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  1. #1
    Join Date
    Mar 2015
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    2

    Default Employer Denies that Injury Occurred at Work

    Hi everyone. Just looking for some non bias people to talk to. I live in Pennsylvania. I got hurt on thanksgiving. Slipped on some ice, caught myself, twisted my knee. Did everything I was supposed to do, initial diagnosis from ER and my employers follow up doctor was an LCL sprain. Began receiving temps compensation. Two months later, still painful and swelling, employers doctor sends me for MRI. Complex, completely torn meniscus. At my 90 day review on Feb 25, employers insurance company conveniently denies my claim. I immediately hired an out of town attorney from a large firm with good reviews, got all my petitions filed and all my documents in order. I've never been treated for this knee period. My first hearing is on April 13. I'm lucky enough to have 10 weeks of paid leave accrued that I'm using now, but that will run out far before this is done. I just want my surgery and to go back to work. The doctor treating me is actually really good and is willing to testify for me, and my lawyer is confident. I'm just stressed out. I want this to be over. I still have 8 weeks of rehab when I get the surgery.
    Last edited by NervousonComp; 03-30-2015 at 06:50 AM. Reason: addition

  2. #2
    Join Date
    Oct 1971
    Posts
    5,193

    Default Re: Stressed Out and Waiting

    Without knowing the reason for the denial, it's impossible to comment - not sure of what you're asking.

    Tony
    Last edited by tony; 03-30-2015 at 07:25 PM.
    Moderator Responses are based on my personal bias, experience and research - They do not represent the views of the admin nor may be accepted in the legal community, always consult an attorney.

  3. #3
    Join Date
    Mar 2015
    Posts
    2

    Default Re: Stressed Out and Waiting

    The reason is that I didn't get hurt at work. Nonsense. Because she could, that's why I was denied. Now the burden of proof falls on me, which is cut and dry, but I just have to lose sleep wondering how I pay my bills while I'm waiting for a court to decide.

  4. #4
    Join Date
    Oct 1971
    Posts
    5,193

    Default Re: Stressed Out and Waiting

    At the end of the day, your case will be decided by the medical evidence.
    You'll need a doctors opinion that this injury occurred during the course of employment to prevail.
    You are correct in that it is the burden of the claimant to prove his case, all the carrier has to do is poke holes in the evidence.

    If you have a doctors opinion supporting your claim, you should be fine.

    Tony
    Moderator Responses are based on my personal bias, experience and research - They do not represent the views of the admin nor may be accepted in the legal community, always consult an attorney.

  5. #5
    Join Date
    May 2015
    Posts
    5

    Default Re: Employer Denies that Injury Occurred at Work

    How did you make out? Any luck?

  6. #6
    Join Date
    Aug 2016
    Posts
    7

    Default Re: Stressed Out and Waiting

    tony,
    my husband was denied, the medical evidence was there, however because the primary dr did not remember where and what type of my husband did -- the judge deemed the primary dr not credible.

  7. #7
    Join Date
    Oct 1971
    Posts
    5,193

    Default Re: Stressed Out and Waiting

    Quote Quoting Snowman12 View Post
    tony,
    my husband was denied, the medical evidence was there, however because the primary dr did not remember where and what type of my husband did -- the judge deemed the primary dr not credible.
    That's a valid reason to deny the claim.
    Just proving an injury exist isn't enough - they may admit an injury but deny it's work related.
    You'll need a doctors opinion that this injury more likely than not, occurred during the course of employment to prevail.

    Tony
    Moderator Responses are based on my personal bias, experience and research - They do not represent the views of the admin nor may be accepted in the legal community, always consult an attorney.

  8. #8
    Join Date
    Aug 2016
    Posts
    7

    Default Re: Stressed Out and Waiting

    Quote Quoting tony View Post
    That's a valid reason to deny the claim.
    Just proving an injury exist isn't enough - they may admit an injury but deny it's work related.
    You'll need a doctors opinion that this injury more likely than not, occurred during the course of employment to prevail.

    Tony
    tony, thank you
    during an appeal how can this new opinion be introduced???

  9. #9
    Join Date
    Oct 1971
    Posts
    5,193

    Default Re: Stressed Out and Waiting

    Quote Quoting Snowman12 View Post
    tony, thank you
    during an appeal how can this new opinion be introduced???
    It can't, the trial is over -that train left the station.
    Like Tim Belt said in your other thread, new evidence can't be considered on appeal.

    Tony
    Moderator Responses are based on my personal bias, experience and research - They do not represent the views of the admin nor may be accepted in the legal community, always consult an attorney.

  10. #10
    Join Date
    Feb 2007
    Location
    831 East Morehead St., Ste 355, Charlotte, NC 28202
    Posts
    3,808

    Default Re: Stressed Out and Waiting

    Unfortunately, litigation of a denied claim has to be done right the first time. No do-overs if the evidence was not sufficient the first time. An appeal is not a do-over by any stretch of the imagination. This is why it is so important for injured workers to hire lawyers who know how to try a work comp case in court, and who have done it at least a few dozen times before they hire them. The best lawyers for work comp are often the ones with the most experience taking denied cases or denied issues to trial--and WINNING them. If you do your research, you can find out who these lawyers are.
    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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