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  1. #1
    Join Date
    Dec 2012
    Posts
    2

    Question Employers Insurance Company Denied Claim and Now Wants to Settle Before Hearing

    My workers compensatiojn claim was made in the State of: Arizona

    my claim was denied because my boss said that i didn't report my injury right away.(i reported it the next day because it didn't hurt until i got home) and my boss said when i reported my injury all i was concerned about was "when will my disability checks arrive". he said my statements were inconsistent. i recorded my meeting with my boss wasn't acting like he was taking my back injury seriously.

    i filed an appeal with the state and served my employer with an interrorgatory which he refused to answer. The interrorgatory focused on everything said in the meeting as well as my interest in disability checks.
    two weeks ago i sent my employer and the court an audio recording of themeeting which shows i never inquired about disability checks but i did ask about sick pay while i was out. the recording paints my employer as a liar.

    now after being denied the insurance company wants to settle.
    my medical bills were $2200 and the insurance company wants to settle for $1850 with me signing a nondisclosure.

    i was out of work for 10 days and got no workmans comp pay.

    should i settle or keep my court date which is in two weeks. am i not entitled to workmans comp pay and is it normal for an insurance company to act like this? should i counter offer.
    any ideas as to how to proceed?

    Thankyou in advance for everyone's input

  2. #2
    Join Date
    Oct 2006
    Posts
    9,073

    Default Re: Employers Insurance Company Denied Claim and Now Wants to Settle Before Hearing

    Go to court. They hate going to court.
    Costs more then the settlement.
    They'll try to settle later.
    Ask the court for penalties.

  3. #3
    Join Date
    Feb 2007
    Location
    831 East Morehead St., Ste 355, Charlotte, NC 28202
    Posts
    3,808

    Default Re: Employers Insurance Company Denied Claim and Now Wants to Settle Before Hearing

    Going to court "holds their feet to the fire" and many cases settle "on the courthouse steps" or in the conference room at the courthouse right before the trial starts.
    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

  4. #4
    Join Date
    Dec 2012
    Posts
    4

    Default Re: Employers Insurance Company Denied Claim and Now Wants to Settle Before Hearing

    It is very normal for an insurance company to act like this. They do business on the premise that the IC (Insurance Carrier or Worker) does not know the law enough and does not have enough money to live on in order to get the benefits that are owed to them (Worker's Compensation cases can take years). These insurance company's have lawyers on retainer at all times to deal with people who want to seek benefits. You will want to hire an attorney but be careful. Attorney's for the injured worker can be shady and are only looking out for their own wallet. They will give up if they don't think they have a good case. The best thing you can do is never back down and never give up. Fight them tooth-and-nail every step of the way.

    Here's what I did: I was diagnosed with Bilateral Carpal Tunnel in both of wrists due to a temp position from a staffing agency that I kept for 4 years while in school. The economy was horrible in 2008 which was my first year in college and it was almost impossible to find summer work. I went to the staffing agency who placed me at a 10-12 hour a day job for $9.00/hr where I would be using a vibrating hand sander and using fine motion manipulation of my hands throughout the entire day. I kept that job throughout college and worked during breaks and summer vacation. Most recently, in May of 2012 when the semester ended, I called the staffing agency who told me they had a job that paid $10/hr but was much harder work. They were not kidding. I was a mule for the month I was there, working my entire 12 hours days hammering holes out of concrete forms. After a month I could not make a fist with my hands. The pain was so excruciating at night-time when I was trying to sleep that I would lay up for hours with ice-packs on both of my hands, unable to sleep. My girlfriend made me go to the doctor and within the first 3 minutes of me explaining the symptoms he said I had Bilateral Carpal Tunnel that will require surgery. He was absolutely sure on how someone with no medical history of wrist problems, and who was only 25 years old, could have such a severe case of this syndrome... my job.

    The first thing I did when I returned home from the doctor was research the laws on workers compensation in my state. I was up all night reading of the statutes and regulations, and developing a plan. The managers of the staffing agency were hell-bent on me not filing a claim with the state or their insurance company. The operations manager even coerced me and my girlfriend in to going to the office and discussing "financial reimbursement" which was her telling me to file for disability and go to food pantries.

    After that I filed the motion with my states department of workforce development seeking benefits for my injury. I e-mailed the workers compensation insurance carrier for my company who had already been ducking my phone calls after our initial conversation. I told them I filed the claim with the state and if they want me to see their IME (Independent Medical Examiner) I would like my attorney, primary care physician and girlfriend at the appointment and I expected reimbursment for gas and lost time wages. I also made it clear that regardless of the IME's determination, I was going to follow the advice of my primary care physician.

    Eventually weeks went by where I didn't receive a phone-call or a e-mail from the insurance company. All the while I was going to my doctor's appointments, having them check "Work Related" on the appointment sheet, and telling them to bill my employer. I kept copies of everything and saved copies of all of my e-mails. After several months I got an attorney (you have to get one if you want to settle with IC's like these) and I got surgery on my right wrist.

    I filed for the hearing quickly, and got all of my appointments, surgeries and other semantics out of the way as fast as possible. We got a hearing 6 months after my initial diagnosis which is very rare. Usually these things take years. 3 days before the pre-hearing conference my lawyer called me and told me the insurance company is going to pay for everything and I will receive a check in 6 weeks.

    You have to know your shit so these company's can't take advantage.

  5. #5
    Join Date
    Dec 2012
    Posts
    2

    Default Re: Employers Insurance Company Denied Claim and Now Wants to Settle Before Hearing

    Thank you so much for telling your story. i too have immersed myself into the world of workmans comp law in arizona so to not be taken advantage of by the company and its insurer.

    thank you for showing me that I'm on the right track. one good thing about going to court next week is that since their star witness (my boss) refused to answer the interorgatory, he won't be able to testify on court and it will basically be my word(case) against nobody. if i understand the administrative code correctly by him not cooperating with my investigation he forfits his right to testify in the hearing.

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