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  1. #1
    Join Date
    Jun 2018
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    1

    Default WC Ins Co Not Complying with State Labor Board Judgement

    My Workmans' Comp claim was made in: NH.

    In a nutshell: is there any way to "go after" a WC IC legally, like sue for punitive damages, causing needless pain and suffering (literally), and force them to comply with the state labor board's verdict: WC IC "will be responsible for any and all medical expenses arising from or related to the original injury."

    I understand that they have the right to protect themselves from fraudulent claims, but this goes way beyond that; they've consistently seized upon any and every means to delay or avoid payment altogether. I got forced out of a pain clinic because they weren't paying the clinic, and the clinic eventually refused to make any further appointments until the balance was settled. It remains unsettled three years later.

    I live at a 6 on the 0-10 scale. It only goes up from there. I need some means of pain relief, and massage and chiropractic are pretty much all that are left (surgery isn't an option, tests revealed), and they just don't want to pay for these (I pay the providers, then seek reimbursement).

    How can they get away with this? It's not just immoral, it's illegal, isn't it? I've been told repeatedly that "well, yeah, that's just the way they are and there's really nothing you can do about it." I find that hard to believe, and I'm here looking for a "second opinion," of sorts.

    I realize that any assessment of my situation and options is hard to make without pretty comprehensive information, but I'm just trying to find out if it's even possible at all to make life as difficult for them as they are making it difficult for me, via legal means. If it's "no way, no how," then I guess that's that. If not, though, I'm extremely interested to hear just what I can do.

    Hoping for a favorable reply, but ready for further disappointment. Can't get much worse than it already is.

  2. #2
    Join Date
    Oct 1971
    Posts
    5,089

    Default Re: WC Ins Co Not Complying with State Labor Board Judgement

    KRH
    is there any way to "go after" a WC IC legally, like sue for punitive damages, causing needless pain and suffering (literally), and force them to comply with the state labor board's verdict: WC IC "will be responsible for any and all medical expenses arising from or related to the original injury."
    they've consistently seized upon any and every means to delay or avoid payment altogether.
    Did the carrier give you written notice of the denial, a reason and advise you of your right to appeal?
    If not, file penalties for non-compliance - if so, did you file an appeal?

    Payment of Medical Bills
    The carrier has the obligation to pay the cost of medical, hospital and remedial care related to the injury.
    The carrier has thirty (30) days from the date of receipt of the invoice or statement to make payment or deny the bill. The denial must be in writing to the injured employee, copy to the provider and to the Labor Department, provide a reason for the denial and advise the employee of their right to request a hearing. Failure to make payment or to deny within thirty (30) days will result in a fine of up to $2,500.00[/B].
    https://www.nh.gov/labor/workers-com...ical-bills.htm

    Failure to Pay or Deny - Lab 512.01
    The commissioner shall assess civil penalties of up to $2,500.00 against employers and insurance carriers who fail to pay or deny compensation promptly, fail to give the commissioner timely notice of such action, or fail to provide vital information in a timely manner. In determining the severity of the civil penalty, the commissioner shall document violations of the carrier or employer and the fine shall be based on the number of violations of the statute and rules prior to the assessment.
    The commission may assess a civil penalty of $2,500 for failure to pay a medical bill or to deny payment, notifying the health care provider, employee and labor department of the denial. 281-A:23V(e)
    https://wiki.theclm.org/wiki/290#Pen...X0yLYVGQyHOGAA

    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.

  3. #3
    Join Date
    Feb 2007
    Location
    831 East Morehead St., Ste 355, Charlotte, NC 28202
    Posts
    3,771

    Default Re: WC Ins Co Not Complying with State Labor Board Judgement

    I imagine a fairly simple motion to compel payment could have been filed and pursued, and they would have had to pay. But for that you would need the help of a competent workers' comp lawyer. I am unaware of any effective way for an unrepresented person to make the system work like it should. The pro se person just does not know how to pull the correct levers of the legal system.
    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
    Oct 1971
    Posts
    5,089

    Default Re: WC Ins Co Not Complying with State Labor Board Judgement

    complwyr
    I imagine a fairly simple motion to compel payment could have been filed and pursued, and they would have had to pay.
    Maybe, it depends on the reason for denial.

    They can't just willy nilly deny without cause plus they have to follow protocol as stated above.
    From what I've seen over the years, there's more to the story than what's being posted.
    That carrier isn't about to expose themselves to penalties on a whim - usually when they deny they have standing to do so.

    Without knowing the reasons for denial, we're just guessing - it's impossible to have an objective debate.
    This is why people need to include relevant info in the initial posting instead of adding facts with each response - that get's too convenient.

    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.

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