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  1. #1
    Join Date
    Jan 2013
    Posts
    14

    Default Workers Comp Claim Was Denied

    Real long story short: i worked for a manufacturer in NWI, less than 30 employees. started by an ambitous and intelligent guy who died and his kids took over. I worked there from 7/2010 to 10/2012. in april of 2012 i (as everyone was told to do by the plant superintendant the presidents husband) went to my foreman when i had an injury, my shoulder started to get sore from doing the same heavy work involving 12foot long rods cut down to length using a tool and die, and i was told i was a p&$$y and he kinda laughed and continued to inform me of his 17 years there and his aches and pains and to just deal with it. over the next 6 months i attempted to report my injury as it was getting worse as time went by and i got the same response the 2nd time and some other brushoff the 3rd time and the fourth time he told me layoffs might be coming up soon and they hate it when people file claims (we had 2 workers lose body parts that year) so in oct of 2012 i was laid off and was told to come in for paperwork the following monday. I came back monday and they tried to get me to sign a voluntary layoff form, which was not filled out to their liking and i recieved a copy for court use. and during this I said I know i have a right to be evaluated by a doctor for my shoulder, was subsequently told ummmm no i dont think so i better call adp and see what they say (they had NO HR department and outsourced it to adp) at this point i was being told "it will get better in a week, especially now that your unemployed". so i left and decided to call a lawyer in the parking lot because i had been getting seriously screwed by people at this company for the past 6 months. he told me to call whoever signs my checks.... ADP. so i did maid a claim and went to a doctor of their choosing. the diagnosis was pt and follow up with restrictions and was told in writing that the insurance company would pay for the PT. 2 days later i recieved letters from me employer and the insurance company stating my claim has been denied, not compensable. I immediately filed with the indiana wcb following procedure to get assistance and dispute a denial, i was also on medicaid so i started getting diagnosed. 2 mri's and multiple dr visits later i have 2 tendons and my labrum torn in my right shoulder.... I am on unemployment since they laid me off and am due for another ortho visit tomorrow with another sitdown with my attorney the day after tomorrow. there are alot of different factors going on here but on my bottom line i am looking at unemployment (which is a pittance, especially married with kids) atleast 2 surgeries, probably more and a lifetime of pain. i have no trial date as of yet, but am expecting one soon..... any thoughts, tips, suggestions here? I know this is a resourceful and intelligent community and would like enjoy some experienced feedback. Oh and my sitdown with the lawyer is to talk about Bad Faith, so anything pertaining to that or getting the IC to help with TTD would be particularly helpful... if its even an option considering i wasn't aloud to physically file a claim until i went to their check writer. oooo and one more question, I asked about the unemployment insurance process and if I would get it. And they said Yes just fill out the paperwork we will have for you when you come in.... which turned out to be a voluntary termination form which the president said she knew nothing about..... but arent they obligated under law to explain UnemploymentInsurance to me accurately? when questioned about it? --------- my fam and I are a little worried how the whole denial of claim, dispute process works, but i suppose if a lawyer took up my case it can't be that bad.

    - - - Updated - - -

    Sorry about the horrible writing involved here....

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

    Default Re: Debacle to Say the Least

    Rare for there to be bad faith in WC...you are not the insured party.
    I asked about the unemployment insurance process and if I would get it. And they said Yes just fill out the paperwork we will have for you when you come in.... which turned out to be a voluntary termination form which the president said she knew nothing about..... but arent they obligated under law to explain UnemploymentInsurance to me accurately?
    Your ER is not required to explain UI to you... you get that info when you file the UI claim with the state, the state makes the determination. Not the ER.
    my fam and I are a little worried how the whole denial of claim, dispute process works, but i suppose if a lawyer took up my case it can't be that bad.
    Info on WC in Indiana is here my fam and I are a little worried how the whole denial of claim, dispute process works, but i suppose if a lawyer took up my case it can't be that bad.

    Legal questions should be directed to your attorney.
    Sorry about the horrible writing involved here....
    Would help if ya just hit the "enter" key now and then... make some paragraphs. Big blocks of print are difficult to read.

  3. #3
    Join Date
    Feb 2007
    Location
    831 East Morehead St., Ste 355, Charlotte, NC 28202
    Posts
    3,762

    Default Re: Debacle to Say the Least

    You have made a number of missteps already before getting a lawyer involved, so I hope you have engaged a very competent, experienced and aggressive workers' comp lawyer to help you. It sounds like your shoulder was injured over time, rather than in one accident, and those cases that develop over time are harder to prove (win) than cases arising out of one accident. I suspect the insurance company may find your thread here and identify you so be careful how many details you post.

    But an aggressive workers' comp lawyer who knows what he or she is doing is what you need now. And I agree with the comment above that a "bad faith" claim does not seem to be a proper claim to make since you are not the insured. If a "bad faith claim" is really what your lawyer is talking about pursuing for you, then you need to ask a lot of questions and confirm that you have chosen the best lawyer for your problem. Good luck to you.
    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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