CHARLESTON, W.Va. -- In 1990, Carla Strahl fell down trying to lift a patient up to her bed in a Wheeling nursing home.
Jerry Stover once was West Virginia's Teacher of the Year, but fell and injured himself in Clay County High School in 1999.
Both got workers' compensation benefits for their injuries. Both received medical treatment from the Workers' Compensation Fund.
But now, Memphis-based Sedgwick Claims Management Services has taken those benefits away.
The company recently repossessed Strahl's wheelchair, and is refusing to provide physical therapy or pain medication for Stover.
Today, Sedgwick is re-evaluating "Old Fund" benefits paid to West Virginians hurt on the job before July 1, 2005. That is the date Gov. Joe Manchin and the Legislature decided to begin creating a privatized workers' compensation system.
Strahl and Stover are just two of hundreds of injured workers whose benefits are being challenged.
BrickStreet Mutual Insurance handled "Old Fund" claims at first. Cambridge Integrated Services Group became the first private company to handle those claims, beginning in December 2006.
Then Sedgwick won its bid for a new contract and began administering Old Fund claims in December 2007.
Gregory Burton, BrickStreet president, says the Old Fund claims are out of his hands.
"We don't have any involvement anymore. I have heard they are handling medical claims more aggressively," Burton said.
Wheelchair repossessed
"I was a nurse at Peterson Hospital," Strahl remembers. "One day, when I was transferring a patient from her chair up to her bed, she got combative. I fell down.
"She was an old patient and would get combative at times. The poor soul is gone now," Strahl said.
Strahl got hurt on July 19, 1990, when she was 40. Today, she still has great difficulty walking and standing. Her back injuries also created circulation problems in her legs.
Strahl received workers' compensation benefits and medicines for more than 18 years. But in January, Sedgwick began taking those benefits away.
Strahl has used wheelchairs since she was hurt. But on Jan. 30, a truck arrived at her house to repossess her wheelchair. They left a receipt behind on her porch, confirming they took it away.
Prasadaras B. Mukkamala is a Charleston physician Sedgwick hired to examine medical records of Old Fund beneficiaries.
In his report about Strahl, Mukkamala stated she "does not require any further treatment whatsoever with relation to the compensable injury ... other than a home exercise program."
James L. Comerci, Strahl's physician in Wheeling, disagreed, challenging that evaluation in a Jan. 5 letter.
"It appears [Mukkamala] has done an evaluation of this patient based on records with no physical evaluation of this patient," Comerci said.
He writes that Stahl "continues to have significant contractures of the lower extremities and footdrop from her compensable injury.... It has also been determined that her knee pain and thrombosis was a direct result of complications of her compensable injury."
Mukkalama admits he would rather make a recommendation based on a patient visit.
"From a professional point of view, I would prefer to examine the patients. I would have the first-hand knowledge of how the patient is doing," Mukkalama said.
"I have all the records related to her treatment. It is a common practice to look at the records and make an evaluation. If we examined her, we would be in a better position.
"But claims administrators often prefer physicians to make recommendations based on the record," Mukkalama said.
Sedgwick spokesman Frank Huffman declined to comment for this story.
"We work on behalf of the state of West Virginia. We do not respond to questions about individual claims," Huffman said.
Strahl is appealing Sedgwick's ruling to the Worker's Compensation Office of Judges.
CHARLESTON, W.Va. -- In 1990, Carla Strahl fell down trying to lift a patient up to her bed in a Wheeling nursing home.
Jerry Stover once was West Virginia's Teacher of the Year, but fell and injured himself in Clay County High School in 1999.
Both got workers' compensation benefits for their injuries. Both received medical treatment from the Workers' Compensation Fund.
But now, Memphis-based Sedgwick Claims Management Services has taken those benefits away.
The company recently repossessed Strahl's wheelchair, and is refusing to provide physical therapy or pain medication for Stover.
Today, Sedgwick is re-evaluating "Old Fund" benefits paid to West Virginians hurt on the job before July 1, 2005. That is the date Gov. Joe Manchin and the Legislature decided to begin creating a privatized workers' compensation system.
Strahl and Stover are just two of hundreds of injured workers whose benefits are being challenged.
BrickStreet Mutual Insurance handled "Old Fund" claims at first. Cambridge Integrated Services Group became the first private company to handle those claims, beginning in December 2006.
Then Sedgwick won its bid for a new contract and began administering Old Fund claims in December 2007.
Gregory Burton, BrickStreet president, says the Old Fund claims are out of his hands.
"We don't have any involvement anymore. I have heard they are handling medical claims more aggressively," Burton said.
Wheelchair repossessed
"I was a nurse at Peterson Hospital," Strahl remembers. "One day, when I was transferring a patient from her chair up to her bed, she got combative. I fell down.
"She was an old patient and would get combative at times. The poor soul is gone now," Strahl said.
Strahl got hurt on July 19, 1990, when she was 40. Today, she still has great difficulty walking and standing. Her back injuries also created circulation problems in her legs.
Strahl received workers' compensation benefits and medicines for more than 18 years. But in January, Sedgwick began taking those benefits away.
Strahl has used wheelchairs since she was hurt. But on Jan. 30, a truck arrived at her house to repossess her wheelchair. They left a receipt behind on her porch, confirming they took it away.
Prasadaras B. Mukkamala is a Charleston physician Sedgwick hired to examine medical records of Old Fund beneficiaries.
In his report about Strahl, Mukkamala stated she "does not require any further treatment whatsoever with relation to the compensable injury ... other than a home exercise program."
James L. Comerci, Strahl's physician in Wheeling, disagreed, challenging that evaluation in a Jan. 5 letter.
"It appears [Mukkamala] has done an evaluation of this patient based on records with no physical evaluation of this patient," Comerci said.
He writes that Stahl "continues to have significant contractures of the lower extremities and footdrop from her compensable injury.... It has also been determined that her knee pain and thrombosis was a direct result of complications of her compensable injury."
Mukkalama admits he would rather make a recommendation based on a patient visit.
"From a professional point of view, I would prefer to examine the patients. I would have the first-hand knowledge of how the patient is doing," Mukkalama said.
"I have all the records related to her treatment. It is a common practice to look at the records and make an evaluation. If we examined her, we would be in a better position.
"But claims administrators often prefer physicians to make recommendations based on the record," Mukkalama said.
Sedgwick spokesman Frank Huffman declined to comment for this story.
"We work on behalf of the state of West Virginia. We do not respond to questions about individual claims," Huffman said.
Strahl is appealing Sedgwick's ruling to the Worker's Compensation Office of Judges.
Sue Howard, Strahl's lawyer in Wheeling, said, "She was fundamentally confined to a wheelchair because of her injury. Over time, it has gotten worse. The occupational injury has ruined her family's life.
"Patients bedridden for several weeks tend to form clots," Howard added. "It is important that Strahl continues to have Coumadin to thin her blood and have regular lab tests to see she is getting the proper dosages."
Sedgwick is refusing to pay for Strahl's pain medicine and muscle relaxants.
In 1991, Strahl spent three weeks in the hospital after getting hurt.
"I was pretty much bedridden. And a massive blood clot in my right leg hurt my whole leg. The clot was related to my back injury," Strahl said.
"I have no idea where to get another wheelchair. I will probably have to get a loan for it," she said.
"I never had any trouble when it was workers' comp. Then it changed to Sedgwick. That is when everything started."
Howard said, "Sedgwick and BrickStreet have become a nightmare."
Always in pain
Jerry Stover was an inspirational art teacher whose students said they wanted to take his classes twice.
He was named West Virginia Teacher of the Year in 1994. West Virginia Public Television profiled him and aired it statewide.
Five years later, on Feb. 16, 1999, he fell and was injured at work at Clay County High School.
Bobby Green, an Oak Hill chiropractor, said Stover suffered injuries to his lower back, his right shoulder and right leg as the result of his fall.
"The patient's condition is now permanent and chronic and will most likely cause him pain and dysfunction for the remainder of his life," Green wrote in a March 16, 2007 letter.
Larry Gillespie, Clay County Schools superintendent, called Stover "one of the most respected and upstanding employees in our entire system," in an Aug. 22, 2008 letter to BrickStreet.
Stover's injuries, Gillespie added, "will most likely cause him pain and dysfunction for the remainder of his life."
Sedgwick is actively opposing any further treatment or medications.
On April 28, Stover appeared before the Board of Review in Charleston, asking them to restore his benefits. A ruling is likely in the hear future.
During his hearing, Stover said, "I am in pain all the time. The only way I can get relief is through therapy."
Assistant Attorney General Anna L. Faulkner, representing the Clay County Board of Education and Insurance Commissioner Jane Cline, seemed sympathetic to Stover's challenge to Sedgwick.
"There should be a solution other than litigation," Faulkner said. "We will see what we can figure out. We should take this out of litigation."
Barbara Schamberger, Stover's lawyer, said, "Worker's comp trades your right to sue your employer in exchange for getting benefits.
"You get less money, but you don't have to sue. Maybe we should go back to a system where everybody is allowed to sue," said Shamberger, West Virginia's Secretary for Education and the Arts under Gov. Gaston Caperton.
"He just wants his medical treatment. The board has a lot of cases before them. I found them to be reasonable and very sincere.
"But why do we have to go all the way to a hearing just get this man's treatments for his back? We are not asking for money."
Denying disability benefits, Shamberger believes, is a way to discourage people.
"And in this case, our employer stands with us. This is a legitimate injury that happened to a person working for a school system."
Shamberger said the vast majority of disability claims filed with Social Security, BrickStreet or Workers' Compensation are initially rejected.
"Routinely turning down workers who get injured is a very effective way to cut benefits. A lot of people just give up."
Reach Paul J. Nyden at pjny...@wvgazette.com or 304-348-5164.
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I agree with you, but now the old WC claims (and Melinda Kiss probably) are under the Insurance Commission - Brickstreet, of course the CEO - Atty's, etc. probably make 100 thou a year !!!. The beautiful building have now - all that paid from Employer premiums when they invest and make millions. Supposedly all EMPLOYERS have to have a type of WC insurance on their employees - and yes it was first started to protect the EMPLOYERS from being sued which Attorneys of course got millions then also. Now most attys will only represent huge companies - claimant attys - turned scapecoat and cowl down to Bricksteeet - going where the money is NOT WHERE THE NEED IS. Small employers like yourself and truly injured workers will suffer most in the fiasco of privatizing WC..