Koyaanisqatsi

A lot of people who know me but aren’t in my immediate circle of friends have only gotten snippets of information about what happened to me in October and the ensuing trouble with my employer’s insurance company. I decided to write this to clarify exactly what has happened so that if you read or hear anything about it in the future on my Facebook or elsewhere, you’ll have a frame of reference. For the sake of simplicity, throughout this article I will be referring to my employer’s risk management supervisor as simply “my employer” because his function is (or was) to be the go-between for me and the company. Everything in this story is exactly how it happened, without exaggeration.



I: Status Post Injury

On October 15th, 2010, near the end of my shift as an EMT for a private ambulance company, I transported a patient from a nursing facility to a hospital. After lifting the patient from our stretcher to an ER bed, I began to experience a very harsh pain in my lower back. Figuring I simply pulled a muscle, I tried to walk it off, take some ibuprofen (which I kept with me for headaches) and get on with my work.
My partner was driving our rig to the gas station while I finished my report on the patient’s care. The pain in my back began to worsen, spreading down both of my legs. I felt flush and began to sweat. I called the office and informed them of what had just happened. If I have been seriously hurt, I figured, it is best to inform them immediately. My partner was given instruction to take me to a local ER for treatment.
In the emergency room, I was placed in a wheelchair and taken to a room for examination. By this time, I was unable to stand or walk under my own power. My employer sent one of my co-workers to the hospital to stay with me for the course of my treatment there. Not out of concern for my well-being, mind you, but to ensure that I submitted to a urinalysis drug/alcohol test. My treating doctor was flabbergasted as to why they would want this, as I had not been involved in a motor vehicle accident with one of the company’s trucks, but had rather hurt myself lifting a patient. The doctor would not perform the drug test on my co-worker’s say-so, and had my employer called the ER and explain to him why they wanted it. As I do not use drugs and do not drink on the job, I had no problem submitting to the test, although I did agree with the doctor’s view that it was inappropriate of my employer to order this, for reasons already stated.

The doctor ordered an X-ray and the urinalysis. After both were performed, he came back with the results which did not show anything abnormal, so he gave me some pain killers, some muscle relaxants and told me that it was probably just a severe muscle strain. I was ordered to follow up with my work doctor and sent home. I informed my employer of this via e-mail. My employer responded with my appointment date and time with the work doctor.

Three days later, 10/18/10, was my first appointment with the work doctor, Richard Koff M.D. He did not examine me himself. rather, a student doctor took my history and examined me, then Koff came in and gave me a doorway diagnosis of muscle strain. He prescribed some more muscle relaxants (as the ones I got from the hospital made me too tired) and sent me on my way. I was to follow up with him a few days later. I informed my employer of this via e-mail.

A few days later, (10/22/10 to be exact), I had my follow up appointment with Dr. Koff. He asked me if I was feeling any better. I told him that I was not, and in fact that I felt even worse than I had a few days earlier. He told me that this would pass, and that he was sending me back to work the next week- light-duty for three days and then a return to full duty. I said to him, “If next week I still can’t get around without this pain, will you order an MRI then?” He said yes.

Once again, I informed my employer of the doctor’s orders via e-mail and got no response. I was not offered light duty, or any work at all. I was not acknowledged by my employer whatsoever.

The next week, I had experienced no improvement in my condition, so I went back to see Dr. Koff again on 10/28/10. I explained that I still could not get around without severe pain and that I wanted something done. Again I requested that he order an MRI so we could find out what the problem was. This time, he refused to order an MRI, stating that his reason was because they might not get paid for performing it if they don’t find anything. By this point, I came right out and said, “I don’t give a shit who gets paid for what. I want to know why I’m constantly in agonizing pain.” Again he refused to order the MRI that he told me last week he would order, and instead referred me to an orthopedic surgeon, Dr. Anthony Salem. (What he thought an orthopedic surgeon would do with no MRI is beyond me.) Dr. Koff rushed me out of his office and back to the reception area where he told the girls to get me an appointment with Dr. Salem. The receptionists attempted to get me the appointment, but were unable to for two reasons:

1.) Dr. Salem refused to see me without a referral from my primary doctor (who was not involved in this case at all.)

2.) The receptionists were unable to provide Dr. Salem’s office with the information they wanted because somehow in the six days since my last visit there, they managed to LOSE my fucking FILE in an office the size of a coat closet.

I was sent home with no follow-up appointment, no pain killers, no instructions and no idea what to do next. I called my claims adjuster at my employer’s insurance company and told her what was going on. She said that I couldn’t see Dr. Salem anyway, because she didn’t know if he was on the panel of “approved” doctors that I could see. She said she would find out whether he was or not and that either she or my employer would call me back with that information.

After a week, I had not heard from either of them, so I started calling her back. After a week of phone calls, I got my nurse case manager on the phone and she gave me my adjuster’s e-mail address. Once I e-mailed my adjuster, she responded fairly quickly and told me that she requested my medical information from Dr. Koff’s office two weeks ago and had still not received it. She proceeded to tell me to go ahead and call Dr. Salem’s office up and make the appointment anyway, because she hadn’t found out if he was a panel doctor or not, but I needed to continue treatment regardless. She also told me to fax her any medical bills pertaining to my treatment so she could forward them to the billing department and get them paid. I followed her instructions to the letter. As of today, 3/2/11, the X-ray I got on 10/15/10 has still not been paid for.



II: Salem Trials

Per my adjuster’s instructions, I called Dr. Salem’s office and left them a voice mail stating that I would like to set up an appointment.

On 11/15/10, after three weeks of ignoring me, my employer decided to call me back- not regarding my care, of course- but because he needed me to be deposed downtown for a completely unrelated case. The next day, I went downtown, spent my own money on parking (for which my employer only partially reimbursed me) and was deposed for the aforementioned case. Now face to face with me, my employer could no longer pretend I didn’t exist, so I demanded that something be done about my treatment. He assured me that he would get me the appointment with Dr. Salem. The next day, I received a phone call from Dr. Koff’s receptionist telling me that my employer got me an appointment. I replied, “with Dr. Salem?”

“No,” she said, sounding confused. “With Dr. Koff.”

So the next day, (11/18/10), there I am back in Dr. Koff’s office. He came in to the room and said “What are you doing here? I sent you to Dr. Salem.” I explained the whole story to him. He said, “OK, excuse me for a minute.” He left me alone in the examination room for about fifteen minutes. Finally, he reappeared and informed me that he just made me an appointment with Dr. Salem for that very day and that I could go right over. Dr. Koff further stated that he also spoke to my employer and that my employer would take care of getting Dr. Salem put on the panel, so that would no longer be an issue.

Back out in the reception area, I was getting ready to head over to Dr. Salem’s office when Dr. Koff’s receptionist stopped me. She told me that I shouldn’t go right over to see him, but rather that I should first go home and wait for a call back from them notifying me that he had been put on the panel and that I could see him. The reason for this, she explained, is that they would hate to have me drive all the way over to see him and be told that he won’t see me until he’s on the panel.
I asked her, “Are you sure about this? Does Dr. Koff know that this is what’s happening, because this is pretty much how my last appointment here ended.” She assured me that Dr. Koff knew exactly what was going on and told me to go ahead home and wait for the call.

I received no call back that day. The next morning, a Friday, I called Dr. Koff’s office and asked the receptionist if it was taken care of yet. She said that they had not received a call yet.

The following week, having received no call back, I started ringing my nurse case manager, because she told me to call her about any problems with my treatment. She said that she could do nothing about getting Dr. Salem put on the panel, but that she finally received the medical records from Dr. Koff. She said that Dr. Koff “forgot” to address the status of my ability to work in his notes. Since my ability to work (or lack thereof) is at the very heart of the matter, she contacted his office and they faxed her a note from Dr. Koff stating that I was “out of work until seen by an orthopedist.”

After this, no one responded to any of my calls or e-mails until the following week because of the Thanksgiving holiday. The day after Thanksgiving, (11/26/10) I received a letter from the insurance company dated 10/27/10, which stated that they have received notification of my injury and listed the names of my nurse case manager and adjuster. Gee, thanks.



III: Lost Contacts

On 12/1/10, just after 10:30am, I received a voice mail from another adjuster at my employer’s insurance company, who said that he would be taking over my case from my former adjuster and to call him because he had some questions, but to call back before noon, because he would be leaving early that day. I got the message and called back around 10:45am. I got his voice mail, so I left him a message. After eleven, I tried him a few more times, every fifteen minutes or so, in an attempt to catch him before noon as he requested. Around noon, I made my last call and I decided to go ahead and leave a second message, saying that I tried to get him but we missed each other and that we would talk later.

Since I couldn’t get my new adjuster on the phone, I decided to call my employer and see what the hell was going on with Dr. Salem. I asked my employer, “What’s the story? Is he on the panel, yet? Can I go see him now?” After a long pause, my employer said, “Uh... I was under the impression that you were cleared to go back to work.”
“Since when?” I asked. “Who said I was cleared for work? Last week, Dr. Koff told me that you were getting Salem put on the panel so I could go see him! What changed since then?”

“Uh... Gimme a couple hours and I’ll call you back,” my employer said, and hung up. I never heard from him again.

I fired off an e-mail to my nurse case manager telling her about all of this. She wrote back that “all adjusters are busy,” and to “just call once a day.” I wrote back to her once more, asking for my new adjuster’s e-mail address, since my old adjuster was easier to reach in that manner. She never responded to that e-mail. I never heard from her again.

Two days later, my new adjuster returned my calls. Right off the bat, this JERK-OFF tried to reprimand me for “tying up” his voice mail box with all two of my messages. I told him that I was only trying to catch him before he left the office at noon as he requested, so he changed the subject and started badgering me about my medical history and saying shit like, “You’d better be completely honest about everything! We’re gonna find out if you’re lying about anything!” Just RANTING like fucking maniac. Hostile language. Confrontational tone of voice. Totally uncalled-for, jerk-off behavior. He asked me when I was born. I told him. He replied, “You’re telling me that you’re 27 years old and you’ve NEVER been treated for a back injury before now?”

“Yeah, that’s about the size of it,” I told him. “If it’ll make you feel better, I’m sure my primary doctor has the medical records to prove it.”

He asked me if I’d ever received worker’s compensation before. I began to say no, but then I remembered that had been out on worker’s compensation for a short two or three week span several years ago when I was diagnosed with cervical strain (whiplash) after an incident at another job. He said, “OH! You remember THAT now?!” I laughed in disbelief. I couldn’t believe how fucking crazy this guy was. Well, that just set him off.

He started hollering at me and asking me what I found so funny, like he was fucking Pesci in Goodfellas. I told him that nothing about this was funny and that I was laughing out of sheer frustration and exhaustion. I told him that I was laughing in disbelief at the entire situation, because I had been in severe pain for almost two months with no relief and that I was extremely anxious. This finally calmed the sociopath down and he started talking like a normal human being. I quickly found a way to end the conversation got off the phone.

At this point, I have been in agonizing pain for over a month and-a-half, I have been out of work for the same amount of time, and I have not received a cent in compensation. Now my employer is having imaginary conversations with a doctor who won’t treat me and I’m getting yelled at by some fucking asshole insurance adjuster in Florida who’s probably taking his frustration out on me because of his severely inadequate genitalia.

Time to get a lawyer.



IV: Real Treatment

In hindsight, I can see now that I should have consulted with a lawyer much earlier, but I had never been in a situation like this before and thought I was doing the right thing by seeing the work doctor and just following orders.

In mid-December, I hired a lawyer who specializes in worker’s compensation cases and he let me in on a few secrets. For starters, I could go see any goddamn doctor I wanted to. Goodbye Dr. Koff! Second of all, I was under no obligation whatsoever to talk to my jerk-off adjuster, ever. That’s two problems gone. Things were already looking up.
I was already planning to change my primary doctor to my girlfriend’s, because she recommended him and his office very highly. My primary used to be the same woman my parents saw, but I didn’t care much for the way she worked, so I made the change and set up an appointment with my new primary. I couldn’t get an appointment with him until after the holidays, but that wasn’t really surprising, so I settled for my mid-January appointment. Meanwhile, my lawyer filed a claim petition (an official request for the insurance company to pay me what it owes me) and a penalty petition (which is a petition for them to pay interest penalties since they were supposed to send me lost-time wages a good long time ago.)

My new doctor examined me, ordered an MRI (Callooh Callay!) and scheduled me for some physical therapy. I got right over to the hospital that week and got my MRI done. The following weeks, I began physical therapy, which was extremely painful and difficult, but I expected that. Meanwhile, my lawyer informed me that the insurance company was now trying to dispute my disability. They’re not disputing the fact that I am injured- just that I am unable to work. Right.

Now I haven’t been paid in over four months, I can’t afford food, rent, my car payment or anything else, and now I find out that this case is going to litigation, which means it will definitely be several MORE months before I see the money these pricks owe me. I asked my lawyer if there is anything I could do as far as income. He told me that there are no easy answers for this, because there is no safety net in the system for someone in my position, but that I could do any light-duty work that my doctor approved.

My follow-up doctor’s appointment had to be canceled because it was the day of a very large snowstorm, so I went back to see him about two weeks after we had planned, on 2/22/11. He had not received the results from the MRI for some reason, so he got the hospital on the phone and had them fax the report right over. He came back into the room and told me that I had three herniated discs. He ordered me to stop physical therapy immediately and told me that I am to perform absolutely NO physical labor of any kind. No stretching, bending, pushing, pulling, lifting. Nothing. He referred me to a neurosurgeon, who would decide the next medical course of action.


Now my situation is this:

A.) I am under medical orders not to do any work. This means that I can not get a light-duty job. This means no income.

B.) The insurance company that is SUPPOSED to be supporting me while I’m disabled is trying their damnedest not to do their job. This means no income.

C.) I am fucked.


I asked my lawyer if I could apply for SSI disability, since I am medically unable to work. He said that I could and should do whatever I must to survive until this case is settled, (short, I assume, of armed robbery) so I went online and filed for disability and SNAP, which is what they’re calling food stamps this month. Last week, I received a letter from my employer stating that they are cutting off my main health insurance, since I am not working and therefore not paying toward the premium. As a result of this, I also filed for Medicare. The welfare office mailed me a form to have my doctor fill out, stating that I am medically unable to work and therefore a potential candidate for disability. When I took it to him to fill out, he also referred me to another doctor so I could get an EMG prior to my visit to the surgeon. That way the surgeon will know where nerves are being compressed and will therefore be able to make a more informed decision on my treatment.

That brings us up to today. Next week is my EMG, followed by a visit to the neurosurgeon to see if he wants to stick needles in my back or just slice it open and rearrange shit. Lovely. On top of this, my employer’s insurance company now wants me to go see their surgeon, whose job it is to find a way to disagree with my doctor’s diagnosis.

In the meantime, I have to hope that I am approved for disability, because if I am not, I will be homeless by the end of the month.