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  1. #1
    Join Date
    Dec 2012

    Default Claims Administrator Denied Claim

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

    Come to find out my doctor's office or CA completed Industrial Commission paperwork. I had asked CA amd WC responsible for WC at my doctors office several times if Industrial Commission received my claim. Well, NO they had not. My employer was notified within an hour of my fall, CA called for details how the fall took place and my injuries etc.

    I received a letter from CA my claim is denied and injuries was NOT work related. Also stated in the letter if Industrial Commission paperwork is filed my claim will be denied.

    I had an IME just over a week ago and have not heard any results from the IME, however maybe I have thus claim denied!!! Pre-existing conditions and because I was seeing a Pain Management doctor because I had injuied my back a little of a year ago, everything is Pre-existing. I do meet with an attorney this coming Thursday. The attorney as well as the ICA representative this is common practice for IC/CA to lead IW in believeing all paperwork has been filed. Since I had received a WC# and script card for meds all paperwork was filed.

    I have received a bill from the scripts I thought was being paid for by IC/CA and expect to receive bills from my doctor visits as well.

    Is this normal from IC/CA??? Please anyone with similar situations or experiences please share your experices!

    - - - Updated - - -

    Sorry I meant DID NOT complete Industrial Commissions papwork! How can my injuries NOT be work related when I fell at work, injurying my neck, right shoulder. I had a back issue so I guess I understand lower back was pre-existing, even though by back is worse because of the fall. My doctor I saw after my fall at work treated like additional pain, but only mentioned I saw him after falling at work. UNBELEIVEABLE!!!!! No one has any advice for me or similar situations to share with me.... Would really appreciate your input...

  2. #2
    Join Date
    Jan 2013

    Default Re: Ic/California Denied Claim

    Get ready for a long stressful ride. I too,feel at work 7 months ago. I got the same as you, a packet from WC. I receive no medical from my employer instead I got terminated. So i went to the doctors own my own. After 5 months and after deposition my claim was accepted, two weeks later it was denied. GET. AN ATTY. Let him/her fight this for you. If you don't you will go crazy from stress and pain. Also pray with out ceasing,may God bless you and keep you strong for the fight that's ahead.

  3. #3
    Join Date
    Feb 2007

    Default Re: Ic/California Denied Claim

    While the injury/claim has to be filed with Industrial Commission...DWC/Dept of Workers Compensation, that isn't all that important to your situation.

    Calif does not use IME's. PQME/Panel Qualified Medical Evaluator is likely what you saw. You should have been notified of your right to select the specialty and Dr to act as PQME.
    If the PQME found non industrial... you file for a expediated hearing with judge at WCAB. Judge will have final determination.
    Aggreviation to a prior injury IS generally a compensable injury.

    You should NOT have to pay for Dr visits, or medication, once the claim is filed, you are entitled to medical/meds up to 10K during the first 90 days while the claim is investigated.

    If this is a Calif claim, and you live in AZ, you still need a Calif WC atty.
    You can go to for names of attys close to you.

  4. #4
    Join Date
    Dec 2012

    Default Re: Ic/California Denied Claim

    Thank you both for your reply. It really helps to know someone in the IW forum cares. The company I worked for is in Arizona and my injury was in Arizona. I am meeting with an attorney this Thursday. I am in shock to receive bills for medication. I am hopeful AZ will allow me medication and medical. My fall was on 12/21/12. It seems CA is doing everything to keep me away from seeing any specialist/doctors. I had no notification until last week when I received a letter stating my claim was denied and even if I filed the claim with the Industrial Commisssion they stated in the letter will be denied.

    Thank you again for your help, I really appreciate any help.

    - - - Updated - - -

    You were denied again after they accepted? Now what are you going to do? Thank you for your help. I am in pain all day and night and have no money to see doctors or pay for meds. I am meeting with an atty this Thursday and have filed a claim with the Industrial Commission. As the letter I received stated the IC/CA will have claim denied after they receive.

    Let me know how your claim is going and if the claim was accepted again. Thank you

    - - - Updated - - -

    CA is not California it's Claim Adjuster. I guess that is where the confusion is. Not sure why title has California on the header. I thought I put "IC denied claim."

  5. #5
    Join Date
    Feb 2007
    831 East Morehead St., Ste 355, Charlotte, NC 28202

    Default Re: Ic/California Denied Claim

    Your claim is denied, so you will get nothing until you hire a good workers' comp lawyer, file the right papers (the good comp lawyer will do that for you) and pursue the claim through the proper channels.

    Good luck!
    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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