A couple of weeks ago we were contacted by a NSW injured worker, who shared his long and rather complex workcover story. The injured worker who will be facing a Hearing in a few months’ time would like to see if other NSW injured workers are having the same issues or troubles, and says “it would be fantastic to hear any comments that may help me through these very cloudy uncertain days.”
Pre-existing condition, aggravation of injury – a NSW injured worker shares story
The injured worker’s story
I am [in my mid thirties] now but [about 12-13 years ago] I originally injured myself in a work accident where I ended up sustaining an injury to my spine where I had bulging discs, extreme lower back pain, numbness to my right shoulder and tingling fingers and severe sciatica numbness and pins and needles down my right leg.
I made the mistake of quitting work.
After the original X-ray I was informed that I had quite bad scoliosis. Which is a S shaped spine. (which I never knew I had or had any issues with back pain or anything in the past I was an extremely active sportsman playing soccer football cricket and even representing the far north coast in indoor cricket.)
After 7 months of waiting after the injury and MRI’s X-ray and seeing 3 surgeons, I was given a new treatment that was going to be the best thing since sliced bread at the time (12-13 years ago). It was called a cryo papain injection; it was introduced to possibly replace a spinal fusion.
It turns out that after doing this operation on less than approximately 1000 people it was banned in Australia and the US.
It turned out that out of the 1000 people in Australia that it was performed on, 200 found that it made improvement 600 people need future treatments of the injection or had to be given spinal fusions, 150 people were left in extreme pain and had no relief and remained in a lot of pain or left in a worse state and the other 50 people had allergic reactions and even 10 or 15 of those people died. (Approximate figures only).
So in [3 years after my injury/accident] I applied for lump sum payment for permanent impairment. After seeing 5 different specialist and going back and forth with offers I was found that I had 40% permanent impairment of my spine 25% permanent effective use of right leg 10% of effective use of right arm and with a 10% reduction of payout due to pre-existing injury ( the scoliosis).
I eventually (3 years after my application for a lumpsum payment) accepted, after the insurance company doing everything to wear me down and give in.
I was given the final offer from the insurance company to take an offer of [around $30,000] with option for future claim or take them to court and may end up with nothing.
My [child] was born less then 12 months earlier and not being employed and having bills everywhere and about to lose my car and everything I saw no other option but to take it after signing off on it. I was advised by my solicitor at the time I made the right decision.[Around] 2007-2008 I became a single father. I had no choice but to force myself to take part time work in a super market as a night filler. Being in extreme pain after every 4-6 hour shift 3 times a week I had no choice but to medicate and deal with the pain to the extent of finishing a shift and having to lay down due to the pain my spine would lock up and I wouldn’t be able to move for 4-6 hours.
But hating being on government payments and needing to do what I had to for my [child] so he could have everything he needed ( those good parents know you will do anything so your children will have what they need even drive yourself into the ground to do it).
and I was called into work for a meeting to tell me my payments have stopped and because I had stirred up an old injury they weren’t taking liability anymore and because I can no longer preform my pre-injury duties and they don’t have any suitable duties for me that met with my clearance medical certificate I was having my permanent part time contract terminated and also my employment.
So after explaining my story to a compensation solicitor supplied by my work union he advised me there’s not much we can do about being terminated but however with your first claim for lump sum your old solicitor should have also claimed for weekly loss of wages. Which I was never informed I could do the first time around.
So he put in a claim for loss of weekly wages and loss of future earnings as well as another lump sum payment. So [around 2012] after seeing 3 specialist the insurance company offered around $12,000 lump sum payout on the condition I drop the claim for loss and weekly payments.
My solicitor said its up to me if I take it, however with just the lump sum the offer should be around $25000 alone. So I decided not to take it and we went to the arbitrator were it dragged on and the insurance company wouldn’t offer any ground and continued to drag proceedings by requesting information and reports they claimed they never had which they did.
So I got to the point where we were at the stage of the face to face final arbitrator hearing and was told by my solicitor that this is it after [that day] it will be over one way or another. It was a great feeling.
But towards the end of the hearing my solicitor tells me the insurance company have now said they are going to claim section 15&16 of the workers comp act which is aggravation to a pre-existing condition (because of the scoliosis). Which was never been brought up prior to this at all in the arbitrator phone conferences.
But due to what the arbitrator called fair process he would have to consider this.
So for our claim to continue we had to hold proceedings and bring in my last employer the super market because the act says that pre-existing aggravation is the last employers problem.
So we have brought in the last employer and had our arbitrator phone hearing with all parties; my specialist report says the super market injury was a aggravation to the first injury from (about 12 -13 years ago). The supermarket specialist says that the supermarket injury was a aggravation to the injury from the first injury and the scoliosis has nothing to do with it.
So I am now waiting till the hearing in [later this year/early next year]; the arbitrator even advised all parties in the phone hearing that I had been put through enough delays and stalling tactics and the hearing will conclude in a decision.
because they will have to pay me weekly wages from [the first injury 12-13 years ago) till now minus of course any earnings or Centrelink disability pension payments.
I was a store manager at the time of the injury [12-13 years ago/time of 1st injury] earning [around] $800 a week, so with inflation that’s about $1800 a week today.
As well as with the new WIRO hearing decision just making the ruling that because I am assessed at being 40% permanently impaired under the disability tables [of year 2002] I am also entitled to future weekly payments without review because I don’t need the 30% WPI rating because I am more than 30% permanently impaired under the old table.
The injured worker who will be facing a Hearing in a few months’ time would like to see if other NSW injured workers are having the same issues or troubles, and says “it would be fantastic to hear any comments that may help me through these very cloudy uncertain days.”
A few pointers from aworkcovervictimsdiary
If you suffer from a pre-existing condition / injury and your pre-existing medical condition has flared up as a result of your duties at work, you may be entitled to workers’ compensation benefits, however the catch in the legislation (all states) is that work must have been a “significant contributing factor” causing the “flare up”. What’s perhaps even worse is that many workcover insurance companies and their so called “independent” doctors will go to great lengths to ensure that there is no “significant contributing factor” at work that caused the exacerbation or aggravation, but that the injured worker suffers solely from “old”, “pre-existing” or “degenerative” injuries, and deny compensation! We posted an article titled “Work injury deemed pre-existing – a shameful story ” which may be of interest to you, and people facing similar issues.
f it can be proven that the underlying condition was substantially aggravated by a work place activity or incident the injured worker should receive workers’ compensation benefits. Even if the arthritis pre-existed the accident and predisposed the worker to a herniated disc or torn ligament, if it can be proven that the work injury aggravated or exacerbated the underlying arthritis and is a substantial contributing cause to the condition and disability it should still – theroretically speaking- be considered compensable.
In reality, however, so called “independent doctors”, insurance companies, case managers and even some judges like to see some sort of change anatomically such as a herniated disc, or torn ligament, etc…and that is where the problem starts – because the injured worker needs to prove that the aggravation/exacerbation (i.e. flare up of arthritis, tendonitis, herniated disc, torn ligament etc) was caused by the worker’s work.
As we wrote in our article titled “The ongoing abuse of Independent Medical Examinations“, The workcover insurer makes the final decision as to the liability of your claim ! Not even the IME nor your treating top specialists in the field of your injury.
You may also be interested to read our article entitled”When work is not “a Significant Contributing Factor” to causing the work injury: a painful story ” even though assuming that the worker suffers from “old age” (degenerative) or a pre-existing condition/injury, workers’ compensation benefits may be available to employees who suffer either exacerbation or aggravation as a result of a work place injury which substantially contribute to the cause of their condition and/or disability.