Doug Lee of Magalia, CA, injured his spine while at work as a professional logger. His insurer cut off payments for his physical therapy a month after the surgery in which his vertebrae were fused; he walks with a cane and now relies on social security disability benefits.
Mr. Lee waits in limbo, never knowing if his medications will be approved by his workers’ compensation insurer. Even when he hired a lawyer and the court ordered his prescriptions filled, his insurer failed to fill them. “The fines they might face,” he said, “are nothing compared to what they save by denying everyone’s medical care.”
Aaron (who asked that only his first name used for fear of retaliation) was 38 years old and working on a construction site when a jib (the projecting arm of a crane) fell on him. He had a collapsed lung and major injuries to both shoulders, among other problems. He had to be intubated and spent nine days in the ICU and trauma wards. A judge ruled him 100% disabled. “I miss working a lot.” Aaron said, “I don’t get out that much. I’m in pain all the time, and it’s not going to go away.”
Yet over the past year, every one of his medications, pain treatments and physical therapy have been denied. It was clear to Aaron that the independent medical reviewer did not know his situation at all. (The QME’s report cited an article in an obscure medical journal that had nothing to do with his injuries.) “They scare injured people,” he said, “…intimidate them until they go away.”
Edward Peterson of Auburn, CA, was at work as a cost estimator for Aerojet when he suffered three related injuries. The first happened as he tried to cross the street to visit one of the company’s plants. There was some confusion at the crosswalk, causing him to turn back hurriedly, and as he did so he strained some of the tendons in his left ankle. The workers’ compensation-approved physician who treated him put an Ace bandage on his ankle, put him on crutches and sent him back to work.
Mr. Peterson was still in a great deal of pain, however, and the weight of his torn ankle was left unsupported. The pain persisted, and after talking with a senior executive at Aerojet, he visited his primary care physician, who immediately put an air cast on the ankle. Unfortunately, because he continued to work full-time and was putting less pressure on his casted left ankle, he ended up pulling a major muscle group on his right side, simply from overuse. (Had he been put on light or restricted duty by the treating physician, the outcome may have been different.) This second injury put him in a wheelchair, but after much work in physical therapy, he went back to walking with crutches, with a brace on his left leg.
The third injury happened on his very first day off the crutches; his manager grabbed him by the elbow and there was an audible and palpable “pop” in his lower thoracic spine. This “grabby” manner was not uncommon for his manager, who was retired from the military and had a physical way of expressing himself. Still, Mr. Peterson had come so far in his healing — from a wheelchair to crutches and finally walking on his own again — that he did not see this coup de grâce coming.
Until recently, Mr. Peterson had been managing his spinal injury without medication, by means of heat packs, stretching exercises, acupuncture every 3-4 weeks, chiropractic visits every 4-6 months, and orthotic shoes every 6 months. But his workers’ compensation insurer abruptly began to deny treatments– first the acupuncture, then the chiropractic visits, and finally, the orthotic shoes. The pain was increasing. He persevered with his regular stretching exercises when he experienced a spasm on his right side. After his physician witnessed a similar spasm in the exam room from attempting another recommended exercise, she prescribed water therapy to help him gently build his back muscles to their former strength. But his workers’ compensation insurer approved only six sessions. They were certainly helpful, but six sessions were simply not enough to build his strength enough to do his exercises out of the water without harm.
Tired of living in pain and trying to work full time without any medical support, Mr. Peterson recently accepted the severance package that Aerojet offered. He does his stretching exercises twice a day, tries not to rely on pain medication, and hopes the pain will decrease if he works hard at it. Accidents happen, and often one injury does lead to another, but what seems most unfair about Mr. Peterson’s predicament is that when he was evaluated by an independent medical examiner after his back injury, it was determined to be a long-term situation, and that the insurer would provide medical support “as long as it was needed”. This commitment to care has been broken, and Mr. Peterson now bears the brunt of it, with no long-term income or the prospect of returning to a productive life.
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