Catastrophic workplace injury claims are medically complicated, especially when the injury leads to amputation and 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 replacement, especially first class state of the art devices are expensive. Don’t let L&I use IME doctors to get out of paying for expensive medical procedures, prosthetic devices, hospitalization, medication, and on-going lifetime medical care. Insist on the best. See IME for information about independent medical exams.
Amputations are one of the costliest injuries in the workers’ compensation system. Injured workers who have an 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, artificial 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. Insist that your medical experts 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 medical 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.
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, but you can do something about it and help yourself too.
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 concern. Get over it. Stop denying the problem and do something to help yourself.
Mental health treatment is good for you in three ways.
After you receive a prosthetic device you will want to know about L&I rules for ongoing medical care. To their credit once L&I agrees to accept responsibility for a prosthetic device or joint replacement, they will usually be fair with ongoing lifetime medical treatment for the accepted condition.
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.
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
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.
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.
If you have a serious job injury then L&I or the Self Insured employer owe you substantial benefits. Make them help you. Don’t take “no” for an answer to your requests. If you could use legal advice or a free claim consultation contact L&I Lawyer Christopher Sharpe
Telephone – Call for information or a free strategy session – 206-343-1988