Illinois Worker's Compensation - Help For Injured Illinois Workers

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  1. #11
    Join Date
    Jul 2009
    Posts
    8

    Exclamation Re: What Do U Do

    Quote Quoting BeachGirl View Post
    Unless you are in a remote area there should be other qualified Drs that can help you. I'd pick another, even if not as well known, that I knew wanted to operate on me without fearing lack of payment.

    It isn't odd that this Dr doesn't want to do the surgery. Most people want to be assured they will be paid in a timely manner before they render their services.

    Was the claim denied? If it was you go to another Dr and don't mention WC, and put it through your PI, and the same thing won't happen. If it hasn't been denied your attorney needs to get off his/her duff and get in front of an arbitrator and get your surgery approved.

    You've been given sound advice here and from your attorney. Follow the advice, get your surgery done and worry about everything else later.

    beachgirl



    Then there's more to your story then you are revealing. Unless you give the folks on this forum all the facts no one can help you more than they already have.

    beachgirl
    I have given you all the facts! Perhaps if you would read what I have written you wouldn't be so quick to judge. I have never been thru this legal stuff before and I have told you what is going on, without giving my name, etc, which by the way, I thought this site would help to answer my questions, its only more confusing when you ask a question and then get told you are not telling everything, I think I know what I am going thru I just dont understand all the legal stuff and the runaround. If you want to know more then ask!

  2. #12
    Join Date
    Aug 2007
    Posts
    504

    Default Re: What Do U Do

    Quote Quoting tryn2cope View Post
    I have given you all the facts! Perhaps if you would read what I have written you wouldn't be so quick to judge. I have never been thru this legal stuff before and I have told you what is going on, without giving my name, etc, which by the way, I thought this site would help to answer my questions, its only more confusing when you ask a question and then get told you are not telling everything, I think I know what I am going thru I just dont understand all the legal stuff and the runaround. If you want to know more then ask!
    I have read everything you have written and offered the same advise your attorney has given you regarding getting the surgery you need.

    When you brought up the subrogation letter it appeared that there is another dimension to your case you failed to mention. Subrogation is common when there is a third party suit involved. Is there a third party involved in your case?

    If there is subrogation being dealt with then I would think there would be an accepted claim, yet denial of surgery points to an unaccepted claim. I have asked you at least once if your claim has been accepted and you have not answered the question.

    Here's what you posted about your claim:

    You have a shoulder injury that needs surgery.
    Your surgery has been denied.
    You are not getting any TTD.
    Your DR will not proceed with surgery using your PI.
    You have some sort of medical card.
    You have an attorney that has scheduled trials 3 times and none of them have happened.
    You received a subrogation letter.
    You think you are being given the runaround.

    You are no less frustrated than those of us trying to help you with such limited information. And no one is asking you your name.

    BTW the vast majority of the poster here had zero experience with WC before they were injured themselves, just like you. Most of us did research and worked shoulder to shoulder with our attorneys to get the knowlesge we now have. Those of us that stick around after our claims are settled do so because we want to help others. Some times it is necessary to ask more questions to be able to give support. Don't be offended by questions asked of you.

    beachgirl

  3. #13
    Join Date
    Jul 2009
    Posts
    8

    Exclamation Re: What Do U Do

    Quote Quoting BeachGirl View Post
    I have read everything you have written and offered the same advise your attorney has given you regarding getting the surgery you need.

    When you brought up the subrogation letter it appeared that there is another dimension to your case you failed to mention. Subrogation is common when there is a third party suit involved. Is there a third party involved in your case?

    If there is subrogation being dealt with then I would think there would be an accepted claim, yet denial of surgery points to an unaccepted claim. I have asked you at least once if your claim has been accepted and you have not answered the question.

    Here's what you posted about your claim:

    You have a shoulder injury that needs surgery.
    Your surgery has been denied.
    You are not getting any TTD.
    Your DR will not proceed with surgery using your PI.
    You have some sort of medical card.
    You have an attorney that has scheduled trials 3 times and none of them have happened.
    You received a subrogation letter.
    You think you are being given the runaround.

    You are no less frustrated than those of us trying to help you with such limited information. And no one is asking you your name.

    BTW the vast majority of the poster here had zero experience with WC before they were injured themselves, just like you. Most of us did research and worked shoulder to shoulder with our attorneys to get the knowlesge we now have. Those of us that stick around after our claims are settled do so because we want to help others. Some times it is necessary to ask more questions to be able to give support. Don't be offended by questions asked of you.

    beachgirl
    First of all I said the workmans comp was denied, I have a medical card thru the state of Illinois, and my employer, if there is a third party involved I'd like to know who it is as this is all thats involved with the case. I was denied workmans comp therefore am taking it to court to resolve the medical issues and to get the medical bills paid, and to get the surgery done that needs to be done to get me back to work. why should the state have to pay for medical bills when its a work related injury so perhaps this is what they feel too! I dont know, yes I am offended, I have been very honest and upfront in simple details and when I ask a question of what something means I normally would get a response not an accusation. I have never been thru this before so pardon my ignorance!

  4. #14
    Join Date
    Aug 2007
    Posts
    504

    Default Re: What Do U Do

    Quote Quoting tryn2cope View Post
    First of all I said the workmans comp was denied, I have a medical card thru the state of Illinois, and my employer, if there is a third party involved I'd like to know who it is as this is all thats involved with the case. I was denied workmans comp therefore am taking it to court to resolve the medical issues and to get the medical bills paid, and to get the surgery done that needs to be done to get me back to work. why should the state have to pay for medical bills when its a work related injury so perhaps this is what they feel too! I dont know, yes I am offended, I have been very honest and upfront in simple details and when I ask a question of what something means I normally would get a response not an accusation. I have never been thru this before so pardon my ignorance!
    Ok your claim has been denied. You need to call your attorney and ask why you received the subrogation letter. Subrogation is used when an IC is trying to lay claim on potential settlement from another policy, ie a third party lawsuit. IOW if you were driving a taxi and another car crashed into you while on duty the IC for your employer would want to be reimbursed for what the claim cost them in medical, etc. from the settlement from the IC of the driver that crashed into you. If there is no third party claim involved I have no idea why this letter was sent to you.

    Is the medical card, medicade? If it is that may be why the Dr is saying no to the surgery. Many Drs will only take a certain number of medicade patients. If it is a regular PI through your employer than my original answer to why the Dr won't do the surgery stands as is.

    What reason have you been given as to why your claim was denied, are they claiming pre exisiting, or ??? Does your attorney feel you have a chance to get it accepted? Has s/he filed for a 19b hearing yet? Just so you know even after a 19b hearing takes place it can be up to 180 days until you receive an answer.

    And again don't be offended. Questions are a necessary part of support on forums like this.

    beachgirl

  5. #15
    Join Date
    Jul 2009
    Posts
    8

    Smile Re: What Do U Do

    Quote Quoting BeachGirl View Post
    Ok your claim has been denied. You need to call your attorney and ask why you received the subrogation letter. Subrogation is used when an IC is trying to lay claim on potential settlement from another policy, ie a third party lawsuit. IOW if you were driving a taxi and another car crashed into you while on duty the IC for your employer would want to be reimbursed for what the claim cost them in medical, etc. from the settlement from the IC of the driver that crashed into you. If there is no third party claim involved I have no idea why this letter was sent to you.

    Is the medical card, medicade? If it is that may be why the Dr is saying no to the surgery. Many Drs will only take a certain number of medicade patients. If it is a regular PI through your employer than my original answer to why the Dr won't do the surgery stands as is.

    What reason have you been given as to why your claim was denied, are they claiming pre exisiting, or ??? Does your attorney feel you have a chance to get it accepted? Has s/he filed for a 19b hearing yet? Just so you know even after a 19b hearing takes place it can be up to 180 days until you receive an answer.

    And again don't be offended. Questions are a necessary part of support on forums like this.

    beachgirl
    I'm sorry but I do not understand all the initials for your descriptions, as I said I have never been involved in anything like this before, have never had to use a lawyer and have never been involved in a court system ever in my life. As far as getting denied, they feel the injury was not done at work, as I had no witnesses to the incident and I kept on working thru the pain, believing that it would in fact pass and I would get better. As far as hearings and what a 19b is I have no clue what all that is, all I do know is we are waiting for the doctors to do their depositions before we go to an arbitration hearing, as there are several doctors involved at this time. I hope I have answered your questions, I'm sorry I am not tryn to be offended I just feel ignorant when you type initials to items I have no idea what they mean. As I said prior I have never been thru anything like this before so if you would please explain to me what you are trying to say to me in simpler terms I may understand it better. Just a bit frustrated with this incident and the months that have already passed while still in great pain! Thank you for your responses and your assistance in this, this is a great forum and I am trying to comprehend what all this means to me and my rights.

  6. #16
    Join Date
    Aug 2007
    Posts
    504

    Default Re: What Do U Do

    Quote Quoting BeachGirl View Post
    Ok your claim has been denied. You need to call your attorney and ask why you received the subrogation letter. Subrogation is used when an IC is trying to lay claim on potential settlement from another policy, ie a third party lawsuit. IOW if you were driving a taxi and another car crashed into you while on duty the IC for your employer would want to be reimbursed for what the claim cost them in medical, etc. from the settlement from the IC of the driver that crashed into you. If there is no third party claim involved I have no idea why this letter was sent to you.

    Is the medical card, medicade? If it is that may be why the Dr is saying no to the surgery. Many Drs will only take a certain number of medicade patients. If it is a regular PI through your employer than my original answer to why the Dr won't do the surgery stands as is.

    What reason have you been given as to why your claim was denied, are they claiming pre exisiting, or ??? Does your attorney feel you have a chance to get it accepted? Has s/he filed for a 19b hearing yet? Just so you know even after a 19b hearing takes place it can be up to 180 days until you receive an answer.

    And again don't be offended. Questions are a necessary part of support on forums like this.

    beachgirl


    IC=Insurance company
    PI=Personal Insurance

    19b is an emergency hearing in front of an aribtrator comingly used to get get weekly payments (also knows as TTD) started or restarted, get medical bills paid and get denied claims accepted.

    Considering your employers IC for their WC (Workmans Comp) is saying you were not injured at work I now understand the delays. Im thinking it is going to be a fight of length to get to the final decision. That might be why your attorney has toild you to change DRs and get your surgery done. If your claim is accepted, even after you have surgery, the IC for your employer will have to pay the cost of surgery or pay back your persoanl insurance, if that is what you would be using. You didn't say if the medical card is personal insurance or medicade.


    If no one has provided you with the Handbook on Workers Compensation and Occupational Diseases I highly suggest you go to the state web site, www.iwcc.il.gov, and read the handbook. It will help you understand the way WC operates in Illinois.

    Did you ask your lawyer why you received a subrogation letter? I'd do that if I were you if you haven't already.

    beachgirl

  7. #17
    Join Date
    Apr 2007
    Posts
    186

    Default Re: What Do U Do

    I had the same problem in 2004. My work comp insurance company didn't deny my claim but did deny my first surgery that was ordered by my surgeon. I had to hire an attorney at that time and he took my surgeons deposition and filed for a 19b emergency hearing. I had to testify at this hearing along with the deposition of my surgeon. The arbitrator ruled 100% in my favor that my injury was work related and ordered the IC to pay for my surgery right away.

  8. #18
    Join Date
    Jul 2009
    Posts
    8

    Smile Re: What Do U Do

    Quote Quoting BeachGirl View Post
    IC=Insurance company
    PI=Personal Insurance

    19b is an emergency hearing in front of an aribtrator comingly used to get get weekly payments (also knows as TTD) started or restarted, get medical bills paid and get denied claims accepted.

    Considering your employers IC for their WC (Workmans Comp) is saying you were not injured at work I now understand the delays. Im thinking it is going to be a fight of length to get to the final decision. That might be why your attorney has toild you to change DRs and get your surgery done. If your claim is accepted, even after you have surgery, the IC for your employer will have to pay the cost of surgery or pay back your persoanl insurance, if that is what you would be using. You didn't say if the medical card is personal insurance or medicade.


    If no one has provided you with the Handbook on Workers Compensation and Occupational Diseases I highly suggest you go to the state web site, www.iwcc.il.gov, and read the handbook. It will help you understand the way WC operates in Illinois.

    Did you ask your lawyer why you received a subrogation letter? I'd do that if I were you if you haven't already.

    beachgirl
    The medical card is issued from the state, for my children and myself, so I would assume its our personal insurance and the only insurance that we have. According to my attorney, the third party is human services wanting there monies back regarding the bills that they have paid thus far. We are waiting now for the arbitration trial to commence and until then I have no money coming in to live off of with the exception of child support. Still waiting to see if my disability claim will be accepte which it should seeing as my employer has denied that I did in fact do the injury at work. Time will tell and I realize this is going to be a lengthy battle. Again pardon my ignorance on all this, but with the more research I am doing, the easier I understand the time this will take. Thank you all for your answers and responses, I am learning but slowly, thanks for being here just to vent!

  9. #19
    Join Date
    Aug 2007
    Posts
    504

    Default Re: What Do U Do

    Quote Quoting tryn2cope View Post
    The medical card is issued from the state, for my children and myself, so I would assume its our personal insurance and the only insurance that we have. According to my attorney, the third party is human services wanting there monies back regarding the bills that they have paid thus far. We are waiting now for the arbitration trial to commence and until then I have no money coming in to live off of with the exception of child support. Still waiting to see if my disability claim will be accepte which it should seeing as my employer has denied that I did in fact do the injury at work. Time will tell and I realize this is going to be a lengthy battle. Again pardon my ignorance on all this, but with the more research I am doing, the easier I understand the time this will take. Thank you all for your answers and responses, I am learning but slowly, thanks for being here just to vent!
    Now it makes total sense.

    The Dr doesn't want to take the state insurance card. Many Drs won't take that card or if they do they limit the number of patients they see that have it.

    Good for you for calling your attorney and asking. The subrogation letter now makes total sense too.

    Hey, any time.

    If there is anything else I can help you with post here, or of it's something you aren't comfortable talking about on the open forum you can private message me.

    beachgirl

  10. #20
    Join Date
    Jul 2009
    Posts
    3

    Default Re: What Do You Do If You're Denied Worker's Comp

    hi there, been gone for awhile just now able to physicaly and mentaly get back on. this same thing happened to me. in 07 my doctor ordered medical procedures--being it was workcomp it had to be approved by them. they would not aprrove it. in the state of illinois if you have a letter from your w/comp stating they will no longer pay for any further medical treatment your personal insurance or ss is then able to cover it.
    be warned that the w/comp do not like to write this letter as it comes back to haunt them if they are found liable at that time to have been responsible for your medical care. my w/comp atty took almost 1 year to write the letter but as soon as it was written ss and my personal ins took over immediately.

    my trial will be coming up to determine whether or not they were liable for not only the medical but ttd that they stopped.

    if anyone has had experience with going to trial in il i would like to know what to expect. my attorney has no doubt i will win--but i would like to know how the w/comp atts handle the questioning etc,

    thanks in advance

    fireball

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