Insurance Company Battles Student

by Staff

ByJamaal LaFranceStaff Writer

A former university employee said she’s been getting the”run-around” about receiving worker’s compensation benefits after shesaid she was injured in a fall on campus.

Smith, also a graduate student at San Diego State University, hasbeen in court for four years.

Marva Smith, 44, was an administrative assistant inTelecommunications Network Services at San Diego State University.She said she was carrying an empty box from the BusinessAdministration and Mathematics building after work in July 1996 whenshe tripped over a cement ashtray and hurt herself. She said theashtray was propping the door open.

Smith said she injured her hands, left shoulder and right foot inthe fall and needs surgery on her foot. She’s battling with SDSU’scurrent insurance company Ward North America.

But medical reports from doctors contracted by the company saidher injuries were preexisting, and not a result of injury on the job.

Smith said Ward North America initially offered her $5,000, buther lawyer advised her not to take it because the surgery would costnearly $10,000.

Timeline

Under California State University guidelines, all employeesinjured on the job are entitled to worker’s compensation benefits.Cesar Portillo, SDSU’s worker’s compensation manager, would notcomment specifically on the case, but said the university pays forall medical costs in worker’s compensation injuries.

According to SDSU’s Return to Work policy, the injured employeemust report all injuries, no matter how slight, immediately to theirsupervisor. Smith said she did so the Monday after the fall when shebegan feeling pain at work. She said she did not attribute the painto the fall at the time.

Smith said her supervisor told her to go to Student HealthServices. There, she was examined by Dr. Thomas McGrath. McGrath’smedical notes said Smith was suffering from fibromyalgia, a tissuedisorder, and multiple sensitivities that may be related to siliconebreast implants she received a few years prior.

But there was no comment in the reports regarding the injury toSmith’s right ankle. McGrath testified in San Diego Superior Court inOctober 1998 that he told Smith to see an industrial medicineprovider because it was a worker’s compensation injury. He also saidthat he did not recall Smith making any complaint about an ankleinjury.

Smith said she can’t remember if she told McGrath about her footat that time.

Smith said she then went to see a doctor at the Sharp Rees-StealyMedical Group, Inc., an SDSU-contracted medical facility. She saidshe was dissatisfied with the medical treatment she received and wentto see her own doctor. The California Worker’s Compensation Handbooksays an employee has the right to request a change of physician.

Smith said she consulted rheumatologist Dr. Raymond Press in 1998,who told her she had developed fibromyalgia as a result of siliconeimplants and that it may have slowed her recovery from the fall.

A representative in Press’ office said he would not comment on hisdiagnosis because of patient confidentiality.

Insurance agencies make the final determination regarding thebenefits an employee is entitled to. Occasionally, the claimsadministrator may investigate facts surrounding the injury and willdelay benefits, according to SDSU’s Web site.

Difference of opinion

Smith said she then went to see Dr. Drew Peterson, of theUniversity Avenue Orthopedic Medical Group, who said the injuryshould have healed within two weeks. He concluded in his report thatshe does not have symptoms of fibromyalgia, that she should be ableto return to work with no permanent disability and no need forfurther treatment.

She said her disability pay was cut soon after Peterson’s 29-pagereport was considered by Ward North America. Ward’s adjuster refusedto comment and said all worker’s compensation claims areconfidential.

Smith said X-rays were taken about three weeks after the fall atSDSU, and it was determined that her ankle was OK. But because ofconstant swelling, she said she didn’t believe the diagnosis andwanted a second opinion. A bone scan was conducted in April 1999 byDr. Mike Keller, a private practitioner, and it indicatedinflammation in certain areas, suggesting some type of disorder orabnormality.

Keller then wrote an order for an MRI, but Smith said Ward NorthAmerica would not pay for it. Smith had it done anyway at Mission BayHospital, which agreed to perform the MRI on “lean” — meaning thehospital will be paid when the case is settled.

Smith admits that fibromyalgia may be to blame for the slowhealing, but said she still deserves money for surgery on her footbecause she fell at work.

“I just want to get proper medical treatment under state worker’scompensation guidelines,” Smith said.

What now?

Smith is scheduled to see a toxicologist Dec. 20, who she said iswilling to refute Peterson’s findings. After she sees the doctor,another court date will be set and a judge will rule on her case.

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