VERY strange story.....


Am I screwed?
No, you are fine.
25%
 25%  [ 1 ]
You should be fine, may be a bit tricky though.
75%
 75%  [ 3 ]
Should be ok, but will need lawyer.
0%
 0%  [ 0 ]
Need lawyer, but is still gonna be very tough.
0%
 0%  [ 0 ]
You are screwed.
0%
 0%  [ 0 ]
Total Votes : 4

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PostPosted: Fri Jul 04, 2008 9:05 am   Post subject: VERY strange story.....  

Ok. Last year in November I was walking down some stairs in a building here in Phoenix. The handrail was loose and not knowing I grabbed it and it gave out and I fell. I had an ER visit and had some neck pain upper back pain and some left hip pain. Everything was just strain or sprain. Nothing too serious. The company had Farmers for their property insurance and they were actually very nice and the insurance adjuster was nice as well. We got everything worked out and I received my wages, medical bills and apprx. $3500 pain and suffering, which I thought was very fair. Now the STRANGE part. And I realize you do not know me from Adam but I am a very honest person. Last week just about the same thing happened at a different building. When I fell, I notified the office (property management) and they sent me an email stating they were sorry and that they'd had several calls about it but "just never got around to calling someone out to fix it!" This was a lot worse of a fall when it comes to the injuries. I had a bulging disc, nerve impingement and my right wrist sprained (I guess the wrist is not a big deal). Now the insurance sent me medical auth forms and they are going over everything. I told them, and as the medical records state, the first fall was left hip, high back, etc. and this is totally different. Much more painful, more treatment, etc.



I guess my question is am I screwed? I know it is coincidental but it is honest. From my conversation with the agent today he is not questioning the fall, but a pre-existing injury.



I kind of don't get that though. Am I in trouble here? The doc has told me I cannot work for a while. More than likely up to 6 weeks he states. Can't afford to not be able to recover that money, not to mention the doc fees, etc. I honestly did nothing wrong.



Thank you in advance for any opinions.



Steve

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PostPosted: Fri Jul 04, 2008 2:09 pm   Post subject:   

First of all

Quote:
they sent me an email stating they were sorry and that they'd had several calls about it but "just never got around to calling someone out to fix it!"
Keep that email because it's GOLDEN...
Quote:
From my conversation with the agent today he is not questioning the fall, but a pre-existing injury.
Of course he is...he has to make certain that 'they' didn't just aggrevate a pre-existing condition (which frankly isn't worth as much as 'causing' one)...
Quote:
Am I in trouble here?
NO, you're not...
Quote:
The doc has told me I cannot work for a while. More than likely up to 6 weeks he states. Can't afford to not be able to recover that money, not to mention the doc fees, etc. I honestly did nothing wrong.
No, all of that will be covered, worse case scenerio is if it were pre-existing, but you had fully recovered, (how long since you last treated with your prior fall?), it may reduce your pain and suffering etc...However, aren't these injuries in a totally different area of your body? (
Quote:
I guess the wrist is not a big deal).
They owe you for wrist same as the back! It's as big a deal as your back is ...



Are you using the same doc? If so he/she will be able to provide documentation and agrument if necessary that one is unrelated to another....



IMO I'd wait it out, some and see if they try hard to put this as pre-existing and you don't seem to be able to get them to move off of that, then you may want to think about an attorney...Remember the rep ask you that prior to seeing any medical information right?



I say hang in there awhile before you give up a third of your settlement... Wink


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PostPosted: Fri Jul 04, 2008 6:13 pm   Post subject:   

It has been about 7 months since I treated that injury. It was very minor and yes I fully recovered. And they asked me about prior injury when I talked to them. I guess they have a data base or something but they knew already. He even said it "looks like you have a previous slip and fall back in 07" That was when I explained it. They knew before they even received back the medical auth forms. I can feel from them they are thinking I am in some way being deceptive. I mean there is no disputing the fall, and with the email the prop mgmnt sent me, I hope I'm ok. All I want is the money I am out from work and medical. I don't even care about additional for pain and suffering to be honest. No I haven't told them that Smile

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PostPosted: Sat Jul 05, 2008 5:03 am   Post subject:   

I think I can solve the puzzle for you......the insurer is likely to know if they're the member of MIB.



MIB represents not the Men In Black, but the Medical Information Bureau WinkLaughing



Like the famous credit reporting agencies, MIB maintains the medical history of the individuals carrying individual health care plan and make the records available to their partner health insurers as and when needed.



MIB maintains the health related records of over a billion Americans and provide the information in demand of the health and life insurance companies, in their underwriting process. This is done in order to prevent frauds and deceptive actions of the consumers.



Hope it clarifies your doubts to some extents.

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PostPosted: Sat Jul 05, 2008 2:06 pm   Post subject:   

I'll be honest here, if I got a slip and fall claim and the same person had suffered a previous slip and fall,well you do think...ott-oh! and the red flags go up...cause honestly I'm 48 and a giant clutz, and never had a slip and fall claim..most people could say the same, so it's normal to look it over closely...but are some people just unlucky? darn right ! You'll be fine (IMO) once the adjuster reviews all the information...you are entitled to the pain and suffering don't cut yourself short also don't accept the first offer... Wink



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PostPosted: Sat Jul 05, 2008 4:05 pm   Post subject:   

Ok thank you. I completley understand what you are saying, however, I am a delivery driver and while the average person is in a building maybe 23 times a year and has to climb stairs, I am in the 40-50 times A DAY. So in a way I would have a much greater chance of that kind of accident. Also, to the person who told me about the MIB, or anyone else who may know about it, how detailed does it get, for example, does it say there was a claim for a slip and fall, or does the adjuster see EVERY detail of the slip and fall?



Thanks again everyone.



Steve

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PostPosted: Sat Jul 05, 2008 10:45 pm   Post subject:   

Wait.....did you fall while working? If so that's workers comp and totally differnet...work comp takes priority will settle your claim then go after the building owner in a subrogation claim (least in my state)...



Also yes, the reports are detailed, (usually) slip and fall at this location etc..with such and such insurance company etc.



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PostPosted: Sun Jul 06, 2008 12:50 am   Post subject:   

I am a contractor. So I am technically not employed, therefore, no workers comp. They have accepted liabilty. They say anyway.



However, after their initial investigation and stating they have accepted liability, can they at some point afterwards, decide to not accept it? I mean can they change their mind? If so, how likely would that be?



Thank you



Steve

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PostPosted: Mon Jul 07, 2008 11:42 am   Post subject:   

Rarely would they 'change' their minds...however the work comp thing could do it...but if you are an independent contracter then perhaps that doesn't apply...(never worked work comp claims in my life)....



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PostPosted: Tue Jul 08, 2008 6:58 am   Post subject:   

Ok I talked to the adjuster today and he told me they are going to have to review the past notes. That it is mentioned that I had a l5-s1 degenerative condition or something similar. And they are questioning if this was just a reaggravation of it. I don't know what is going to happen. I called an attorney and they won't take it because they said I already dug holes by sending in the med auth forms. All I know is it said I had to by law. Guess I messed that up. I have done so much research online about pre existing injuries, etc and get so many different answers. I just hope to God they don't come back and say they are covering zilch. I have already paid out of pocket. I'm not just some single guy with money to throw away, I have a family and live check to check. This is really starting to worry me. Confused

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PostPosted: Tue Jul 08, 2008 12:33 pm   Post subject:   

I seriously doubt they won't pay zilch...however aggravating a pre-existing injury just well isnt' ''worth'' what ''causing'' an injury is for obvious reasons....why don't you call your doctor and talk with him about it...re: degenerative disc disease, honestly I think almost everyone after a certain age ends up with some of this...if the bulging disc is in an area where you have this, then there may be some association with an already present weakness...call your doc, or talk with him/her when you see him next and get their fix on it, and what they will do to help you, re: their reports...still have the wrist injury too...



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PostPosted: Thu Jul 10, 2008 3:06 pm   Post subject: No work comp  

Independent contractors have no work comp due to the fact that they have no true employer. This should be treated as a private citizen claim and should not matter if you have had 2 or 10 falls. Unless the bulging disc was a preexisting condition according to your Medical Records (ie, diagnosis or treatment) than it is going to be very hard for the owner of the building to not accept liability. One more thing, as Lori mentioned, "KEEP THAT EMAIL"!!!!! It is your secret weapon!

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PostPosted: Thu Jul 10, 2008 5:02 pm   Post subject:   

Ok thank you. I think what they are going for is just that: Pre exisiting. From what I've read on line, and I don't take it all too serious, is that I may still be entitled to something if it was a aggravation of a pre existing injury. Does that sound right? Also I have an odd question, say I miss 6 weeks of work, can thay come back and say that if I had not been hurt in the first place that this fall may have only caused me to miss 2 weeks, for example?

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PostPosted: Thu Jul 10, 2008 11:20 pm   Post subject:   

Quote:
Does that sound right?
yep, as mentioned aggravating a pre-existing injury isn't 'worth' as much as causing the inital injury...but 'if' that is the case you are still due a settlement, just not as much as it would have been had THIS fall CAUSED the bulging disc...make sense? Also I have an odd question, say I miss 6 weeks of work, can thay come
Quote:
back and say that if I had not been hurt in the first place that this fall may have only caused me to miss 2 weeks, for example?
Well, I personally wouldn't if I were handling the claim AND you had not missed any work prior for this supposed pre-existing injury...HOWEVER, had you been off here and there for it then yes maybe.


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PostPosted: Fri Jul 11, 2008 5:43 pm   Post subject:   

Eek, I just read this thread. I hope everything works out for you!

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