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Agent coming today - HELP! Indiana

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  • Agent coming today - HELP! Indiana

    Hello! I am having moderate/severe back pain. I was injured at work roughly 8 weeks ago, lifing containers in the shipping department. I am being forced to go to their selected medical facillity, which I have little confidence in. I was diagnosed with a lower lumbar strain/sprain. I asked for several weeks for an Xray or MRI. They refused outright. Finally, due to lack of finances, I had to return to work. This was against my better judgement. I worked for 3 days. On the third day, my back hurt so badly that I was in tears, and I couldn't return. My employer claimed that this was a "new injury", since they had already closed my first case. They sent me back to the same medical facillity, and started the cycle over again. This time however, I did finally get an X-ray and MRI. I guess they were just trying to get off as cheap as possible the first time around. The MRI shows some bulging in one of my discs, but the doctor (so he claims) says it "may or may not be work related". I have no faith in what he says. I have not yet recieved any workmans comp, though I have been requesting it. I am on the verge of loosing my house. The insurance carrier is investigating my claim, before payment of WC benefits. Today they are sending out an on-site investigator to my house. I think he is going to ask me alot of questions. Probabaly some are designed to trick me into loosing my potential benefits. What are his rights to ask, or not ask? Can he legally ask to take a tour of my house? Can he ask me to touch my toes? How might I protect myself? Should I get a lawyer? He gave me only 24 hours notice before his arrival. Nor would he give me an exact time he would be here. Seems like they may be trying to rush this. Please help, he will be here in several hours! Thank you!
    -Erik

  • #2
    What are his rights to ask, or not ask? Pretty much anything he wants but he's not going to be interested in anything other than what is pertinent in attempting to establish liability for your injury.

    Can he legally ask to take a tour of my house? No. He's a guest in your home. You set the rules of what he can see and not see.

    Can he ask me to touch my toes? Sure. It's up to you whether you want to comply.

    How might I protect myself? Protect yourself from what? What's taking place is a routine inquiry as part of your WC claim.

    He gave me only 24 hours notice before his arrival. Nor would he give me an exact time he would be here. Seems like they may be trying to rush this. He probably has other similar appointments that day, doesn't know how long they will take and therefore can't give you an exact time. Additionally, under State law the WC carrier has a limited amount of time in which to determine liability and compensibility.

    Should I get a lawyer? Consulting with a WC attorney would be a good idea.

    Comment


    • #3
      Beth,
      Thanks for your quick response! I have one additional question: What if I go and get a second oppinion from an orthopedic Dr. of my choice? Would doing this have any adverse effect on my WC claim? Would my employer and/or insurance carrier be legally allowed to ignore the second oppinion? My main goal is to get my back fixed and back to work as soon as possible. But their process is just wasting week after week, dealing with their "hired gun" doctor.
      -Erik

      Comment


      • #4
        Q: Can I go to my own doctor?
        A: In Indiana the employer directs medical care. If you do not feel that you are receiving adequate medical care you may file an Application for adjustment of Claim with the Workers Compensation Board. Make sure that you always communicate with your employer regarding medical care!

        This is straight from the state site. Just going to your own doctor is not sufficient. If you want your employer to pay for it, you have to play by their rules.

        If the doctor does not verify that the disk bulge happened when you lifted the container, or the subsequent re-injury, then it isn't covered under WC. Treatment for the back strain/sprain would be if that was sustained at work. WC does not cover everythin that is wrong with a particular body part, just whatever occured definitively during the accident.

        As your case appears to be contested, consulting with a lawyer wouldn't be a bad idea. Also from the state site

        Q: What do I do if I have trouble receiving benefits or compensation from my employers Workers Compensation insurance carrier?
        A: First, talk with your employer's insurance carrier or your self-insured employer to find out why your claim is denied. Often disputes can be resolved by sharing information or obtaining medical records.

        If you cannot resolve the dispute, you can contact our ombudsman division to explore Alternative Dispute Resolution options. If these alternatives do not help you must file an Application for Adjustment of your claim with the Workers Compensation Board. This form is available on the Workers Compensation website at http://www.in.gov/icpr/webfile/formsdiv/29109.pdf.

        Most workers' compensation claims are resolved to the satisfaction of the injured employee, employer, and insurance carrier. Usually, the appropriate payments are made and services provided. However, there are times when the employee disagrees with an employer's/carrier's decision and wants to formally challenge that decision.
        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

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