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  1. #1
    Join Date
    Feb 2012
    Posts
    3

    Default Workers Comp Nightmare Need Some Advice

    Hello all,
    I will try not to make this too long but here is my story: I injured my knee last May at work and have been through a nightmare with workers comp! After filing for workers comp I was almost immediately denied my claim for some bogus reason. I appealed their decsion sending in plenty of evidence from the doctors I saw after my injury and even letters from coworkers who witnessed my injury. After 6 weeks off, no answer, and bills starting to pile up, against my orthopedic doctors wishes I returned to work on modified duty. My time off I basically only got to see a doctor, since my claim had been denied I could not get an MRI to figure out the exact problem with my knee. So as time passed I get more letters from these "lawyers" who are working against me in this claim and all their evidence against me. I worked through the pain on a part-time basis since unable to work my job full-time. I got laid off a few days before Christmas due to there being no more work for me until the upcoming Spring. So on New Years eve, my knee just gave out, I visited my primary doctor explained to him all that had happened with my case, he ordered an MRI. After the MRI I found out my injury was more serious then my orthopedic doctor originally thought all those months ago which requires surgery and a very lengthy recovery period. I was referred back to my orthopedic doctor by my primary doctor which didn't do much good because I still had not received a decsion from the workers comp judge at the time. Days later I received a letter from the judges office saying they ruled in my favor. It wasn't but a few days later that I receive another letter from these nice "lawyers" saying they are appealing the decsion. Last week though the insurance company mailed me two checks for the time I missed at work, a card to use for any medical treatment, and a few other papers. I'm not sure if I should cash the checks and be able to use the medical card now that the case is being appealed.

    So what should I do and what can I expect? Any help or advice will be appreciated!

    Thanks!

  2. #2
    Join Date
    Oct 2006
    Posts
    9,080

    Default Re: Workers Comp Nightmare Need Some Advice

    cash the checks and expect to win the appeal.
    they have to pay the uncontested issues so I suspect they only appealed part of the original court award.

  3. #3
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    17,945

    Default Re: Workers Comp Nightmare Need Some Advice

    Last week though the insurance company mailed me two checks for the time I missed at work, a card to use for any medical treatment, and a few other papers. I'm not sure if I should cash the checks and be able to use the medical card now that the case is being appealed.
    Of course you can use the card... the claim is "accepted" until another judge issues a finding denying compensability on the appeal. WC or defense attorneys do this all the time... these attys are building billable hours...your atty (you do have an attorney?), are not paid until the claim resolved.

    If you don't have an attorney... get one, you can't go up against savvy WC defense attys on your own...

  4. #4
    Join Date
    Feb 2012
    Posts
    3

    Default Re: Workers Comp Nightmare Need Some Advice

    Quote Quoting .SH View Post
    cash the checks and expect to win the appeal.
    they have to pay the uncontested issues so I suspect they only appealed part of the original court award.
    My concern is that if cash the checks and go out and start using the medical card, the case will get overturned and I will have to pay everything back. Right now in my current situation (being laid off, injured, and requiring surgery with a lengthy recovery time) having to pay back all that money at once would be impossible for me.

    Quote Quoting BvIA View Post
    Of course you can use the card... the claim is "accepted" until another judge issues a finding denying compensability on the appeal. WC or defense attorneys do this all the time... these attys are building billable hours...your atty (you do have an attorney?), are not paid until the claim resolved.

    If you don't have an attorney... get one, you can't go up against savvy WC defense attys on your own...
    I do not have an attorney, I didn't think it would take this long and be this much of a headache just to even get the answer to the first appeal. To me and any other normal intelligent person, this case would be pretty cut and dry, but when you get lawyers involved who try and throw in any reason against you they can find, no matter how stupid and irrelevant to the case it is just so they can continue to get paid, its just a nightmare. I wish way back when I would have gotten an attorney now knowing how serious my injury actually is and will not even be able to work for a good while after my surgery. Unfortunately I guess I kind of bit myself in the butt by returning to work, now all the time I will be off after the surgery will be unpaid, I don't think workers comp will cover that time since I previously returned to work after the injury. Or will it?

  5. #5
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    17,945

    Default Re: Workers Comp Nightmare Need Some Advice

    Unfortunately I guess I kind of bit myself in the butt by returning to work, now all the time I will be off after the surgery will be unpaid, I don't think workers comp will cover that time since I previously returned to work after the injury. Or will it?
    You're answering your own question, then asking it.
    That would tell me you need to consult with an attorney... WC is full of litigation.
    To me and any other normal intelligent person, this case would be pretty cut and dry,
    There is no such thing as "cut and dry" in any comp claim. You are demanding your ER/IC pay for treating your injury, no one disputes you are injured, only to what extent the ER/IC is liable. If there is a way to deny a claim, of course they will. Same as your homeowners policy carrier would try to deny your claim if I fell on your front steps.
    My concern is that if cash the checks and go out and start using the medical card, the case will get overturned and I will have to pay everything back. Right now in my current situation (being laid off, injured, and requiring surgery with a lengthy recovery time) having to pay back all that money at once would be impossible for me.
    Cash the checks. Use the card... you are NOT going to be faced with the bills to treat your work injury. You NEED to discuss this with a comp atty.... there is no fee for this... and you would know where you stand. You are basing your thought process on your own experience... WC doesn't work that way.

  6. #6
    Join Date
    Feb 2012
    Posts
    3

    Default Re: Workers Comp Nightmare Need Some Advice

    Thank you for your advice and help. I will definitely seek an attorney now and hopefully soon get this case resolved.

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