This is a long winded one, but if anyone of you know me well, then, well you know I can be long winded at times.
Workers comp rules state that to reopen a claim you have to have objective evidence that your previously closed injury has worsened since it was closed. My back injury case was closed in March 2010. I went back to work as a firefighter in mid December 2009. Since that time I've missed a significant amount of work; as I've struggled with chronic back pain, an unfortunate result of a failed surgical procedure.
I had an MRI in February, right before my independent medical exam. After the IME they closed my case. Although my work related case has been closed I've suffered from pretty significant back pain, sufficient enough that I've taken powerful pain meds as needed for pain. I hate taking pain meds, but in many ways it was the only way I could figure to maintain any quality of life, and also go to work. Given how long I have taken them, they have lost their effectiveness. Additionally they cause me to be a real pain to be around. Unlike most, pain meds make me hyper, give me really bad insomnia, and they also make me super irritable. As much as my wife has tried to be loving and patient, the injury and especiallly the meds have really challenged our relationship. The meds also make going to work questionable, given my altered state. After stopping the meds has also been tough, as I try to readjust to the pain and recover from not sleeping in a few days because of my pain med induced insomnia. Hence, I burned up all my sick leave and my SVDs, merits, etc, while dealing with pain and the meds. The bottom line is it has been a struggle, to put it mildly.
In June my family practice doctor referred me to a pain management specialist. That doctor has done a number of procedures, all unsuccessful, to help with my pain. In August I had another MRI done. That MRI looks just like the MRI from February. I have had pain since the closure of my case; it has not gotten worse, it is just bad. My MRI results show no change. Given no change in my status, then the case is not warranted to be opened by Workers comp.
I know this is a long story, but I figured you both were interested, and cared, since you've read this far.
Only two remaining procedures are left to help me deal with the pain. I've stopped taking any pain meds. I refuse to take them. I cannot afford to miss any more work; nor can I allow it to continue to effect my marriage, life, etc. I've been OK, but still in a bunch of pain, since coming off the pain meds, which started in late November, when I went on disability. On 6 December I had a procedure done to help alleviate some of the pain. Basically they led an electrode into my lumbar region that used radio frequencies to destroy the nerves that cause the perception of pain in my back. They are not alleviating or removing the cause of the pain; just stopping my ability to perceive that pain, by destroying the nerves that perceive back pain. The destroyed nerves regenerate in about 12-18 months, so it is something that I'll most likely need to get repeated, if it is successful.
It has about a 20% chance of helping. So far it seems to have helped. We'll see. I come back to work on 16 December. The procedure takes about two weeks for max effectiveness. In the meantime while recovering I have pretty significantly weakened neurological function in my leg (I was given a walker on the 6th, but traded it in for crutches). My leg strength is improving, but it is unreliable, due to trauma around the nerves that control my leg muscles. It should get better. The neuro function is caused by localized inflammation and some temporary damage to the large nerve root that controls the leg muscles, which lies in very close proximity to the nerves that control my back.
I have the procedure repeated on the right side of my back on 6 January. I should be out of work for about a week for that procedure. We'll see. It is based on how quickly I recover from this one.
I am not going to take pain meds any further; period. Long term use of pain meds leads to a permanent hyper sensitization of the body's pain receptors (nioceptors), resulting in diminished effectiveness of pain meds. Additionally I have no desire to be tied to a bottle of addictive medication for minimal relief. Throw in the issues that the meds have caused with my marriage and my ability to work, and it makes no sense to pursue that as a solution. If I am unable to work due to pain than I have decided that I'll leave the fire department, as much as I love this job.
As a caveat to this long winded story; my treatment by my pain management doctor is not being currently paid for.
Because I have not pursued workers comp reopening the claim, based on my very clear understanding of the rules and my status, then they are not taking any responsibility to cover either the cost of my medical treatment or my time off. Regence has also declined payment, stating that it is due to a work related incident. Despite the case being closed, and my explaining to them that it would be moot for me to attempt to reopen the case, they still refuse to pay. After contacting the Washington State insurance commissioner, Regence called me to tell me that if I were to pursue reopening of the case, and then appeal the almost certain denial of the reopening, they might cover the cost of these procedures. I told Regence that based on previous experience that would take nearly a year, and in the mean time I'm left owing my doctor over 10,000 dollars for procedures. They apologized, but in reality I know they could care less.
This previous January I dropped my wife and kids from the Union's health care, and they now have their health care exclusively provided by my military retiree health care coverage, Tricare. Since dropping them I have not had one unpaid medical bill; or have I had to pay one penny more than my monthly member fees; which works out to about 100 dollars a month for me and my entire family. I am covered under this health care plan. Unfortunately, by law my Tricare Insurance has to be secondary to any work provided health insurance. No problem, I'll just drop my Union and work provided insurance. Not a big deal I thought. Besides, it seems that it would be in the Union's best interest; given that Regence has had to pay out so much more for my family, due to my wife having knee surgery last year and her unexpected but very serious complication of a deep vein thrombosis in her leg after the surgery. Her surgery, followed by her DVT resulted in multiple follow on specialist visits, along with two or three ER visits, CAT scans, expensive anti clotting medications, ultrasounds, etc.
I had worked it out so that my military retirement health care (Tricare) would pay for the entire procedure. The only hitch to that was by federal law I cannot use my retirement health care if I have a work provided health care. I had my doctor ask my military health care for approval to conduct the procedures, along with having them submit my medical bills to Tricare. They agreed to both pay the bills and cover the procedure. I then pursued leaving the Union provided health care, assuming that given my current situation, compounded by other issues with Regence (I've paid out over 5000 dollars in the last year with Regence; which should not have occurred given that I have two very comprehensive plans).
Despite my naive assumption that the Union would release me, they in fact have refused to let me go. They state that they cannot let me go, based on federal laws. I have received a letter from the Union's health care attorney and it appears somewhat ambiguous on how I might find a method to leave. That law or regulation, is governed by the Department of Labor, and is titled "Employee Retirement Income Security Act", or ERISA. http://www.dol.gov/dol/topic/health-plans/erisa.htm I'm not an expert on law, especially Labor laws, but I can find nothing in this law that states I cannot leave my Union provide health care. The Union is hiding behind stating it is a federal law. Nope, just a convenient method to justify not letting me go.
The Union states they are only looking out for my best interest, but I find that hard to believe, given that the Union provided health care has cost me so much time and money and refuses to pay for my ongoing pain related treatments. Somehow I think the Union has an underlying motive rather than my best interest. At this point they have not stated any reason they want to keep me on our Union health care, other than " the law won't let you leave, and we think our health care plan is really all you need."
To add insult to injury, they contacted all my providers and have told them that in fact Regence is my provider, and do not send any bills to Tricare. Now I am back to where I have started. No one is paying my pain management procedures. I'm not sure whether my doc will allow the procedure to be done on 6 January. I'm not certain how long it will be before they pursue going through collections for payment of my procedure costs. I am back to having Regence handle all of my medical costs; which most likely will mean I will continue to have problems with payments, and it will continue to cost me money.
Right now I'm in a state of limbo; having an attorney research my options and the likelihood of my ability to leave the Union health care plan, by pursuing an appeal and any legal actions, such as suing the Union, if they deny my appeal request.
What a mess. Most would be happy to have two healthcare plans. I'm not so sure. I guess only time will tell.
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