Legal Question in Workers Comp in New York

my rights

i was injured on the job 5/00 and out of work for 8 weeks with a herniation of my lower back i also complained of left shoulder pain and neck which my doc asked for an mri of both the lower back and shoulder but only the lower back mri was approved by w/c insurine went through p/t for 2 years and had 2 hearings and both times an mri was asked for and denied saying they needed more information on why i needed it. had stopped going to p/t because my back and shoulder felt better. now on 11/03 i hurt my neck and was having pain again in my left shoulder do to work went back to the doctor and finally recievied an mri for my neck and shoulder and was found that i have a large hurniation of the c5-c6 and a slight hurniation of the c4-c5 was refurred to a spinal surgion for a second opiotion and was told that i need a spinal fusion for c5-c6 i will be haveing the surgery on5/12. my question is can i fault the first ins company for not approving the mri my job has a new ins carrier with is covering this even those they stated this should have been handled in 2000 the p/t and surgion say that if i was treated i would'nt be having the problems i have now.do i have a case of neglect from the fist ins company and what are my opitions.


Asked on 4/30/04, 8:15 pm

1 Answer from Attorneys
Andrew Frisch Morgan & Morgan, P.A.

Re: my rights

First, the good news is that the MRI was finally covered. This is more of an insurance issue than something you need be worried about although it could prolong your case.

Technically, the old case (assuming that prima facie evidence was found of your left shoulder in the old case) should be reopened and payments/medical tied to the left shoulder should be divided up between the old carrier (from the first case) and the new carrier (from this case).

I'd say leave well enough alone though for now. The important thing is that you're getting the treatment you need now.

It's not clear from your post whether you believe your neck was injured in both accidents as well, but from the brief facts you have given it does not sound like it was. Your back is not just your back. It is made up of you cervical spine (neck), your thoracic spine (middle), your lumbar spine (low back) and sacral spine (tailbone). It is very possible and from the facts you've given quite likely that you injured solely you low back in the first accident. If that is the case, an MRI of your neck would not have been properly OK'd by the WCB in that case.

If you have any further questions, feel free to call me in the office for a no fee consultation at (718) W-O-R-K-E-R-S.

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Answered on 5/01/04, 8:20 am


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