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  • WC denied Pennsylvania

    I have a back injury that was denied WC because my claims adj. said that she did not get the medical paperwork from the doctors saying that there was in fact an injury at all so that she did not know it was a wc claim or not.
    In the paper that said I was declined the first two boxes were checked off. Those two boxes checked basicly said that I had agrevated a previous injury and or that the injury was not in the scope of employment.
    At the bottom of the checklist there was a box she could have checked that said "other"and a space where she could have explained why. It also said that "failure to obtain medical confirmation of the injury will not be good cause to deny benefits if caused by dilatory conduct of insurance carrier or employer"
    It has been three weeks since I was injured at work and I have yet to get any benefits from WC. Phyisical Therapy is billing my Primary ins. for now and sending the bill to WC also. So far they have not asked for my $40 co-pay but I am starting to worry.
    The follow up doctor that I have been to 6 times since the injury tells me that they have sent bills faxed and mailed to the WC insurance co., so how they can say that they did not get any info from the doctors yet is beyond me.
    The run around that I am getting is getting old real quick and it looks as if it will be at least 2 more weeks until I can return to work. Bills are starting to kill me and my landlord is not going to so forgiving much longer. Why and how can the WC company do this to me? I have been with my employer for a long time and my store manager is not concerned with me getting better but how soon can I return to work because he is way short staffed. That does not make any sense to me because if I return earlier than I should I will just be hurting myself again and miss more work in the long run. I know life is not fair but this is rediculus.
    I have contacted an attorney and have been to the spine dr. that he reffered me to. Another question I have is why would a lawyer be interested in my case? What does he stand to gain by it? The dr. said that My WC ins would not cover the visit and my primary would not either becuase I was injured at work but told me not to worry because the lawyer that reffered me to him would work it out.
    I plan on returning to work and should not be out much more than 6 weeks total since the incident.

  • #2
    Sending bills to the carrier is not the same as sending medical reports. Bills just state that you were there and treated on a particular day, not why or for what. I suggest you or your attorney contact this doctor and request the medicals be sent. They may want authorization from you before they do so.

    How were you injured? What were you doing at the time? Is that part of your job?

    The lawyer stands to get paid if you have a viable claim.
    I post with the full knowledge and support of my employer, though the opinions rendered are my own and not necessarily representative of their position. In other words, I'm a free agent.

    Comment


    • #3
      How were you injured? What were you doing at the time? Is that part of your job?

      Pushing a vehicle. It is part of doing a wheel alignment. Yes.

      The lawyer stands to get paid if you have a viable claim.

      Who pays him? Viable claim. What does that mean?

      If the WC company accepts my claim because they finnaly get the proper paperwork then who pays the doctor he sent me to?

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      • #4
        If you were doing the duties of your regular job then it is not clear why they indicated that the injury was not in the scope of employment. Getting the medical records to the carrier is the best way to clear this up.

        Your attorney's fees and any IMEs your attorney sent you for would come out of the award you would receive for the injury. If the injury is denied in its entirety, it is not a viable claim.
        I post with the full knowledge and support of my employer, though the opinions rendered are my own and not necessarily representative of their position. In other words, I'm a free agent.

        Comment


        • #5
          Your attorney's fees and any IMEs your attorney sent you for would come out of the award you would receive for the injury. If the injury is denied in its entirety, it is not a viable claim.

          If I recover from my injury, return to work and my claim does get accepted without the attorneys help what is the award I would get? Does that mean he gets a % of my WC pay? I did not think I was intitled to any sort of award.

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          • #6
            If there is no award, there is nothing to receive fees from. If there is an award of some kind, then yes, the attorney is entitled to a portion.
            I post with the full knowledge and support of my employer, though the opinions rendered are my own and not necessarily representative of their position. In other words, I'm a free agent.

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            • #7
              Anotherwards if I recover to where I can return with a full recovery the attorney is out of luck?

              Comment


              • #8
                If WC never pays out anything to you, then what exactly do you think they are going to pay the attorney out of? It isn't a legal question. It one of logic.

                If they reconsider paying you the lost time on their own, then no, your attorney doesn't have anything to be paid for.
                I post with the full knowledge and support of my employer, though the opinions rendered are my own and not necessarily representative of their position. In other words, I'm a free agent.

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