I have carpal tunnel surgery in both hands. Sedgwick was a nightmare to deal with, as they continued to deny my claim. My employer also continued to try to close my claim. I suffered almost 1.5 yrs- going to therapy, IME exams, numerous doctor visits, etc... At first, Sedgwick allowed everything. They even approved my surgery. I had a date set for surgery, mgmt was informed, etc... and then a short time later, I got notice that it will not be paid for- denied again. Sedgwick sent another denial letter & my employer tried again to close my claim. L & I approved my claim (final & binding) - an order of allowance was in place when I first filed the claim almost a year & a half ago! I feel like I went through all of this & suffered too long. There's a lot I'm leaving out, due to space.
The only real action you can take is to make sure you receive all of the workers' compensation benefits you are entitled to under your claim. These might include the following: 1) additional medical treatment, 2) additional timeloss or loss of earning power benefits, 3) an award for permanent impairment, 4) vocational retraining or a pension.
You should call an attorney to discuss your claim. An attorney will ask you questions about the status of your workers' compensation claim, what formal legal orders have been issued, your employment status, your medical status, and other issues.
If appropriate, an attorney might get a copy of your entire claim file to review it in detail. He or she will then be able to explain what additional benefits you may be entitled to and whether you would benefit from actually having an attorney represent you. This type of consultation and claim review should be done free of charge. Good luck to you.
Grady B. Martin
The Grady B. Martin Law Office
Sedgewick has proven to be very difficult to work with on these claims. Getting a lawyer won't change that... You need to see a lawyer to get a free and complete evaluation. Sounds like you a still working. Keep working if at all possible. It only gets worse if you are off work. The most important consideration is your health. It might be possible to get your surgery done thru your private health insurance, if you have any, and then continue to pursue your case for treatment thru the Board of Industrial Insurance Appeals. Call if you want to talk or want a free evaluation.
The general rule is that an injured worker cannot sue their employer for negligence. However, there are limited exceptions.
A Washington employer must either buy industrial insurance from the state fund or be self-insured. Sedgwick is one of numerous self-insured service companies. In 1989 the Washington Supreme Court held that bad faith claims cannot be filed against workers' compensation service companies.
You can file a request with the Department of Labor and Industries to have your self-insured employer decertified. This is a very complex procedure and requires at least one other injured worker with a grievance against the same employer.
Any Department Order can become final and binding, but only to the decision stated on the order. In your example, the allowance order determines that you suffered an on-the-job problem, for which you are entitled to proper and necessary treatment at the hands of a doctor of your choice. However, that order does not itself establish what treatment is proper and necessary.
Your best choice is to consult with a competent workers' compensation attorney. You do not have to face Sedgwick alone. Attornys charge a contingent fee on benefits secured by our services.
I agree with the other Washington attorney's responses to the L&I issues you raised. Ignore the California guy -- you can't sue Sedgwick for bad faith.
In addition to duties under the Industrial Insurance Act, self-insured employers also have duties under the state and federal laws against discrimination. If you employer fails to accommodate your disability, including providing you an ergonomically correct work station, you may be able to get relief through the discrimination laws. You may want to talk to an employment attorney about that issue.
It sounds as though you have now received all of the treatment that you and your physician feel is necessary (carpal tunnel surgeries). If you feel that you need an ergonomic desk, then you may want to ask your treating physician to write you a prescription for this and request that Sedgwick pay for this equipment pursuant to your carpal tunnel syndrome accepted condition.
I am assuming that you do not have an attorney for the claim who can advise you on the elements of bad faith. The insurance company has a duty to deal with you fairly and not unreasonably deny benefits. They can fight things that are questionable, however when it happens over and over again the pattern and practice can be considered. All that being said bad faith against a carrier is a specialty and many attorneys would probably not be willing to go after Sedgewick, even if bad faith established if there havent been suffiecient damages. Talk to a workers compensation attorney first, and discuss whether a referral to a bad faith attorney makes any sense given the facts of your case
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