What To Do When Workers Comp Says Injury Isn't Work-Related

lucy · 02-15-2006, 04:50 PM

Lets say if WC has paid your medical bills and treatment for 8 months ( This is for Carpal Tunnel) and when the Dr says You need surgery then WC denies it saying it is not work related?
Would they not have already excepted responsiblity with the treatment payments and Dr bills? Why would they pay out this and then say it was not work related. Also if you are denied WC and have surgery anyway does not your private insurance have to pay?
These questions are for co-workers that have carpal tunnel and are having problems with WC. I my self have carpal tunnel and cubital tunnel and I have had no problems so far with WC. I have had one hand done and the other next month.There have been two before me who had the surgery with no problems with WC and another co-worker is off work recieving WC payments with carpal tunnel.Another worker who is now seeking medical attention and I know of another who is having hand pain. All of us have been working for this company for 6 years plus. Thats is 4 who have been excepted and two denied and 2 awaiting.Our company has a private WC company and I can bet their premiums will go up.

I would just think that if they pay your treatment and Dr bills and then turn around and say 8 months later it is now not work related when surgery is needed sounds funny to me.
Any in put ont his would be greatly appricated.Also we are in Indiana.

knowknees · 02-15-2006, 06:07 PM

Do you for one minute think an W/C IC is going to give you 'free' medical treatment? You are either denied or your not? You should of received an acceptance or denial letter from the IC and given a case or load number. A copy of that also, in my case, goes to the state W/C system. Start there. They want you to go to your PIC (Private Insurance Carrier) To my knowledge the W/C system is a State Run Agency, all with their own screwy rules. I think you may be getting a little mixed up. Now rules differ if your ER has fewer than X amount of employees. Different types of trades, also have some really confusing rules. You were being treated for an injury you sustained at work, now its not work related? What kind of work do you do? Where do you live? I will tell you if you go to your PIC for an on the job injury you will be in for a long fight as to who is responsible for the bills. (And in the end it might be YOU.) Might want to post your state and talk with an attorney. Good-Luck.

Greg

anon2600 · 02-15-2006, 06:09 PM

What state are you in?
Also, bear in mind that ALL injuries are different and you can not make comparisions and come out making any kind of sense of this. Different if only because there are different people involved...different ages, llfestyles, just different. And the outcome will be equally different.

pt · 02-15-2006, 07:03 PM

Yes. to all of the above, insights.

The IC brought a Neurologist into my situation when my Doc reported discomfort that I was experiencing involving a wrist - I was DX'd with a case of moderate to severe, Carpal Tunnel.

Unless it can be related to my work-related injuries; or to an incident that occurred involving an IV during the last surgery; I don't know what will come of it.

What I 'do' know'.... is that being 'small-boned' runs in our family - Research tells me that being pre-diposed to Carpal Tunnel is 'not' that un-common amongst folks like me/us.

How this will all pan-out, is anyones guess - Don't underestimate the power of evidenced based, "anything.' In the long-run... it will not serve to help in your 'overall' recovery.

Either in life; or even in WC...No two people are ever alike.

pooh · 02-16-2006, 12:56 AM

Lucy

In some states there is no time limit on acceptence or denial on claim acceptence for WC by the insurance company. This is where the terminology is some state have "timely acceptence" in their laws some states do not have those terms. Some states do states that they have to be accepted or denied in a certain time period - i.e. 90 days. You really need to know your rights under your state laws under this.

After you have been denied, normally the only recourse is getting an attorney and battling it out in WC court. This is a long drawn out process normally. In some states it takes about a year or longer to get a denied claim in front of a WC judge to be heard. You can check your state WC laws, most do state that your health insurance has to cover treatment for WC injuries that have been denied. You will be responsible for any co-pays and deductables - and will need to keep track of anything that you spend. (i.e. keep copies of all that the insurance spends, all that you pay, etc for later court appearences) Again however, I would not advize you going this route without an attorney. An attorney can tell you your full rights. And there will be many things that will be involved - i.e. time off work (TTD reimbursement later on), possible loss of job if off longer than the 12 weeks FLMA, calculations later on for getting health insurance reimbursed and you reimbursed should you win your case, etc etc etc.

I was treated for 18 months prior to denial - so clearly not accepted or denied in a "timely" manner as by state laws. Reason for denial - 1 asthma inhaler used 6 yrs prior to the initial injury. go ahead and laugh - doctors and attorney have been for the past 4 yrs. And I still have no end in sight - meaning I am still fighting. However, my case is quite more complicated than just CTS - i.e. multiple injuries. I kept working and incured more work related injuries because of the initial injury - i.e. repetitive motion injury, cts, and back injury (due to safety violation of line supervisor).