Denied a settlement claim for refusing to take a recommended drug

Hi All-

Question: Has anyone been threatened with a denial for a settlement claim for refusing to take a recommended drug (biologic)?

I was injured at work two years ago with a diagnosis of carpal tunnel, which was diagnosed as RA three months after that. I had always been active and a hard-worker. It's my understanding that it's very difficult to win any compensation with an RA diagnosis to begin with (although I didn't know that I had it at all until the 'blow-out'), but the defense is refusing to compensate due to my not wanting to take a biologic. I'm scared to try a biologic, as those of us with RA are already threatened with cancer and I don't want to add to the threat with a biologic. Am I being unreasonable? Do we not have a say in what treatments we want to pursue? I've been backed into a corner and I don't know what to do. The court date is pending...

Thanks

37 Replies

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  • you have to be approved to go on biological drugs, having tried other quite powerful drugs first.,so I don,t understand this at all.

  • I've seen three rheumy's and all of them suggested that I go on a biologic, after most of the other drugs made me sick. Am managing on sulfasalazine and methylpred, but apparently they think that I could be doing better on a biologic. The defense agrees with them and feels that I am being unreasonable to refuse a biologic.

    I don't understand it, either, as there is a reason why the biologics are saved for last when all else fails.

  • Biologics are saved for last because they're very expensive. Its difficult to reassure you, but I have been on biologics for about 15 years. They monitor you very carefully for unwanted effects. It made my life much more bearable - until a doctor thought that the remission I was in meant I could do without them.

    My mother had RA before the days of biologics and her hands and feet were in a terrible state. This hasnt happened to me (yet). I would read the NRAS literature and see what you think.

  • Interesting...

    Biologics are very expensive, but I always thought that they were saved for last because they are much more toxic. I am glad that you have been helped by using them, but there are so many stories to the contrary.

    Thank you for the reply. I will do some more research!

  • I can't be sure but I've always assumed it was the cost. The one I take is about £10k a go, and I have it every six months. The most toxic I've ever taken has been methotrexate which upset my gut and damaged my liver, but that's just me. And if I could take it again I would for the benefits you get.

    I stopped worrying too much when I realised the damage untreated RA can do.

  • Yes, definitely about the cost - I've seen a number of NHS papers looking at where to put the cut off line for eligibility in order to keep the costs under control, while recognising that many people under the cut off point would actually benefit from them.

  • Sorry to read of your effects, but as someone with non - alcoholic or cancer cirrhosis - as told to me by the specialist last year - I think my liver was toxic because my doctor kept giving me different types of anti-depressants for my TBI after a brain Haemorrage . Just because I kept asking for help with after effects of BI, I wasn't depressed just frustrated. With no support network, the medical profession was the only place i could turn to - and look where that's got me also!

    In fact I have so many things gone wrong, and numerous different infections over last 2 years, another doctor told me last week, (confirming what I'd found out for myself) that I have Thrombocytopenia! A collection of different infections I've had and I am now Autoimmune with a platelet count of only 45 000 instead of between 250 000 - 400 000.

    Increasing Bone deformity is one of he contributory factors to the Thrombo!

    I'm not on treatment except Thyroxine daily and a liquid VIT D3 monthly, also 1 off liquid dose of Antibiotic taken yesterday for a UTI.

    I stopped taking all others because they were also messing with my brain in a different way to the BI? I knew the difference, and the liver carries toxins to the brain via the bloodstream.

    3+ years it's taken me to get this far, as well. I'm convinced if I'd known then what I know now, my platelet count wouldn't be as low!

    I'm waiting for result of a Vitamin B12 blood test, one of the most, if not The Most, essential vitamins our bodies need to maintain a healthy balance, and help the Thyroid, pituatory and Hypothalmus Axis., especially the cerebral cortex. B12 being essential for the whole Endocrine system.

  • are you that much better that you can do without them? pat.

  • meant for Cathie.

  • No. It was a medically induced remission. Coming off methotrexate put me into a long flare and it's still not fully sorted. I changed my rheumy because I wasn't getting good treatment

  • You are right that in the UK biologics are saved for when all else fails, but in other countries they do treat much earlier with biologics. It is primarily about the cost in the UK, and not about either effectiveness or risks. I understand your wariness about cancer risks, but if you look at recent research, the risks aren't nearly as bad as they first thought, and the increased risk (over the risk for the normal population) is very little more than the normal population, and even that is really only for the blood borne cancers (which aren't particularly common anyway) not solid cancers. The highest risk groups are children and adolescents, not adults. Maybe you could ask your rheumatologist to provide you with some up to date information on the risks of biologics (compared to the normal population), and that might ease your mind about taking them.

    As far as your compensation case goes, unfortunately they are going to be able to argue that you should be denied compensation because you have refused to take a recommended medication and I doubt whether you can fight that, especially when your medical records will show not just one but three rheumatologists recommending it. What is your lawyer advising?

  • Hiya Denise. Gosh, what a concern & I'm afraid I have no firm answer. Maybe things are different in the UK to the US anyhow so hopefully a member with expert knowledge of the legal system there will kindly reply.

    The holes I'm going to pick are only my thoughts, I have no written evidence to back them up but if I understand correctly you're saying the CT syndrome was caused by your injury? Could it not have been pre diagnosis RD inflammation causing the CT & it only came to light you had CT when you were being seen for that injury? By that I mean you already had RD but not yet diagnosed & the inflammation of the median nerve & therefore CT was a result of not being diagnosed/medicated at that time?

    Another thing that bothers me, what does you not preferring to go onto a biologic have to do with the case? If you weren't diagnosed at the time you hadn't even started treatment. Not only that, you wouldn't ordinarily have a biologic as your first treatment, you'd be started on DMARDs first. There are quite strict guidelines here to qualify for biologics as they're not cheap, around £10,000 annually here I believe. Even thinking further, could this form part of your defence, that your insurance cover wouldn't stretch to the cost of biologics (only if that would be true of course). Unless I've misunderstood the compensation is for injury caused pre RD diagnosis so you wouldn't be taking any medication at that time never mind a biological.

    Sorry if I've not understood correctly but it doesn't make sense in my addled brain. What I would do anyway is involve your union rep (if you're a member of a union/have unions) plus seek advice from a disability rights website if you have similar to what we have here in the UK or failing that a lawyer well versed or practicing in disability rights. x

  • a lot of damage to me after 35 years of severe r.a. maybe not if more powerful drugs had been available.saying that no one should be forced to take them. as Cathie says you are monitored with blood tests ect.,but that said it is still up to you.pat.

  • Hiya! I'm so glad you responded, and you're absolutely right!!

    It shouldn't matter to them what I'm taking, or not taking now. The point is, the work they had me doing exasperated the RA (which I didn't even know that I had) and caused the blow-out. It may not have reared it's ugly head for another 20 years! You gave me hope, and I thank you!

  • Not sure if this was for me Denise but it does seem nonsensical. Why on earth should it even come into the discussions? Not sure about it may not have raised it's head, couldn't be proven so wouldn't apply but nevertheless still crazy mad. x

  • Yes, it was meant for you. It's been a while... I was feeling defeated, until you posted. I have a lame-ass attorney who works for our union, but who is worthless in that he doesn't anticipate a win with a settlement, so puts very little effort into representing me. All of the doctors I've seen have indicated that the injury exasperated the underlying RA, but because RA is considered to be inherited and/or pre-existing, it will be a battle to prove it work-related.

  • Yes, you've not been round much lately. May be wrong but we assume if there's an absence all is ok, obviously not always the case & I'm sorry you've had this to contend with.

    Well, I'm sorry if the attorney works for the union & doesn't back you what use is he? Whatever his thoughts on the likely outcome it's his job to represent & support you, in other words fight your corner. Do you have written independent evidence from each of the 3 doctors & if so has the attorney had sight of them? If it's a medical claim, which it is either their or yet another doctor's considered opinion should be included as evidence in your favour to add to supporting evidence. x

  • It's hard to comment as I think the biggest difference between UK & US is in things like legal rights.

    Is what they're trying to argue that if you'd take the biologics then you wouldn't have physical problems so no need to claim? Because if so there's no guarantee that they'd work any better than any other drug - so it's a pretty weak argument. There's a lot of research out there that shows that what will work for one person won't work for another, so what you are or aren't taking is not relevant.

    It does really sound as if you need expert advice on this, as I can't imagine how you are going to be able to prove that work triggered the RA rather than anything else? I feel for you, as ending up in court is the kind of stress you need.

    Over here, the general view seems to be that biologics are much more easily tolerated, with fewer side effects and can be extremely effective. So people dream of being offered them, often in vain as there use is very restricted here because of cost. A real example of grass is greener on the other side of the fence!

  • That is what I assume they mean. Also, it is a work comp issue and if I go back to work they won't be as responsible for the injury. It's just my thought.

  • The issue is that you, as a claimant, have to show that you are doing everything you can to minimise the size of your claim ( in other words, you have to mitigate.) Therefore, if there is an accepted and approved course of treatment which you have chosen to refuse, then it can be said that you are not doing everything in your power to minimise your disability. I'm saying this with my legal hat on, not my patient one. You have to weigh up what is in your best interests and if you decide ( after taking advice) that biologics are not in your best interest then you will have to find an " expert" to back you up. Personally, I have found that biologics have made a huge difference to my life with no side effects at all. Clemmie

  • I understand what you are saying. If I at least try a biologic to pacify the defendant, regardless of how I respond or how I feel about it, then I've covered their complaint. On the other hand, it was the work that caused the condition to arise in the first place, and I would rather none of this had happened at all. My attorney isn't prepared to fight and I know that in the end I will be at the mercy of the Judge .

    There is an accredited Dr./acupuncturist/herbalist/teacher in town who is well-known and whom I had a few appointments with. He suggested that I not take biologics and said they're poison, confirming the belief that I had already formed. Unfortunately, I couldn't afford to continue going to him and taking the prescribed herbs. Hmm, maybe I should talk to him...

  • Hi, I understand your reluctance to take any medication, I used to be the same. Unfortunately in the end it's all about relief from symptoms and preventing the destruction of your joints etc. I understand the bio logics are very good though I don't take them, yet. If herbs and alternative treatments worked we'd all be having them believe me.

    Good luck with your claim. Get the attorney earning his money!

  • If they believe biologics may work for you and your insurance covers it long term then why not try it. I was on humira for a while and felt so much better, I had to come off it and things have worsened. At least you can then say you have mitigated the claim. Maybe the case could be put back a few months in order to see if it works. That would make your case more credible.

  • Don't be afraid of going on the medication recommended for you. I was anxious at first but my consultant told me that leaving RA untreated was far more destructive to the body. There are ways of keeping the immune system healthy by good diet and exercise. I have been on Enbrel for ten years and am very well on it. From being virtually bed-ridden I am up on my feet, out with the ramblers [pensioners section so no more that four miles!] and walk, weather permitting, two to three miles a day

    xx

  • My rheumy has told me the same thing. My main thing is that I don't put alot of faith in the drug companies or their lies. There have been so many drugs in the past that were touted as miracles, only later to be recalled due to serious side effects or death. The biologics haven't been around for a long time, they mess with the DNA and they are considered poison by some practitioners, that's why I'm scared. With me, I won't jump off a bridge if someone else does (ha, ha). I will do more recent research and see what I come up with.

    Thank you. xx

  • hi DD,

    If you think you have good logical reason not to go on Biologic (ie Cancer implications) may I suggest you use all and any reliable search resource you Can dig up, both on here from others, who may have suffered on it,

    also look at the pharma's own descriptions of possible side effects, or use .... drugs.com website, find out the exact make and dosage you would be required to take, put in on their page, and take it from there! Also do comparison against existing meds you may take. Once you find the result keep reading everything it says on that page, not just the headline! Especially look at ALL side effects and exactly whT ingredients are used to make the drug - tested usually on animals that cant talk!

    Print off everything you find in your favour, if you are adamant you don't want to take it.

    Remember we are all individuals - no 2 people have the exact same health conditions or treatments, we also all have different (genetic) health history's with our own families through generations.

    So if you say no - give them an undisputable reason, Not to refuse your claim! Good luck - at least the Internet is FREE! GOOD LUCK!

    I'm just an ordinary person, not involved in the medical or science world, other than researching my own health problems. I used it convince my GP to add some things to a blood test - which I had this morning - and I'll be proved right or wrong. But at least

    I know I've tried!

    I believe in good quality research, blood and other testing results, more than I do the GPS's and some Specialists - unless proved wrong of course!

  • Yes thank you. I am doing all I can to back-up my decision, but I find myself wavering with the mitigation issue, to at least try a biologic to pacify the defense. I will figure it out. I hope your tests come back as you wish. xx

  • Thanks DD. Whilst I wouldnt dare go against what Clemmie says, I just want to ask because you said at start of your post "I was injured at work two years ago with a diagnosis of carpal tunnel, which was diagnosed as RA three months after that."

    The issue here I would have thought is what initially caused the Carpal Tunnel? So I just typed CT into my search engine, and it brought up a whole choice of websites I look at, including a UK NHS one, though most are directed at American Websites which I have found very good and useful with their info. I generally will only research HonCode or Trusted sites, but do often go to Wikipedia to start with, as a good source of initial info.

    Most if not all sites do put CP down to an 'existing underlying condition' and you'll need to be honest with yourself here now, because the Defence will almost certainly investigate all the same possibilities and request your health records. Some websites do though also offer an insight into certain types of work that can cause it.

    Given the definition of CP also explains where and why it affects the wrist, the last thing on the list of choices was RSI. Reptitive Strain Injury, which will affect the wrist in the same way. In the UK, RSI was initially linked many years ago, to being a typist, especially once computers replaced typewriters! showing my age aren't I? Of course new Rules & Regs came out many years later,defining suitable heights and types of computers and desks.

    Sorry I do tend to think 'out of the box' all the time, so if you haven't thought of above, just another avenue to explore.

  • Thanks for your reply. I still have CT, but they don't want to operate due to the RA. First I had synovial cysts appear on the backs of both hands, so they put my on 'light duty' work for a week, but the following Monday I ended up doing everything I had been doing plus, and worked an extra two hours. That following morning I woke up with swollen, painful hands and I couldn't move them. That's when I went to the doctor and have been off work ever since.

  • Excuse my language but sounds like you have as***t employer!

    For cysts and warts wherever, I assume you know that Garlic is good with many things. In UK I had 2 separate friends who needed help, so I gave them my Dads old remedy, told to him in a London hospital just after WW2 by a doctor.

    Dads version :- garlic granules, mix with some veg cooking oil, make it a paste, put on affected area, cover with a plaster and leave for long time, you'll have to wear water proof gloves for washing up, washing etc. Change each day by repeat till they have gone.

    I friend had a wart on back of her hand.

    Other, an older man, had a funny purple colour dried but flat warty looking patch on side of his temple. He did same - both disappeared and dried up!

    Me, one night several months ago, I felt a largish boil on inside my mouth cheek, so with index finger in my mouth and thumb outside - I pressed it! It burst, not sore but I then cut a fresh garlic clove in half, squashed it with a heavy knife to release the juices in it, then rubbed it around the inside of my cheek. First it started to turn into a boil again, much smaller, so I just repeated the garlic rubbing, which removed the skin on the boil, and all healed itself. I did this for a couple of days, and fingers crossed, never had it happen again, don't even know why it did appear to start with!

    Whenever you have a skin problem, rub fresh garlic on it! It's when it's cooked with, it doesn't leave the smell on your breath!

    Sorry none of above helps with your claim but I hope you can get somewhere with your local representative, do you belong to a union at work, if so contact them also! S x

  • My family does incorporate garlic on a regular basis. Glad to know someone else also believes in it's healing properties! I will try your dad's remedy when I can.

    Thank you for your wishes.

  • Denise, were you given any specific reason why they'd not operate, other than you having RD I mean? I had Carpal tunnel release at the beginning of 2013 & I was diagnosed with RD in 2008.

  • I don't know how settlement claims work in the UK, as I am Canadian, but I always go to my MLA ( elected politicain for my area ) for help with dealing with claims and such. I am sure the person elected would be able to help you.

    Best wishes

    Sue

  • I'm in the US (Wisconsin). I will look into that. Thanks!

  • Please do ddahl. This is why we elect them, as they are there to help us :) or we wont vote for them again.. lol. Goodluck!!

    take care

    Sue

  • That's awful. I do take a biologic, but that seems like a personal decision to me. I would not have liked to be coerced into it.

  • I know what you mean, and I'll be fighting it.

    What biologic are you on and for how long?

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