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  1. #1
    Join Date
    Aug 2008

    Default Broken Ankle and New to WC

    Hi this is asked specifically for my mom. Please if anyone could help and answer some of my questions it would be greatly appreciated.

    My mom had just clocked out at her job as an ER nurse. She exited the hospital and was still on hospital property when she fell off the curb and broke her ankle. The ER staff seen her fall and assisted her immediately.

    Turns out she needed surgery and had it the next day. She now has pins and a plate. She is recovering very slow and has been out of work up until yesterday where she returned to desk duty and a cut in hours.

    She was denied by WC because she clocked out. The bills aren't being paid by the insurance company either because they say it's a WC claim. She did higher a lawyer but she wants to know what the chances of this actually turning out to be a WC claim? Is anyone familiar with this type of injury and claim?

    The lawyer says it's a slam dunk case but my mom just doesn't trust lawyers to much.

  2. #2
    Join Date
    Oct 2006

    Default Re: Broken Ankle and New to WC

    ask the work comp carrier for a written denial.
    send a copy of the denial to the health care provider. if they still refuse to provide benefits contact the state insurance commissioner and file a complaint.
    as far as workers comp goes there is an exclusion for going and coming to work.
    there can be exceptions if there are any extenuating circumstances. your mother will likely have to appeal to the work comp commission.
    she can find out more from the handbook

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