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  1. #1
    Join Date
    Oct 2011
    Posts
    6

    Default Insurance Deined Case

    My workers compensation claim was made in the State of: Nevada

    Some might not understand what I am asking, its not about me getting the treatment but about i want this claim closed and when did the insurance company close this case. I went to see the company doctor because i felt some pain in both my knee and left side one day while I tripped at work. I really didn't want to open any case but my employer said i needed to go. After 3 appointments the insurance denied any responsibility to the claim. They said it was a per-exsiting condition After that I started to receive bills from the clinic from the first day i went. I do not want to reopen any claim or have any dealing with the insurance company. What i want to know is if the insurance company denied the treatment and close it, are the restrictions the doctor put on me still in place or were the lifted once the insurance denied any treatment. My company said that they are and consider that I still have and open case.

  2. #2
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    17,943

    Default Re: Insurance Deined Case

    Filing a WC claim is not optional... it's the law. Your ER is liable for the injury/treatment and any other benefits you may be due.
    Yes, you still have restrictions, and if your ER cannot provide light duty/modified work, you can be subject to termination.

    There are no pre existing exclusions in WC.
    NV is about the only state that provides legal assistance to IW... contact the WC commission.

  3. #3
    Join Date
    Oct 2006
    Posts
    9,078

    Default Re: Insurance Deined Case

    Quote Quoting msanti8745 View Post
    My workers compensation claim was made in the State of: Nevada

    Some might not understand what I am asking, its not about me getting the treatment but about i want this claim closed and when did the insurance company close this case. I went to see the company doctor because i felt some pain in both my knee and left side one day while I tripped at work. I really didn't want to open any case but my employer said i needed to go. After 3 appointments the insurance denied any responsibility to the claim. They said it was a per-exsiting condition After that I started to receive bills from the clinic from the first day i went. I do not want to reopen any claim or have any dealing with the insurance company. What i want to know is if the insurance company denied the treatment and close it, are the restrictions the doctor put on me still in place or were the lifted once the insurance denied any treatment. My company said that they are and consider that I still have and open case.
    if they have denied the claim you can send the bills and the denial to your health carrier.
    you can notify the carrier in writing that you will not be pursuing benefits.
    other then that you can't control how the carrier handles their files.

  4. #4
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    17,943

    Default Re: Insurance Deined Case

    Just because a ER/IC denies a claim does not mean your own health coverage will pick up the cost of treatment.
    It's not for you or the defense to determine compensablity, at the end of the day, only a judge can do that. If that were the case, all claims would simply be denied by the carrier shifting the liability to you.

    If you don't want to go through the WC system for a work related injury, you are certainly free to pay out of pocket for treatment.

  5. #5
    Join Date
    Oct 2011
    Posts
    6

    Default Re: Insurance Deined Case

    Bvia you said there are still restrictions in place, but by who the doctors are no longer willing to accept you, the insurance company said there is no claim. Two days after this happen i went out on fmla because my knee was really bugging me. They place restrictions on my lower left side. Well after my flma was up and i rehab myself after a knee replacement my doctor released me back to work full duty. Since the insurance declined the case and my doctor released me back to full duty can the company still say I have an open claim. I wanted this closed an not have any dealing with the insurance comp
    Last edited by msanti8745; 06-18-2012 at 08:50 AM.

  6. #6
    Join Date
    Apr 2012
    Location
    Oregon
    Posts
    347

    Default Re: Insurance Deined Case

    You need a wc lawyer and a hearing before a judge, in that order. You will then get paid for your temporary total disability. We IWs always go through denials, that is why you get the lawyer and it does not cost you to talk to one. DO IT, ASAP. You will be so glad you did. It is just a process we all have to go through to get benefits paid. You may have missed your 30 days to file for a hearing so hurry up and talk to an atty!

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