Fighting a pre-existing condition aggravated by on the job injury

[neverinahurry]

What is the name of your state? Texas
I have a pre-existing lumbar condition with a disc bulge at the L4-L5 level. My back starting hurting back in July and I attributed it to a chair with low back support. I filed a w/c claim and went to the dr. The carrier denies the claim because of pre-existing condition.
In the meantime, my chair rolls out from under me and I land on my tailbone causing alot of pain. I have a witness to this accident. Because of my pre-existing condition and not reporting the incident to a supervisor, the carrier is denying any responsibility.
2 weeks ago I ended up in the emergency room when my back "locked up" and I could not stand up. An MRI was done and determined that I have disc bulges in L3-L4, L4-L5, L5-S1 with compression of the nerve in L5-S1. An MRI that was done a year and a half ago only shows the L4-L5 bulge.
The carrier is denying my claim based on the pre-existing condition. I am very frustrated and tired of being in pain. I have had a benefits review conference and agreed to see the carrier's doctor. That was 5 weeks ago and still no appointment.
What can I do to prove my case? I need help please.

 

[Maze]

Pre-existing condition

What is the name of your state? Texas
I have a pre-existing lumbar condition with a disc bulge at the L4-L5 level. My back starting hurting back in July and I attributed it to a chair with low back support. I filed a w/c claim and went to the dr. The carrier denies the claim because of pre-existing condition.
In the meantime, my chair rolls out from under me and I land on my tailbone causing alot of pain. I have a witness to this accident. Because of my pre-existing condition and not reporting the incident to a supervisor, the carrier is denying any responsibility.
2 weeks ago I ended up in the emergency room when my back "locked up" and I could not stand up. An MRI was done and determined that I have disc bulges in L3-L4, L4-L5, L5-S1 with compression of the nerve in L5-S1. An MRI that was done a year and a half ago only shows the L4-L5 bulge.
The carrier is denying my claim based on the pre-existing condition. I am very frustrated and tired of being in pain. I have had a benefits review conference and agreed to see the carrier's doctor. That was 5 weeks ago and still no appointment.
What can I do to prove my case? I need help please.

Neverinahurry, is the employer/carrier treating this one or two injuries? Just wondering because it seems as these are two distinct incidents. Anyway, when did you report the incident in which you fell out the chair? If this was not reported to a supervisor within 30 days, the carrier can deny the claim and you can lose your w/c benefits. Witnessed or not, it has to be reported. In Texas it does not have to be a written report to the supervisor only a verbal report.

To prove your case, you will need medical documentation that states the chair and/or fall from the chair caused the disc bulges and nerve compression. And if you are to get medical documentation stating such, the carrier will probably dispute those findings, too.

If it has been five weeks since your BRC and still no appointment, contact the TWCC office that conducted your BRC. Someone there should contact the carrier and see what's going on. Another option is to retain an attorney to help with the matter. But remember that Texas w/c is not like w/c in most other states. There is no settlement in Texas w/c. All attorney fees come directly from your weekly indemnity benefit. (In Texas it is called TIBs - temporary income benefits). I think the max attorney fees is 25% of your weekly check. The weekly maximum TIB benefit for injuries prior to 09/01/04 is $537. If you are entitled to the max of $537 and you have an attorney receiving the max in attorney fees you would receive $402.75/week ($537-$134.25).

 

[ellencee]

neverinahurry
I replied to your private message instead of posting. Check your mail, please!
EC