Should workmans comp pay for wls. - ThinnerTimes - Gastric Bypass Forum, Lap Band Forum, and Vertical Sleeve Gastrectomy Forum

BiGMerf · 06-12-2008, 02:12 PM

I wanna know if you guys think that workmans comp should pay for my surgery.Here is my story...

I was always overweight but have dealt with it all of my life (apparently i developed degenerative disc disease in the process) . But then in dec. of 06 i was injured at work (fedex freight). My lower disc L4/L5 bulged out and tore while the one above is about to.I have seen 3 surgeons and all 3 said i need a fusion in my back to repair the damage.. But all 3 claim i cannot unless i lose 100-125 pounds, there fore they refuse to do it. Now i have been out of work since 4-07 due to this and i am at a stall.. My job due to lack of hrs worked dropped my med insurance, but i do continue to receive a weekly check. So i call my wc lawyer to see if he could make my job pay for the surgery so that i can in turn get the back surgery.. He told me they are not obligated, so what the hell do i do now?

*****EDIT*****

Spoke with my workmans comp rep and she told me i have 2 options either settle or stay collecting the way i am. Then i thought of another option

***i called binder and binder and they asked me how long have i been out of work and i told them a yr and a half. Then they asked would my doctor be willing to sign a paper saying that i cannot work the next year. I answered i woudnt see why not he hasn't let me back since march of last year. They then told me i do qalify and that they would help me get social security..I asked about medical and he said it would take effect 2 yrs from the day i stopped working... ANY one ever use medicare for the surgery?

Jeanie · 06-12-2008, 02:27 PM

Quote:

Originally Posted by BuCwiLd

I wanna know if you guys think that workmans comp should pay for my surgery.Here is my story...

I was always overweight but have dealt with it all of my life (apparently i developed degenerative disc disease in the process) . But then in dec. of 06 i was injured at work (fedex freight). My lower disc L4/L5 bulged out and tore while the one above is about to.I have seen 3 surgeons and all 3 said i need a fusion in my back to repair the damage.. But all 3 claim i cannot unless i lose 100-125 pounds, there fore they refuse to do it. Now i have been out of work since 4-07 due to this and i am at a stall.. My job due to lack of hrs worked dropped my med insurance, but i do continue to receive a weekly check. So i call my wc lawyer to see if he could make my job pay for the surgery so that i can in turn get the back surgery.. He told me they are not obligated, so what the hell do i do now?

Not trying to be rude but it's not your works fault that you are overweight. You said yourself you have been overweight your whole life, so honestly you won't be able to prove that you got this big because of your injury, therefore they have no reason to have to pay for this. Plus it's just something that they don't have to pay for. I understand about the not working thing so no insurance have you tried getting some kind of medical thru the state?
Can you go back to work with modified duty so that you can get your insurance back? I know that most employers would rather have an employee working with restrictions then paying out all the money in W/C benefits.

lala46205 · 06-12-2008, 02:29 PM

It Depends On If You Were Overweight Before The Surgery..i Myself Was On Wc And Then Received A Large Sum Of Money From Wc, I Do Know They Are Very Strict On The Issue Having To Do With The Accident. Say You Hurt Yourself And Were Unable To Do Anything And Gained Weight Because Of That Yes But You Would Then Have To Prove That Which Would Be Hard To But If You Were Overweight Before They Wont.gl And I Hop Ea Way To Get This Surgery Finds You!

BiGMerf · 06-12-2008, 02:30 PM

doctor will not let me back.. i was on modified duty from dec of 06 till april of 07 thats when my doc took me off completely becouse i was gettin worse.. i understand that they have no fault in how big i am but i do need a surgery that i cannot have becouse of a wrk related injury. Now woudnt they want to just pay for it instead of paying 500 weeks of w/c.? i just want to get my back fixed, its killing me not being able to do anything!

BabyNicole · 06-12-2008, 02:33 PM

Quote:

Originally Posted by BuCwiLd

doctor will not let me back.. i was on modified duty from dec of 06 till april of 07 thats when my doc took me off completely becouse i was gettin worse.. i understand that they have no fault in how big i am but i do need a surgery that i cannot have becouse of a wrk related injury. Now woudnt they want to just pay for it instead of paying 500 weeks of w/c.?

Were you overweight before you had the disc injury, or did you gain all the weight from being home on WC from the injury?

Jeanie · 06-12-2008, 02:34 PM

You would think that they would want to, but the don't always do things the smart way so to speak. Another way to maybe go about is by talking to your claim adjuster. All though the fact that you have a lawyer they might not want to or be able to talk to you about your claims. Also if you are thinking that you are going to get a pretty nice settlement b/c of the injury you should see if you can get them to pay for WLS then take that out of your settlement or something like that. Can't hurt to try every approach.

BiGMerf · 06-12-2008, 02:38 PM

Quote:

Originally Posted by Jeanie

You would think that they would want to, but the don't always do things the smart way so to speak. Another way to maybe go about is by talking to your claim adjuster. All though the fact that you have a lawyer they might not want to or be able to talk to you about your claims. Also if you are thinking that you are going to get a pretty nice settlement b/c of the injury you should see if you can get them to pay for WLS then take that out of your settlement or something like that. Can't hurt to try every approach.

my lawyer says the settlement comes after everything is over..whatever that means since i cant see anything going any further right now

taleci · 06-12-2008, 02:46 PM

Gosh, I am sorry this is happening to you. I have family with back issues and know how debilitating it can be.

I am in HR and I know that our WC would not pay to cover WLS. While I am in no way a legal expert, I would presume that the reason behind it would be that a work injury would not be the cause of the obesity. Sometimes it is absurd how things work, because in the long run it would probably cost them less to just cover it for you so you could get back to work and off of WC.

It sounds to me like your best chance of getting the surgery covered would be to get a new job with insurance that would cover it. Does your WC cover any sort of job training that could help you to get a new career going that would not be harmful to your back health? Or if that is not possible, does your WC offer PT that might assist you in some way to at least get the weight down enough to have the back surgery so you can get back to your life?

Again, so sorry this has happened to you and I wish you all the best.
Leslie

BiGMerf · 06-12-2008, 03:01 PM

Quote:

Originally Posted by taleci

Gosh, I am sorry this is happening to you. I have family with back issues and know how debilitating it can be.

I am in HR and I know that our WC would not pay to cover WLS. While I am in no way a legal expert, I would presume that the reason behind it would be that a work injury would not be the cause of the obesity. Sometimes it is absurd how things work, because in the long run it would probably cost them less to just cover it for you so you could get back to work and off of WC.

It sounds to me like your best chance of getting the surgery covered would be to get a new job with insurance that would cover it. Does your WC cover any sort of job training that could help you to get a new career going that would not be harmful to your back health? Or if that is not possible, does your WC offer PT that might assist you in some way to at least get the weight down enough to have the back surgery so you can get back to your life?

Again, so sorry this has happened to you and I wish you all the best.
Leslie

yes they do offer retraining in another field.. its the law but i have to get the surgery first and settle before that can happen.Now as far as therapy to assist in weight loss no, especially when i have to lose 100-125 pounds..thats alot!!

bebop · 06-12-2008, 04:01 PM

I tore 3 disks driving a truck. I have gained about 35 lbs since I have been out of work. my injury was in Jan 05. I will never work again. WC is not responsible for wls unfortunately. they would not even consider fusing mine. do alot of research on that fusion! you look pretty young in your pic. everyone I know that had back surgery ended up worse than without surgery. please be careful if you have it done.