on 12/27 I was injured on the job. The actually act of injury was pretty unremarkable. My home care company requires the use of lifts for patients 50+ lbs., but, obviously, I am still responsible for manually turning/repositioning patients, but not always with the ability to properly position changing tables, etc. to work with proper body mechanics.
As I was assisting the mother to help dress the child (100+ lbs) I felt a slight pull around my left lower back. I proceeded to help dress the child as it was a momentary twinge of pain. It wasn't until I sat in my car, about 30 min later, that I began to experience excrutiating pain in my left leg (now know to be sciatica pain). By the time I got home (40 min drive) I had numbness/decreased sensation in my left posterior calf and outer two toes. I now know that this is associated with the S1 nerve.
To make a long story short, my PCP and I strongly suspect it is an L4/L5 herniation that is impinging the S1 nerve. I am walking with a limp and have an inability to do a toe lift with my left foot due to the nerve issues. I was given a 10lb lifting restriction pending reduction in symptoms (numbness/muscle weakness) and some follow-up referrals.
I was hired in July and have a wedding to pay for. The workers comp situation is scary enough but I'm wondering if anyone has had a similar situation and can tell me how long it took them to go back to work? My PCP alluded that as soon as the numbness/weakness went away she would authorize me to return to work...but I'm afraid it will take a while to heal despite PT and pain clinic referrals and definately am smart enough to know not to mess with my back. Either way I plan on asking for a lighter, ambulatory patient when I do return to work while I spend more time strengthening my back (which I have the ability to do in homecare). Has anyone been down this road? Especially with workers comp in Massachusetts? Or with the injury and the average healing time?
In need of guidance...at least give me comments to read - I'm going crazy at home!!!!!
As it is WC you should have the options of seeing a doctor of your choosing.....
Not necessarily true, depends on your state laws. I worked in a physician's office for many years before returning to school & dealt with a lot of WC & PI cases. My state (IL) does give the employee their choice of 2 doctors, & as long as the referral chain is not broken (ie these 2 original choices refer out as needed), & everyone has good documentation to substantiate treatment, there is no reason an injured worker won't be able to see the doctors they want to see & get needed treatments. However, I've been told that neighboring states do not give the employee first choice on who they seek treatment from. Every state has its own laws regarding WC. You have to be pro-active & go to your states website where much of this information should be outlined. Also, don't take anything your employer tells you as the gospel; management often doesn't have a clue what the actual laws are for how to proceed. For instance, in IL, if the employee is cleared for duty w/restrictions, the employer has to let them work, even if it is sitting and answering a phone or stapling paperwork. But I've heard of times over & over where managers said they didn't have light duty & employees didn't work because they didn't realize they were being misled, whether intentional or not. Having an attorney to keep on top of what's allowed or not allowed is definitely a good idea!
in our state, the employer has the right to send you to a physician of their choice once. after that, if you want to keep treating c that doc, that's your treating physician. if you don't, you can choose your own. you are entitled to a second opinion within specialties on the company nickel, but not a third and a fourth and a fifth, though. a good nurse case manager will help you with all that.
Thanks for all the input...I wanted to provide a bit of an update.
First, WC has still not made a determination on my case but I have spoken to two lawyers and plan to retain one. Also, I have been able to receive all the care I need so long as the utilization review board authorizes the treatment beforehand.
The MRI showed a very large L5 herniation with S1 nerve root compression, and, what appears to be a fragment of the disc floating around. This fragment, along with my numbness and muscle weakness has bumped me up for surgical consults and also for the potential of surgery.
This is very scary for me. I'm 28. I haven't had any children yet, etc. Can anyone recommend a good way to look for credible neurosurgeons and orthopedic spine specialists? Can any explain the benefit of a NS over Ortho to me as well? I guess my main objective here is to make myself better (I'm not in pain...I just want the nerve compression to go away) as well as maintain stability of my spine for the future. Any advice or personal stories are welcome...thanks!
i have done this for years, and, interestingly, had a bilevel laminectomy myself, but that was before i knew squat about backs. let me give you some advice from a management standpoint.
1) what makes you think you need a lawyer? most state work comp systems operate by mandatory schedules for settlement, and they cover the medical expenses related to the injury. this means, for example, that your medical costs will be covered unless your employer says you did not get hurt on the job. they also have statutory responsibilities for income replacement (indemnity), meaning that there is no legal way to get your indemnity increased by litigation. assuming that it's clear and documented that you did, in fact, get hurt at work, that's not an issue.
so the only thing at issue would be any settlement for permanent disability. this means that you have to have, at the end of the day, a permanent disability. given that you are in your twenties and have a clear surgical problem, good surgery and, more important, good rehab will probably result in your having none, in the long term (assuming here that you have no other comorbidity that would make that more difficult).
an attorney does not get paid unless you get a settlement; you don't get a settlement unless you have permanent disability. moreover, the settlement amount is also statutory, meaning that litigation cannot increase it. and the attorney is entitled to a good hunk of it (in our state it's 30%), and this come out of your settlement. which you would get anyway.
the only reason litigation would be helpful is in a case where there is some antagonism between worker and employer where the employer is refusing to accept the injury as work-related, or where the employer's work comp insurance carrier is refusing to accept the claim. if this is not the case and everything is going as it should (with allowances for bureaucracy) there's usually no advantage to signing away part of your potential benefits to an atty. you should ask very pointed questions about all this; don't do it apologetically, it's the law. you should ask your atty candidates and your state dept of work comp (whatever it's called) to get the straight dope.
2) as to surgery and rehab: in my experience it doesn't matter who does the surgery; it's pretty straightforward and if you go to someone who does lots and lots of them you should be in good hands. the huge difference between neurosurg and orthosurg in back surgery, at least in all the cases i've seen, is that ortho surg around here gets you up and moving and into activity and recovery sooner. i see far more disability in local neurosurg cases not because of the basic underlying problem but because neurosurg tends to keep people in bed or on very restricted activity (even putting them in corsets or braces -- and this without a fusion to splint:eek:) and so three or four months down the road they are debilitated, have no endurance, and have such core weakness that any activity is painful. you can recover from that but it's very hard work. the pts hate to see these surgeon's pts because they know this song and can name it in three notes. there's no anatomical or surgical difference in these cases, it's solely surgeon preference.
the orthosurg folks tend to collaborate c physiatry and tell you that in two days they want you up and walking outside and doing pt the next week. this prevents deconditioning and does not increase risk of complications.
i had a neurosurgeon, not knowing any better, and had a miserable time, finally going to him at 4 months postop and saying, "doncha think i should have, i dunno, some pt or something?" he reluctantly agreed, and that woman saved my life. it was some of the hardest work i ever did in my life and i took the better part of 2 years to be really normal. in contrast, by the time a few years went by and i started doing comp case mgmt and learned a lot more about this, i sent my brother to my favorite ortho guy who was very rehab-oriented. he was back at work in 2 weeks at a pretty heavy job, because he never had a chance to decondition.
moral of the story is to ask your surgeon candidates very carefully about what they expect for your activity level postop, and what they set up for pt and how soon. if you hear, "just do what you can...stop if it hurts," leave. people who do do less and less because it hurts get into a hole. it will hurt, but you know the difference between dangerous pain and nondangerous pain, and you should ask them what they are if you don't. choose someone with a good interest in rehab, and see a physiatrist postop for followup (most surgeons lose interest after the postop check ).
happy to help, thanks for the kind words. i should have mentioned that eventually my back stopped being painful and since i was about 5 years post op i go many months at a time without even remembering i'd ever hurt it. i have the teeniest residual weakness in one leg, just enough that i notice my socks fit differently and i lift it a bit with a hand when i climb in the car, but that's trivial.
rehab, rehab, rehab, and do not think you have to be at an endpoint at 6 months (which is what the insurance people and attys think); if you think you're at an endpoint (what they call mmi, maximum medical improvement) you'll want to slit your wrists. it's not fair to use that cut-off, and you can ignore it. you will continue to improve for a few years, and you'll get better.
Thought I would pop in and provide an update for anyone reading this thread looking for info. I was out of work for a total of six months. In Mass it took about three weeks for workers comp to cover my medical expenses (so long as them utilization review board authorized them beforehand) and begin to pay me weekly. I was injured on 12/27/11 and did not get seen by a neurosurgeon until the first week of February. This was largely due to the time it took for WC to authorize the appointment and wait time at the office. I looked up the best doc I could find which increased wait. Since my pain had gone away and muscle weakness markedly improved, we decided there was no reason to jump to surgery so PT was the determination. Knowing I would be hard-pressed to have WC admit liability for th injury at the deadline (roughly 6 mos. in Mass) I made it my personal goal to lift 50lbs. by the end of PT so I had the best chance of going back to work. After 12 weeks of PT I did reach my goal. I was on an at-home walking program per neuro and was lifting at PT while doing an hr of stretching a day. Workers comp refused to admit liability after their 6 month waiting period but luckily I was given authorization to go to work. I picked up an ambulatory child doing night shifts and work 32 hours a week. Stretching, weight lifting and cardio (low impact with no hip rotation) is a part of my daily life to stay strong, along with core exercises. While my back gets "tweaky" every so often, enough to constanly remind me of my injury, I am doing well (knock on wood!)The area along most of m s1 dermatome is still numb and I was told if feeling doesn't return within a couple of years it likely never will. My muscle function is almost 100% however at the end of a long walk I can sometimes feel fatigued in my left leg. My advice for someone going through this is to get a lawyer as workers comp does a crappy job at expediting care for those who really need it because they are too busy trying to follow and catch people cheating the system (yes I was followed at certain points) and to walk and stretch as much as you can and to keep up with the PT program to keep your body strong even after therapy has been completed. My future goals have changed. I will never be a med/surg nurse so do heavy lifting and plan to become an advanced practice nurse sooner than later as re-injury is a risk I refuse to take. I hope that I, too, will have months at a time where I forget I injured my back but am happy where I am - certainly better than a year ago!
RainMom
1,117 Posts
Not necessarily true, depends on your state laws. I worked in a physician's office for many years before returning to school & dealt with a lot of WC & PI cases. My state (IL) does give the employee their choice of 2 doctors, & as long as the referral chain is not broken (ie these 2 original choices refer out as needed), & everyone has good documentation to substantiate treatment, there is no reason an injured worker won't be able to see the doctors they want to see & get needed treatments. However, I've been told that neighboring states do not give the employee first choice on who they seek treatment from. Every state has its own laws regarding WC. You have to be pro-active & go to your states website where much of this information should be outlined. Also, don't take anything your employer tells you as the gospel; management often doesn't have a clue what the actual laws are for how to proceed. For instance, in IL, if the employee is cleared for duty w/restrictions, the employer has to let them work, even if it is sitting and answering a phone or stapling paperwork. But I've heard of times over & over where managers said they didn't have light duty & employees didn't work because they didn't realize they were being misled, whether intentional or not. Having an attorney to keep on top of what's allowed or not allowed is definitely a good idea!
Good Luck to you!