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Workers Comp

Workplace injury claims

Sedgwick, administering our warehouse foreman husband's California workers' comp file after a documented forklift crush injury in Fontana and an MRI showing an L4-L5 herniation contacting the S1 nerve root, denied surgical authorization at week 14 via Utilization Review by a physician reviewer in Ohio who never examined him, citing "insufficient conservative care documentation" against MTUS despite twelve weeks of prescribed physical therapy, three transforaminal epidural injections, and a treating orthopedist's PR-4 stating maximum medical improvement was unreachable without a decompression, and offered a modified-duty position at a distribution center 47 miles from home with an eight-pound lifting restriction his treating physician had already rejected in writing, then the URO denial letter recycled the exact same three MTUS citations his coworker got two weeks earlier on a completely unrelated injury. Forced surgical authorization plus a $184,000 medical set-aside and a $92,500 stipulated award using the California URO reversal framework: the IMR filing, the MPN dispute, the treating physician PR-4 correction, the QME panel request timed against the statutory window, the WCAB expedited hearing petition, and the Labor Code 5814 penalty invocation. the complete 22-week playbook from URO denial to signed C&R.

the injury was february, a warehouse aisle in Fontana, and my husband, a foreman with 17 years at the same third-party logistics operation, was pinned between an outbound pallet jack and a shelving...

Posted by patient_renter_128•
6 comments

workers comp IME doctor wrote that my documented L4-L5 disc herniation has "minimal objective findings" and recommended return to full duty - my treating ortho and PT both say permanent 25 lb restriction. how do i fight an IME from a defense-favored doctor when the MRI is right there in the file?

i am in week 18 of a workers comp claim and i think the carrier is trying to push me back to work before i am medically safe. need input from anyone who has been through the IME (independent medical...

Posted by denied_twice_39•
5 comments

Liberty Mutual workers comp carrier denied my permanent partial disability rating after a forklift accident crushed my left foot requiring three surgeries and a partial amputation of the fourth and fifth metatarsals because the IME doctor assigned a 6 percent whole-person impairment instead of the 19 percent rating my treating orthopedic surgeon assigned. Won 17 percent PPD rating using the AMA Guides 6th Edition framework, the Combined Values Chart analysis, and the cross-examination strategy on the IME. The five-element attack on lowball IME ratings

Sharing this because the independent medical examination (IME) used to assign permanent partial disability (PPD) impairment ratings is the single most contested phase of any serious workers...

Posted by worried_homeowner_933•
6 comments

Liberty Mutual denied my workers' comp claim for a herniated L4-L5 disc from lifting a 90-lb compressor at work claiming it was 'pre-existing degenerative disease' even though I had no prior back complaints in 12 years of employment. Won permanent partial disability rating of 18% body as a whole using the AMA Guides 6th Edition, an IME challenge, and Wisconsin's preponderance-of-evidence standard. The aggravation-of-pre-existing-condition framework

Sharing this because the "pre-existing degenerative disease" defense is the single most common carrier tactic for denying workers' compensation back injury claims, and the legal framework for...

Posted by determinedHomeowner76•
7 comments

Workers comp claim journey - 18 months later

Hurt my shoulder at work, thought it would be straightforward. 18 months later Im still dealing with it. Multiple IMEs, disputes over treatment, delays on everything. Just got my settlement approved...

Posted by annoyed_driver_75•
3 comments