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  1. #1
    Join Date
    May 2012
    Posts
    2

    Default Insurance Playing Games

    I was injured at work over 20 yrs ago. Went to court and insurance was ordered to pay for medical. Now they are denying aproval for Dr. ordered supplies. Also cutting out some of the supplies i have been getting for years. They say i shouldnt be injured that long. I wear a Tens unit everyday and now they say i dont need the skin wipes that go with the Tens unit, that i can just wipe my skin off with a rag. They have cut the amount of pads i use a month and now cut the amount of skin preps i use. I run short at the end of the month and have to suffer. Is there anything i can do to get my supplies besides going to court?

  2. #2
    Join Date
    Apr 2012
    Location
    Oregon
    Posts
    350

    Default Re: Insurance Playing Games

    I have a tens too. I hope we don't have to go to court for the supplies. Your adjuster sounds like a real Scrooge and I hope you get this straightened out. Maybe your atty should write a letter for you, if you have one.

  3. #3
    Join Date
    May 2012
    Posts
    2

    Default Re: Insurance Playing Games

    Quote Quoting sees.nakedemperors View Post
    Also have a TENS-type unit, used regularly and longterm. About a year ago my doctor's order for supplies was at the suppliers but payment wasn't being sent. It was a fight for a few months that a rehab coordinator plus lawyer, and the vendor, eventually wrangled through successfully with letters, not a Hearing.

    Does what "they say" come on paper, or verbally, like over the phone? The order for insurance to pay medical must be a paper you have. I've even heard of WC clients' service providers being phoned that services prescribed by the ATP are cut but that's not necessarily so -- a tactic to get folks to believe it and fall away, suffering the loss. Get the denial/cuts/controversion on paper. The doctor's orders are on a script, or paper -- so the payers' refusals should be also!! Lawyers can't do much without the paper 'facts.'
    Contacted my adjusters supervisor and asked for claim denial in writing so i could send it to the Department of Labor and told him how i was being treated and he called me back and said my supplies would be shipped in full.

  4. #4
    Join Date
    Mar 2011
    Location
    Tennessee
    Posts
    73

    Default Re: Insurance Playing Games

    Just a piece of general advice for all with issues related to medical treatment for injuries after you've had a settlement (or trial) with open lifetime medicals. Due to a recent decision by the Davidson County Chancery Court (that's currently pending on appeal to the Supreme Court), the Tennessee Department of Labor is not currently issuing any mandatory orders related to these type of expenses. All they will do is try to help facilitate a resolution if one can be agreed upon. If you actually have to try to enforce a prior settlement giving future medical benefits, you will have to go to Court to do so at the present time.

    Again, this deals ONLY with situations where some treatment is denied AFTER you've settled (or gone to trial) and gotten lifetime future medical benefits.

    Glad you were able to get your situation worked out with the adjusters.

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