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  1. #1
    Join Date
    Apr 2012

    Default Claim Denied 7 Months After Injury

    My Husband was injured at work the end of June last year. He had a large drill fall on his foot, and he was knocked over. He asked to go to the doctor because he knew he was hurt. He went to the doctor and they said his ribs and foot were badly bruised. As standard practice he was administered a Blood alcohol test. He had alcohol in his system. Two days later he was let go for being under the influence at work. He was told to continue to go to the doctor for his injuries by his supervisor because it was still a workman's comp injury. We had good medical insurance at that time, that would be good through the end of June. By the 7th of July he was in so much pain that he couldn't hardly walk. He went to the doctor again and they missed it and his foot was actually broken in two places. We were continued to be told that this would all be covered by workman's comp. The first of february this year 7 months later the claim was denied because he was under the influence, and $4000 worth of medical bills were sent to us. Had we known that Workmans comp wouldn't cover the injury we could have submitted a large portion of these bills to our insurance at the time. I believe we have far exceeded being able to submit them to the insurance we had at that time. Do we have any recourse or are we stuck with $4000 worth of bills? I feel like we were duped. Any help or suggestions would be appreciated.

  2. #2
    Join Date
    Feb 2007
    831 East Morehead St., Ste 355, Charlotte, NC 28202

    Default Re: Claim Denied 7 Months After Injury

    Immediately, and I mean TODAY, submit those bills to your health insurance company. Most health policies I have seen give you a year to submit the bills. You may still have time to get them paid. But don't delay.

    Having alcohol in his system, depending on how much, and depending on how your state law works, may be enough to deny the comp claim.
    The North Carolina Court of Appeals has held that "In contested Workers' Compensation cases today, access to competent legal counsel is a virtual necessity." Church v. Baxter Travenol Labs, Inc., and American Motorists Insurance Company, 104 N.C. App. 411, 416 (1991).

    Bob Bollinger, Attorney and Board Certified Specialist in NC Workers' Compensation Law

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