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Workers Compensation Fraud?

Discussion in 'Personal Injury Law Forum' started by Strongarms38, 16 April 2014.

  1. Strongarms38

    Strongarms38 Well-Known Member

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    I suffered a work related spinal injury nearly 3 years ago. Specialists have told me that surgery is not an option and that the injury will never heal. I've been told to expect that the rest of my life will be living on pain medication and sleeping pills. I see a shrink most weeks and a GP weekly.

    The insurance company have not held up their end of their job for workers compensation. They have not attempted to help me regain my health to a point I could return to work. They've done the exact opposite. Cancelled Physio which was helping, provided me with OT's that have done almost nothing to help me find a job. In most cases they've been told or at least told me that no one will take me given the severity of my injury and the fact that it is easily re injured with just one wrong movement. The insurance company has changed my case worker every other week so I never know who's looking after my case. The new people each time seem to know nothing and documents sent to them for medication reimbursement just magically disappear.

    A neurosurgeon has told me they need to be sued. They have not done their job and my personal injury has become worse over the three years and I'm told will continue to do so. I'm a single dad with 3 kids to look after and my financial future appears bleak. I won't be able to pay for my house and all bills as well as providing for my kids and there needs both schooling and feeding. I'm going to be put on disability bit that won't cover the bills. I need to find a good lawyer to represent me and bill the insurance company for their deliberate mistreatment of my case. I'm told it's a case that is clearly negligent and appropriate personal injury lawyers will bill their time to the insurance company.

    Can anyone help me in this situation?
     
  2. CathL

    CathL Well-Known Member

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    Go see a lawyer immediately as there’s usually a 3 year time limit to bringing this kind of claim.

    As noted in one of the other Personal Injury Law posts: Have a look at Slater & Gordon or Maurice Blackburn – they’re well known in the personal injury law area and have offices in all the major Australian cities. These firms usually offer a no win no fee arrangement that may work for you.
     
    Strongarms38 likes this.
  3. Strongarms38

    Strongarms38 Well-Known Member

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    Thanks for the advice I'll give them a call first thing Tuesday. Much appreciated.
     
  4. CathL

    CathL Well-Known Member

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    Sounds good. I just wanted to add that if you haven’t already, make sure you have documented your situation chronologically and bring along all relevant documents when you meet your lawyer (eg. specialist reports, medical reports, insurance documents, financial info).
     
  5. Strongarms38

    Strongarms38 Well-Known Member

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    Ok that might be a little difficult. They almost never contact me. Almost never have. Any contact I've had with the insurance company has normally seen that there is someone new as my case manager and they have no idea about me or the history. Lots of invoices I've sent to them for reimbursement ie. medication that I paid for that they had agreed to cover to the value of about $2,000 have magically disappeared and no one knows anything about it. Even my GP who fills out my weekly form says he an never get a response from them and the OT they placed me with have done little to nothing to assist my situation. They do tell me that they also have a great deal of difficulty finding anyone that is actually up to date in my situation. They have told me it can be weeks before they receive a response and that the case managers have changed almost every other week so no one knows anything. The OT's have not done anything regarding my rehabilitation. They have not been able to find me any voluntary positions for "work hardening" that don't aggravate my condition. I've asked for some vocational re training which as per usual has fallen on deaf ears. All in all it's a joke. They have not made any attempt to assist me in improving my health to a point where I could return to work or start a different vocation. They change case managers so often that neither my GP or the OT's can get a hold of anyone and if they manage to find someone that's been given my case they usually no nothing about it. They sent me to their neurosurgeon who told me after an MRI that my injury was permanent and surgery offered no help. I was told it's degenerative so will continue to progress for the rest of my life and that I should expect to be on medication for as long as I live. My GP wanted a second opinion so after I saw his neurosurgeon he requested a second MRI. I was then told that the injury was considerably worse. The original 5 disks in my lumbar spine that were damaged had little change except one disk prolapsed had now been torn completely. He also said that there is now new damage in my thoracic that currently affects a further 3 disks. He holds little hope for improvement and suggested that a wheelchair is more than likely in my future. He agreed with the other surgeon that surgery wouldn't offer any benefit. But he strongly suggested that the insurance companies negligence is the likely reason the injury has progressed and will continue to do so. It was his recommendation that legal action against the insurance company would be appropriate given their negligence in assisting me to improve my health as is their job. Their deliberately making contact between myself or my doctors or OT's to maintain contact with them impossible which he explained is normal as they have no interest in actually doing anything. So it's now nearly 3 years since the original injury and the prognosis is not a very pleasant one. I don't want to loose my house or be unable to raise my kids and pay bills. I'm not a materialistic person but being able to keep my head above water would be good. Very concerned that I'll loose everything I've worked so hard for and sacrificed so much for. My kids are my only reason to go on and if I can't afford to look after them as they deserve then there is nothing left for me.
     
  6. CathL

    CathL Well-Known Member

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    How did you go with contacting a lawyer?

    In regard to documentation - its good that you've kept your invoices and its good for you to write down everything that has happened/happens and when in a notebook/journal (for example, even to note that "I spoke to X on Y date regarding Z and they said ABC".). That's helpful for a lawyer to get on top of your case.
     
  7. Strongarms38

    Strongarms38 Well-Known Member

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    Thanks again cathl. I have contacted Slater & Gordon. They were to busy yesterday to give me the proper time to receive my information as it is substantial. I have gone through all my paper work and located every letter of correspondence from them to me or any contact with my OT's. I have also located all the OT's mail to me. Some of which has at least a reflection on them having communicated with the insurer. The first neurosurgeon I saw Dr T listed me as permanently impaired at 11.5% permanent damage. He also was the one that removed my Physio treatments that were showing a positive increase in muscle mass increases as well as greatly improved flexibility also a massive increase in aerobic fotneess. Despite that evidence the insurer removed Physio thanks to the neurosurgeon and his opinion that further Physio would not help. Quite naive considering the physio's report on my progress. My GP has been requesting Physio or at the very least a gym membership as I'm able to train myself. I received a letter from the OT's yesterday that all my GP's persistence had paid off and they have provided me with a 3 month membership using a program to be designed between myself, as I know my limitations and have 5 years pilates training to go by, in conjunction with the OT's Physio. I'll be expected to work autonomously as the insurer is not willing to pay for hands on Physio. Just a fortnightly update to assess the improvements of the 2 weeks and re model the program as required as I hopefully get stronger and reduce my pain level. The OT's have also requested that I see one of their physiologists for an independent assessment. I mentioned to them that I did not see the value in that as I was already seeing a physiciatrist far moree qualified and he's been dealing with me for 3 years. I will attend these sessions but see no value. One problem with conversations with neurosurgeon's and either OT's or my GP is that neither of the 2 neurosurgeons I've seen are willing to put into writing that their belief that the insurance company is negligent for not appropriately attending to my health issues and essentially blowing them off. They may be forced to supply cements in court but aren't willing to do so of their own free will, so I do have reports from the 2 of them, they relate to the injury directly with no side comment. Dr T made his diagnosis sometime within the first year of the injury. The second time I saw him I was expecting a second MRI so as to make an accurate decision concerning the deterioration of my condition but that was not the case. My GP who sees me weekly was not happy with dr T not requesting a second MRI to see the changes, as my GP who is much closer to the situation believes Dr T and his initial assessment of my injury at 11.5% permanently disabled is not correct. Dr W believes the level of injury is far worse than that. Hence he sent me to see Dr N. He requested a second MRI and he explained to me the levels of disability. He told me that without a doubt I'm in the class 3 of disability being between 10-13% but there would be a very strong case to suggest that with the new MRI showing no healing and indeed reflecting a worsening of my condition that I could be classed as a category 4 injury. Which is between 13-20% permanently disabled. Both neurosurgeons have made mention that suing the insurance company could be my best option. I'm not site that either are willing to put that in writing. My GP Dr W is happy to write a supporting letter as is my physiciatrist Dr O'D who is considered one of only a handful of specialists Australia wide that is classed as a leader in his field and up until recently was the Fremantle hospital emergency registrar. He is taking a break to work on his private practice which is where I see him weekly when he's not away on business. This has been the norm since my accident. Sadly the nature of my injury is severe enough that the OT's have found it impossible to place me into any position anywhere in any environment as I'm told no one wants someone like me who could re injure my back severely with just one wrong movement. So it seems I'm unemployable. I have so much on my plate at the moment that life is quite stressful. Having 2 ex partners using the kick him while he's down approach to try and disable our normal custody arrangements with no case to do so and both have been acting illegally according to the family court as the court is the only body that can provide any change in custody arrangements. So I have to now fight them also. I've recently been defrauded in an online dating scam for $23,000 which was the money I was going to use to fight my ex partners. I've nearly managed to find my scammer as I don't believe authorities I'm any country follow up on such crimes. So I'll find her myself. I may never see my money again but if I can have her arrested before she harms another then I'll be happy. The issues with my ex partners is the most pressing at the moment, but making a start on the insurer is probably a good idea given it will be held up in court for as long as possible, by which time it may be to late for me to maintain my house and pay bills as well as feed my kids. Everyone wants money though which is one area I have huge issues. Trying legal aide but have been told it's not likely I'll receive it even with my circumstances as 95% of legal aide goes to women and the other 5% is to those they believe need it the most. My story is a sad one that on occasions seems to much for me. But I think of my kids and am willing to continue to fight. I've sacrificed an awful lot for my kids which I do not regret, but having both ex partners believe it's ok to deny my normal custody which has been observed for 9 years and 3 years respectively on the words of their lawyers instead of following family court requirements which directly attest to the fact that only they can provide permission for custody changes, no lawyer has that power or authority to advise their clients otherwise. So I'm in desperate need of help but sadly have not the financial position to pay high legal fees which appears as the only way to get my kids back and have my rights observed. I guess I'm hoping for a miracle. Thanks again cathl. I appreciate your responses.
     

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