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  1. #1
    Join Date
    Apr 2011
    Posts
    4

    Default WC Insurance Turned Around and Says Claim is Denied, 6 Months After Injury

    Hello All,

    The back story on my girlfriend and her workman's comp claim is pretty much here:

    http://www.workerscompensationinsura...m-a-Second-Job

    Cliff notes: Workman's comp insurance has decided 6 months after injury that my girlfriend has no claim, and has cancelled everything and kicked her to the curb.


    Sorry this became so long...

    She'd been having some issues with workman's comp in the last few months or so. The short of that story is that the WC insurance lady that was handling her claim was on maternity leave, and the lady that covered her in the interim made it very apparent that she was trying to dispose of my girlfriend. She stopped paying all bills, stopped paying all reimbursements, stopped paying all physical therapy and doctor's appointments. All of these things were ordered by the doctors, the lady had orders for all of them, it didn't matter, she just quit paying it all. She also stopped the weekly payments.

    In reference to the weekly payments stopping, what happened was that one of the doctors, a neurological surgeon, released my girlfriend from her care. He said that from a neurological standpoint, there was no reason she couldn't go back to work. She was seeing him to begin with because of bleeding on her brain that occurred from the injury. In the meantime, she still has been in physical therapy, and isn't released from her other doctors to return to work (including her eye doctor- she's now permanently blind in her right eye due to the injury). The witch lady said that since one of her doctors had released her, she no longer had to pay my girlfriend any TTD money, despite the fact that the other doctors hadn't released her for work. This didn't make any sense to us, including the local nurse handling the case. The local nurse said she had never seen a WC insurance company do such a thing.

    This week the old insurance lady returned from maternity leave, and medical bills finally started getting paid again. There were still no TTD payments, or reimbursements, but at least the last two months of physical therapy were getting paid for, and the handicapped/vision assistance items (to help her cope for loss of sight) got ordered. My girlfriend got a call this morning that the WC insurance had ordered occupational therapy for her and that she was next in line at the PT place to start.

    This afternoon, 5:30pm, my girlfriend received a call. The workman's comp insurance company has decided that they are denying her claim. All appointments are cancelled, all treatments are cancelled, no word explanation whatsoever. The local nurse handling the claim didn't have any explanation, just that she received a call this afternoon from the insurance company that they are denying everything and that all treatment stops immediately. She didn't say whether or not the insurance company is going to bill my girlfriend for the last six months of surgeries, hospitalizations, physical therapy, etc (the first week of hospitalization alone was over $50,000). We have no idea what happened.

    My girlfriend was severely injured while on the clock, delivering a pizza. Attacked and beaten, face crushed, blinded in her right eye. I just don't understand how after the last grueling six months of of surgery and therapy, all of a sudden workman's comp says that she has no claim? She was hurt on the job, in uniform, doing her job. Getting paid peanuts to do it. She lost her other job because of it, which was her main income and her insurance for her and her kids. She's never going to get her sight back, and will forever be hindered because of losing the sight in her eye.

    To say I'm devastated right now doesn't put it in words. I've lost all hope. I just really feel like I'm at the end of the line, with nothing left.
    Last edited by slimbobaggins; 09-19-2011 at 05:32 PM.

  2. #2
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,021

    Default Re: WC Insurance Turned Around and Says Claim is Denied, 6 Months After Injury

    In reference to the weekly payments stopping, what happened was that one of the doctors, a neurological surgeon, released my girlfriend from her care. He said that from a neurological standpoint, there was no reason she couldn't go back to work.
    They only need ONE DR to release, and determine compensability of a claim.

    She NEEDS to contact a WC attorney... actually about 6 months ago, but should do so as soon as possible now.
    Her benefits won't be resumed until a WC court judge orders it.

    Don't lose hope, just find an atty and file for a hearing ASAP.

  3. #3
    Join Date
    Jan 2010
    Location
    Pennsylvania
    Posts
    609

    Default Re: WC Insurance Turned Around and Says Claim is Denied, 6 Months After Injury

    The local nurse said she had never seen a WC insurance company do such a thing.
    If this was the IC Nurse Case Manager, she is either very new or a liar. These practices have been going on for years and years. Especially if you are going through this process by yourselves and unrepresented. I am not saying that no one goes through the process and comes out ok without representation, so don't misunderstand that. They are trying and at the moment succeeding at limiting their liability. Ask around in family or friends about compentant Workers Comp attorneys. Try to stay away from very large firms that take on large amounts of cases, most are too busy. If a family member or friend had success and were happy with their attorney, by all means, they are the one to consider. Interview a few...sign nothing until you think it over. But don't waste too much time, you definitly need a lawyer yesterday. BTW, stay away from the IC nurse.......she is not your friend....she works for them and most times your attorney will tell you to not share info with the nurse. Your attny will most likely tell the IC nurse to but out...politely, I'm sure.
    Last edited by explorereb96; 09-20-2011 at 06:09 AM.

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