careful. Pain and drugs can make you do things you would not otherwise do. Get together with your doctors and make a plan. Consider a multi modal pain management program using nerve blocks, epidural injections, anti inflammatory drugs, opioids and mental health counseling.

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