Non-existent epilepsy used to decline my claim: Injured worker

workers-comp-claims-denied-pre-existing

This is quite and amazing story from a recently injured worker who had her claim declined because an insurance company quack claimed her injury resulted from of an epileptic fit. Sarah writes:

I was referred to a neurologist by my insurance company to obtain references to what initially caused me to blackout after the event of my injury his initial diagnosis was that of probable epilepsy a condition which I have never experienced in my child or adult hood to date and have no evidence of it being in my immediate family, from this consultation based on the form of being of an epileptic fit my compensation claim went into denial of liability.

Sarah has since undergone brain scans by a competent medical specialist who can find no evidence of epilepsy

It is no secret that insurers doctor shop and have no trouble getting medico-legal opinions from doctors who should be banned from practicing medicine.  This is just another disgraceful example!!

Here is Sarah’s story:

I’m severely injured construction industry traffic controller who has been under the workers compensation scheme since October 2011.

 I was working as a traffic controller for a company based in Sydney where I had been employed for a short period of time prior to my injury.

 I was working on behalf of one of the major developers in the city on their new site in Sydney.  It was a mild day I fell whilst on site and initially sprained my ankle and the correct procedure of R.I.C.E being applied on site and medical assistance was required by attending a site approved medical centre where I was left to no kind of R.I.C.E was applied and an initial x-ray was approved and sought after,  then I saw a treating doctor who told me to go home and listen to the pain, rest and keep my ankle evaluated over the weekend, they informed me to obtain some for of support but didn’t inform me of the correct type of support to strap my ankle with.   When I did purchase a support for the ankle I was informed by my treating doctor that the one I had actually purchased was not the kind that he would recommend as it didn’t provide me with enough support and he also told me to apply a combination of heat and cold to the ankle and take some Panadol to relieve the pain and discomfort.

 On the following working day I found that I was taken by my employer back to the site for a chat to discuss the injury and incident with them and then was sent back to the medical centre to see a doctor to press for me to return back to the workplace on suitable duties but I was still in a lot of pain and discomfort at this time and still couldn’t bear any weight on my ankle and found that I wouldn’t be fit for suitable duties or returning back on my original position as a traffic controller I soon found that I was going to be sent but after further investigations such as an MRI scan of the injured ankle it was found that my injuries were found to be of a more serious nature of that I had actually damaged my tendons, ligaments and cartilage of the ankle with the restricted movement and sensation of my toes.  When asked about pain relief I was simply told that I was not to have any form of relief as they wanted me to listen to the pain I was experiencing and was offered a workers compensation medical certificate to say that I was unfit for work.  I was unhappy about the treatment experienced by the medical centre that I had been attending and promptly changed to a new treating doctor closer to my residential address as it was easier to get to on crutches.

 I initially visited the new treating doctor who gave me some urgent pain relief of a Norspan Patch which I was in need of this was after being off for 2 weeks at this stage, my new treating doctor then referred me to an orthopaedic surgeon after it was found that my injuries were a lot more severe than that which were first diagnosed of that of a sprain.  It was then suggested by the orthopaedic surgeon at St George Hospital that I was referred to a neurologist to examine why I had not regained the sensation in my toes as both the x-ray and MRI of the ankle showed no breakages of any bones. Further to that I was diagnosed with Complex Regional Pain Syndrome and damage to my nerve extending from my knee to my toes. 

 Getting any approvals for treatment was a long and slow process either because I had been changed from fast track claims back to regular claims but couldn’t sought immediate approval for treatment or assistance and trying to communicate with my claims manager was a no go as he wouldn’t be available to talk to me or others involved in my claim.  Further down the track I had been required to see an orthopaedic medical examiner on behalf of my insurance company who refused to examine me in case he caused me more serious injury or complications due to the pain that I was experiencing and actually agreed with the previous diagnosis made by my specialist and consultants. 

I was then referred to a neurologist by my insurance company to obtain references to what initially caused me to blackout after the event of my injury his initial diagnosis was that of probable epilepsy a condition which I have never experienced in my child or adult hood to date and have no evidence of it being in my immediate family, from this consultation based on the form of being of an epileptic fit my compensation claim went into denial of liability.  This then resorted in me having to attend and sought assistance from Centrelink who placed me on Newstart Allowance with exemptions from their pathways to the workplace.  Also as a result of this injury as well I have had the breakdown in my marriage occur as I am unfit enough to take care of the duties of a housewife and being able to carry out domesticated duties within my household on a daily basis because I am unable to stand up for long periods of time.

 I am now finding myself in receipt of $616 per fortnight to live on but this doesn’t cover me for anything, I find myself battling every fortnight with the expenses of paying my rent on my 2 bedroom unit of $760 a fortnight my electricity and internet expenses for the property and my internet is an essential part of my daily life to my family living overseas.  I recently received my electricity bill for just over $400 for 2 quarters as I was unable to pay the first one off due to the financial situation I am experiencing, I sought the assistance of the Salvation Army who kindly gave me vouchers of $120 towards my previous bill but this has left me with an outstanding amount of $280 approximately in which case I have set up with my banking provider that I would pay them $20 which would leave me less than $30 a fortnight to cloth myself etc as I pay my real estate $550 leaving me with $66 a fortnight.  With this amount left over I find myself in constant arrears with my rent and also unable to obtain my much-required medications and seek the assistance of charitable organisations to help with food and bill assistance.

 Since my compensation went into denial just 3 weeks prior to the period of 26 weeks payments, I have been an had an MRI of my brain carried out and a further visit to my neurologist to prove that I am not an epileptic and this has been found to be a negative on suffering from any form of epilepsy, this medical examiner needs to carefully read injured workers previous medical history and medications to see exactly what they have been treated for before making a dangerous medical diagnosis such as this one.  I also have had to have an EEG sleep study conducted to resolve this issue too. In my eyes un-needed expense to the public system due to a misdiagnosis by a senior medical examiner.

 Since the denial of my claim has meant that the treatment I was receiving prior to this has meant me having to use the public health care system and sit on waiting lists to be seen by specialists and consultants as well as use allied healthcare professionals in the public system rather than under the private system.  This will have prolonged my proposed return to work in the near future it has also stopped any rehabilitation or getting supplies of disabled equipment and practical resources for around my home.  I now find myself unable to cope with the daily pain I am experiencing combined with the lack of pain relief as I can not afford $120 for 30 tablets of one of the prescribed pain killers I have been told to take.  I am in complete and utter despair with all of this.  In August of this year I have also had to have 3 spinal nerve block operations to try and eliminate my pain but these have been unsuccessful and am currently awaiting the result of the request by myself to my pain specialist at one of the city hospitals for Spinal Cord Stimulation trial to be conducted I await the result in due course, until which time it will delay any pain management being done and my recovery and immediate or near future return to the workplace environment.

11 Responses to “Non-existent epilepsy used to decline my claim: Injured worker”

  1. Injured workers should never, ever go to the lion’s den without their recording devices, and their support people. My support people are learning heaps about the nastiness of this system, just be having to accompany and support me through bits of it.
    It would be great to have a legal case challenging these IME reports and the crap they propagate about us. In lieu of that, more injured workers writing complaints to the Medical Practice Boards about the bias, lack of independence, and “constructed” diagnoses in these reports. Fight fire with fire I say. These IME’s will soon find what they’re paid for their “opinions” doesn’t cover the inconvenience and anxiety caused by having to deal with multiple complaints to the Medical Boards.
    My own experience suggests you won’t get justice or even a sense of really being heard by the Boards, but believe me, the IME’s will find the experience somewhat excruciating! And the Boards will start to worry if they get a flood of these.

  2. I was sent for an IME not so long ago, the IME report stated I was uncooperative and did not provide documents. Mind you the IME read all of them in great detail and asked me a lot of questions during the consultation. Anyways I had yet another IME and put all of my medical documents on the IME’s front desk and used my mobile phone to record my actions, am now waiting for the report.

    The camera never lies..

  3. “the old quack had a complete meltdown and kicked our hero and his wife out of the office.

    I,m still laughing

    I will save the mental picture of this for my low days

    Good luck with your quack today too Lisa
    klingon

  4. Absolutely disgusting behaviour by the insurance company and their doctors. They should be sued.

  5. -this outrageous story sadly doesn’t surprise me at all..making bogus diagnoses was standard practice over 20 years in the NSW agency granted powers to assess the medical fitness of NSW public servants (HealthQuest)..those bogus diagnoses ranged from paranoid schizophrenia to dementia and personality disorder and were invariably used against whistleblowers so that they could be instantly sacked and condemned for life…bogus diagnoses has a chilling echo of what went on in Germany from 1939 to 1945 when up to 200,000 people where murdered-gassed shot poisoned starved as part of the NAZI euthanasia killing program=in each case NAZI doctors issued false death certificates stating the victims had died of some natural cause..I have visited Germany and stood in the chambers where many of those victims were killed and after my experience within the NSW State Govt and health system can better understand how such horrors came about..all the stories on this site point to a police state that treats anyone vulnerable or injured or principled with complete contempt..this is so frighteningly parallel to Nazi treatment of disabled as subhuman life unworthy of life.

  6. Funny story – absolutely true! An injured worker was recently sent to a quack psychiatrist by his insurer. He decided enough was enough, after having his words twisted in previous consults with other quacks.

    AT first the quack seemed like a kind older gentleman, however, when our hero (injured worker) stated he wanted to record the interview, the old quack had a complete meltdown and kicked our hero and his wife out of the office.

    TRUE STORY! IT HAPPENED YESTERDAY. Been laughing my arse off ever since.

    • I should add, our hero and his wife were happy with the outcome – they complied with the request by the insurer, however, they were spared another bullshit report from a insurance company quack attempting to minimise his claim or deny it altogether.

      Great outcome! I know our hero is feeling good about it.

      • Talking about quacks, I am spending yet another day attending quack “assessments” and you have just given me a good idea – I will take my voice recorder with me in my pocket, record the quack and AT THE END of the quack exam I will simply state – just to let you know that I have recorded this examination with me being paranoid and attacked form all angles,I always record everything and everyone it’s only natural – thanks and see ya later. 🙂

        As Atlas Legal stated a few months ago, you are allowed to record anything as long as you state that you are recording it (it’s somewhere in a post called on recording telephone conversations).

        I might just add that I also record for my own “training” purposes.

        Yes, I am also sick and tired of receiving grossly misleading “reports” from quacks!

  7. So right! Anything could cause the blackout. Where did that neurologist come from? Having some experience with neurologists (reputable ones) where did that prize scholar get his accreditation ? Bottom of the cereal packet.? To make a diagnosis of epilepsy without diagnostics and only one blackout with no further seizures……WHAT! I’m wondering whether it’s worth taking that type of practice to APHRA. If a Dr is faced with the choice of the loss of their registration or brown nose with an insurance company I wonder where they will put their loyalty .

  8. What a shameful story, appalling behaviour from both the insurer and the “neurologist” who examined you. You could have blacked out from stress, fatigue, not having brekkie, whatever… I mean we all pass out once in our lives!
    I sincerely hope you are able to appeal this decision via Medical Panel and with the help of a decent lawyer and that your claim will be accepted.

    • Sarah does have strong legal representation and her case is up for hearing shortly. We are hoping this blatant abuse is taken further and the quack in question held to account!