The crippling reality that is nerve pain & workcover: ACA featuring Soula Mantalvanos

soula-mantalvanos-current-affair

Anyone who has (had) to cope with the crippling reality that is nerve pain will tell you it is horrendous. And to add insult to such crippling injuries, if they are a result of a workplace accident, most aren’t covered by workcover.
It is with great honour that we present you with the Story of our injured worker friend, Soula Mantalvanos, which featured on A Current Affair. We’re so proud of you, Soula!

The crippling reality that is nerve pain & workcover: ACA featuring Soula Mantalvanos

On A Current Affair tonight!

Continuing on with my awareness for Pudendal Neuralgia and all things pelvic pain, I didn’t pass up the request from A Current Affair to speak about nerve pain and my experience with it and its treatment, predominately focusing on the peripheral stimulation implant. PainAustralia who have become a great support for me and who recently interviewed me for this story; Social Media for Pain Education were contacted initially by A Current Affair asking if they could recommend anyone who had nerve pain and had found relief from a stimulation implant.

Admittedly a little weary of ACA’s style of filming and my preference to not impose my pain onto others, I still agreed realising I could reach many chronic pain sufferers and also give them courage if they were considering a stimulation device implant.

So, here I am, and tonight there I will be, on A Current Affair in all of chronic ‘neuro’ pain’s putrid reality and sharing the modern chronic back pain treatments that truly did save my life and now have me living again. I’m hoping they won’t cut out the emphasis I made about my Theo treatment, he truly is my largest form of pain relief.

And while I have this great opportunity to raise awareness relating to chronic pain, I’d like to add that in no way has my WorkSafe Insurer contributed to any of the costs for this life saving, $60,000 device. I’ll be forever grateful to my private health insurer who forked out a whopping $54,000 of the expense. All other medical costs relating to my injury including the $6,000 gap for the device (and any treatments over the last two years) have been seen as unrelated to my work injury by the WorkSafe Insurer. The implant in particular was not covered on account that my Neurosurgeon’s letter was seen as insufficient. Below is a copy of my surgeon’s letter to my WorkSafe Agent case manager (without personal names) and the snippets of correspondence relating to the matter (I have loads of paperwork but basically this sums up the support (not) from WorkCover:

Dear Mr (case manager),

Re:   Medical Report for Soula Mantalvanos

Thank you for your letter of 8 April regarding Soula.

In response to your queries, I would answer as follows:

Soula was referred to me by Mr Roy Carey (Orthopaedic Surgeon) in October 2010.  Her history was that of, in 2007, having fallen to the floor on her right buttock from a fitball that had burst.  She has suffered severe local sacrococcygeal pain ever since.  She failed to respond to a great variety of conservative treatments at the … and obtained pain relief only by lying inert most of the time.  She appeared to have coccydynia.  A coccygectomy was reluctantly being considered.  This procedure is frequently unsuccessful in relieving coccygeal pain other than in fairly specific circumstances and I felt it worthwhile offering her a trial of peripheral field stimulation in the first instance.

Temporary stimulation was carried out on 19 January, 2011 and resulted in very considerable pain relief.  It was agreed that we should proceed to permanent implantation of a peripheral nerve field stimulating system.  The permanent implantation took place on 2 February, 2011 at Melbourne Private Hospital.

I saw Soula for review on 24 March, at which stage she reported that her system was working very well and giving her substantial pain relief.  She still found that she had to work within her own pre-set limits of functional activity but was now able to get around the house and to be able to sleep.  Examination revealed completely healed wounds and no evidence of infection.

With regard your specific points:

1.   Was the surgery successful and did it proceed without complications?
The surgery appears to have been successful in so far as it has provided a considerable degree of pain relief, increased mobility and improved quality of sleep.  It proceeded without major complication.  There was some concern in the first week that she may have a superficial wound infection but this proved not to be the case.

2.   Did the surgery result in increased function/reduced symptoms/pain?
See above.

3.   If so, please provide details.
Formal assessment in terms of reduction of pain on visual analogue scale and outcome measures were not undertaken at the time of the first clinic review as it was felt too early to make any useful such measurements.  More useful assessment will be made at around three months from the time of surgery at the time of Soula’s next clinic appointment

4.   Did these improvements result in an increased capacity for work and participation in rehabilitation/training?
This will need to be assessed at the time of her next visit.

5.   Has the surgery assisted the patient to progress towards self-management?
Yes.

6.   What restrictions are now recommended to RTW?
See above.

Please do not hesitate to contact me if further information is required.

Yours sincerely
(Neurosurgeon’s name)

And after I had taken the matter to conciliation I received this from the WorkSafe Agent and please entertain me and check the dates of the letters and the words in red below where the Insurer states they did not receive my surgeon’s letter (which I personally emailed copies of after the surgeon mailed his!!!!):

22 July 2011

I am writing to you about the letter dated 15th December 2010 from (Neurosurgeon’s name) received by (WorkSafe Agent’s name), requesting payment for a trial of peripheral field stimulation x 2 electrodes for you.

The role of (WorkSafe Agent’s name)

(WorkSafe Agent’s name) can pay the reasonable cost of elective surgery required as a result of a work-related injury or illness according to the Accident Compensation Act 1985 (the Act).

Review of your surgery request

(WorkSafe Agent’s name) has now completed a review of your surgery request.  When reviewing your surgery request consideration was given to:

the Act, the WorkSafe Victoria Elective Surgery Policy, your WorkSafe claim history and information, the information your surgeon provided.

As part of the review process (WorkSafe Agent’s name) also attempted to obtain further information from (Neurosurgeon’s name) however nothing has been received to date.

(WorkSafe Agent’s name)’s decision

(WorkSafe Agent’s name) are unable to approve the requested trial for peripheral field stimulation x2 electrodes because:

  • Your injury or illness is no longer considered to be work related as per the medical panel’s opinion dated 16th November 2009
  • Therefore, the trial for peripheral field stimulation x2 electrodes is not considered a reasonable medical and like expense according to section 99 of the Act.

Reasons for this decision

The decision not to pay for your trial for peripheral field stimulation is based on the following supporting information:

The Medical Panel Opinion dated 16th November 2009 states that you previously suffered from a soft tissue injury of the lumbo-sacral spine, relevant to the claimed injury, which has now resolved and the Panel conclude the worker is not suffering from any physical medical condition relevant to the claimed injury.

Based on the available information (WorkSafe Agent’s name) are unable to approve the requested procedure.

Visit Soula’s website: http://www.pudendalnerve.com.au/

Invisible pain crippling thousands

Watch the Current Affair’s video here

 



This post has been seen 3604 times.

8 Responses to “The crippling reality that is nerve pain & workcover: ACA featuring Soula Mantalvanos”

  1. I truly feel for you, I am shaking with sadness, I am in a similar position, photos, other PCA’s who have been dismissed to keep quiet, cruelty, doc support from Dept of Health to my allegations and suffering and still CGU state I am not affected, they are repulsive pigs and what is sad when your honest. True and faithful to your workplace ,when it comes to keeping their money that you honestly are entitled too the insurance companies ,you question your honesty, your faith in humanity, your family suffer, you cant even buy shampoo or conditioner in fear of wasting money, there is no Fairwork Australia justice it just looks good on paper. Thank you for fighting and making the healthy and well off people that your fighting for your innocence, honesty and your life.

    Thumb up 0 Thumb down 0

  2. I watched that last night, and can fully appreciate the pain your in. Suffering big time!!

    Thumb up 0 Thumb down 0

  3. WorkSafe Vic – like all other workcover authorities, and their insurance “agents” should be deeply ASHAMED of themselves, denying neuropathic pain and vital treatment for it. As we’ve said before: injured at work = disabled by worksafe vic.
    Can’t help myself but sincerely hope one of those “decision-makers” will suffer from a horrendously painful nerve condition in turn, and hopefully “wake up”, feeling the burning, sharp and truly disabling pain night and day for the rest of their lives…. Imagine being stung by a jellyfish 24/7 – that comes close to describing this kind of pain.

    Soula, you ought to be commended for your strength, courage and for HELPING thousands in turn.

    Thumb up 0 Thumb down 0

    workcovervictim3 October 4, 2013 at 7:39 pm
  4. WorkCoverVictim every time I turn around, you’re there! So love you for it. Thank you for the comments of suppor Bella and Fran. You all give me strength to carry on and keep on yelling about this putrid and primitive system!
    (btw I didn’t include half the documentation between myself and the insurer for the stimulation device. It was the typical nightmare of back and forth, ignorance, ‘I lost this’ etc etc).

    Thumb up 0 Thumb down 0

  5. So, lets follow how the grubs at the insurance company have played this.

    1. They are stalling/denying any medical care, so you and your private health fund provide the money for the $60k surgery.

    2. The agent then writes to your surgeon trying to find out how much your “work capacity” has increased from surgery you paid for! So in other words, we deny all your surgery because it wont increase your work capacity but now you have paid for it, tell us how much your work capacity has increased!

    3. Oh and by the way, now you have paid for your own surgery which we denied, we think you have an increased capacity for work and will now deny your claim for weekly payments!

    Bunch of pigs.

    Thumb up 0 Thumb down 0

    • D. Right you are so spot on. That is exactly what happened.

      I had the implant procedure in early 2009, from that point on the insurer withdrew all medical help on account that the allocated funds (according to the estimate made for my injury when the claim was accepted) had expired!!!!!

      I went on to have nerve blocks (paid by me and the health fund), acupuncture, remedial massage, in and out of anasthetic with no contribution except the weekly payments UNTIL I declared a 9hr capacity early this year. And yes, they then dumped me completely.

      Now I’m ive managed to get my capacity to 15 hours, the min required before you can earn part payments (yet another pathetic way in this system) and I’m in the midst of the battle of presenting the paperwork to see if I ‘qualify’.

      I’ll keep you guys up to date.

      ps Can you please copy/paste your comment on this page of my website too?

      Bunch of pigs INDEED

      Thumb up 0 Thumb down 0

  6. Yes, to be entitled to S.93cc payments you must be totally incapable of working for the indefinite future. To receive S.93cd payments you must be working AT LEAST 15 hours a week receiving $177. So in theory if you can only work 14 hours a week you dont get either 93cc or 93cd payments!

    However I believe the usual test for S.93cc payments is more like “any meaningful work” whereby if you could work 1 hour a week, this would be considered such a trivial amount you would be awarded 93cc payments.

    Oh and once you are able to work 15 hours a week, I can tell you right now what your insurer will say. They will paint this picture.

    You had a zero capacity, then a 9 hour capacity and now a 15 hour capacity. Clearly your condition is not stable (the other requirement for S.93cd payments) and you are on your way to an even greater work capacity in the foreseeable future, therefore application denied!

    The other thing the insurer likes to do it, once you receive S.93cd payments is to send you about once every 3 months (yes thats right, every 3 months!) to one of their IME’s.

    Then all the IME has to say in their report (after seeing you for 15 minutes) is, I think the worker can work more than they are doing (how they justify that is simply “its my medical opinion), then the insurer will terminate your payments because you are “not working to your capacity”.

    So then you have to take the “termination” decision to Conciliation, which will then refer you to the Medical Panel who will then determine your work capacity. By the time you receive the decision of the Medical Panel, probably about 5 months will have past with no payments!

    So you think if you win your S.93cd case at the Medical Panel you have coming up thats the end of it? Ohhhh no its not, the insurer will have you before the Medical Panel as often as they can hoping a different set of eyes each time on your file will result in them upholding the IME’s decision and kick you off your S.93cd payments.

    So after 5 months of waiting (with no pay), the Medical Panel finds you can do “more work” than the 15 hours, you wont receive any of that 5 months of pay, its gone, never to be received. You will then have to increase your hours above 15 and reapply to the insurer who will deny your S.93cd claim and you will have to visit the Medical Panel (in about another 5 months time) to see if you will be entilted to payments on your new number of hours, say 20 per week.

    And expect that merry-go-round to continue so long as you receive S.93cd payments!

    Thumb up 0 Thumb down 0

    • You couldn’t be more spot on D.Right. But I have a different mindset now. Let them bring on their appointments, I can handle it. If they don’t spend their prescious dollars down the drain they won’t learn. It’s the only measure they have, monetary. That’s why it’s so important for injured workers to fight if they can. The more we give up, the more they earn, the more our Government rewards them.

      I can’t let 30 years of wages go. And I was self employed, I paid my own premiums too, gives me more energy to fight.

      I’ll be keeping everyone posted. Thanks for the support I really appreciate it. And the fact all that is online is important too. It’s a true representation of what injured workers face. How WorkCover and our Government think this routine gets injured workers back to work is beyond me. I’d like someone to answer that? There is no question in my mind for the insurer, they are merely doing their job. They answer to our Government’s legislation.

      Thumb up 0 Thumb down 0