workers comp?

[reefreak29]

about 4.5 months ago i had surgery to my knee(cartilage removal from flap) due to a direct blow at work . now i need another surgery carltalidge replacement and workers comp are doing everything in there power to get rid of me.
my doctor is one of 4 surgens in my state to do the procedure. workers comp sent me to one of there doctors and he said it didnt have anything to do with what happened at work???, and there standing by that . they pretty much said oh well now what , has anyone had experience with this?

 

[sigmachris]

I don't know much, but first idea that popped into my head is are you union? If so talk to them to help get their hired guns on your side.
If you are not union, ask your doctor if he would back up the claim in court that your procedure is needed. Then look at the cost of the procedure and the potential cost of hiring a lawyer to fight for you. Is it just cheaper to get the procedure done on your own nickel and hopefully you have good insurance that will help ease the costs.
I'm sorry I couldn't be more help, but good luck to you.
-Chris

 

[reefreak29]

im not union , and yes my doc would back me up. im just wondering why such the hard time, i thought they were for the workers best interest lol thats messed up

 

[c42480]

I just went throught this with my shoulder with workers comp. I had the first surgry and than needed another a few months later. I had to get a lawyer and 8 months later i got what i needed. Workers comp does not like to pay for any more than they have to and they will fight you over everything.
Chuck

 

[crashbandicoot]

Originally Posted by reefreak29
im not union , and yes my doc would back me up. im just wondering why such the hard time, i thought they were for the workers best interest lol thats messed up

They are only out for themselves . Honestly seek a lawyer you will get what you need a lot faster that way . They see the average joe as stupid and once you have a lawyer they can no longer play stupid because the lawyer knows the law and what your intitled to . More times than not the lawyer has a list of doctors to send you to that have no problems going to court or signing testimoials about your injury

 

[reefreak29]

Originally Posted by c42480
I just went throught this with my shoulder with workers comp. I had the first surgry and than needed another a few months later. I had to get a lawyer and 8 months later i got what i needed. Workers comp does not like to pay for any more than they have to and they will fight you over everything.
Chuck
i dont think i could last that long that sucks.

 

[reefreak29]

Originally Posted by Crashbandicoot
They are only out for themselves . Honestly seek a lawyer you will get what you need a lot faster that way . They see the average joe as stupid and once you have a lawyer they can no longer play stupid because the lawyer knows the law and what your intitled to . More times than not the lawyer has a list of doctors to send you to that have no problems going to court or signing testimoials about your injury
yes i am going to see one tomarrow. hope it works

 

[scubadoo]

Originally Posted by reefreak29
about 4.5 months ago i had surgery to my knee(cartilage removal from flap) due to a direct blow at work . now i need another surgery carltalidge replacement and workers comp are doing everything in there power to get rid of me.
my doctor is one of 4 surgens in my state to do the procedure. workers comp sent me to one of there doctors and he said it didnt have anything to do with what happened at work???, and there standing by that . they pretty much said oh well now what , has anyone had experience with this?
Did you sign a release and/or any papers after the first surgery? If so, you might want to read those.

 

[scubadoo]

Originally Posted by reefreak29
im not union , and yes my doc would back me up. im just wondering why such the hard time, i thought they were for the workers best interest lol thats messed up
The job of any insurance company and workers comp is to put as many obstacles between you and paying a claim. Sure, some are obvious and get paid to some extent...but the mission is to pay as little as possible.
Just becasue you are right or even if the facts are on your side...does not mean you get the help/$ you deserve or paid for.

 

[scubadoo]

Originally Posted by reefreak29
i dont think i could last that long that sucks.
This is part of the game...how can you last when you are without pay plus any $ for the surgery..co-pays. deductibles, etc out of pocket.? They are banking you can't...so they'll throw a few bucks your way one day....or they'll bank on you will give up.
Your file will be first in the cabinet one day if you hang in...and they'll offer you a few crumbs. Your atty will advise you to go for it...and he/she will take their cut leaving you even less.
Unfortunately...that is how the workers comp game works. If they have an out...they'll take it...and you'll have a long road to drive down before you see a penny.
Sorry to say this.....but it happens all the time.

 

[darthtang aw]

I second everything everyone has said about a lawyer. Once you get one and he sends off a letter, your comp claim may speed up.
On a side note, isn't workers comp a government funded system in most states?

 

[geridoc]

You have to have a lawyer. When my wife broke her elbow at work she filed for workman's comp, and the doctor who told her that her elbow was broken, and actually casted her arm, came into court and testified that her el bow had not been broken! We won, but only because we had a lawyer. In New York
State you automatically get legal representation, but only at the time you show up in court, so the lawyer probably isn't too familiar with each case. However, ours was particularly incensed by the doctor, and made a real effort.

 

[geridoc]

You have to have a lawyer. When my wife broke her elbow at work she filed for workman's comp, and the doctor who told her that her elbow was broken, and actually casted her arm, came into court and testified that her el bow had not been broken! We won, but only because we had a lawyer. In New York
State you automatically get legal representation, but only at the time you show up in court, so the lawyer probably isn't too familiar with each case. However, ours was particularly incensed by the doctor, and made a real effort.

 

[crashbandicoot]

Also don't be afraid to go to a second lawyer if you dont like what the first one says . When I was hurt in an auto wreck the difference between lawyers was night and day . One got me medicaly ontrack and healthy as well as the full legal amount we could get from the insurance, the first one wanted to go for a quick 13k and didnt give a rats about my medical condition , Just his 33%.

 

[reefreak29]

ty for the replies i will post again after i talk to a lawyer

 

[renogaw]

Originally Posted by Darthtang AW
On a side note, isn't workers comp a government funded system in most states?

i would doubt it, its an insurance made mandatory bo govt, but i can't see the govt funding it.

 

[renogaw]

reefreak--
you need to talk to your boss as well, and ask them how they filed the claim. they should have told their insurance that it was indeed a work accident, and there should be no question. you could also ask your boss to call them and tell them to cut the crap.

 

[jennythebugg]

Originally Posted by reefreak29
im not union , and yes my doc would back me up. im just wondering why such the hard time, i thought they were for the workers best interest lol thats messed up
no one insurance related is for your best intrest only their own

 

[sluggo]

Originally Posted by renogaw
i would doubt it, its an insurance made mandatory bo govt, but i can't see the govt funding it.

I own a small business here in Kentucky and have employees who have to be covered under Workmans Comp. It is not State funded, it is funded by the employers, but administered by the State. Here in Kentucky it is called KEMI which I believe stands for Kentucky Employers Mutual Insurance. My wife does all of the paperwork which is why I am not sure of the name.
Don

 

[reefraff]

Nobody knows the trouble I've seen. Been dealing with workers comp for over 7 years. DON'T SCRIMP ON THE LAWYER. Get a shark. Not only are you moving against the tide in my experience the majority of the workers comp people are boarderline incompetent.
One thing that happens is based on the initial diagnosis they set aside a certain level of funds to handle your case. When you have additional surgeries needing to be done is screws with their structure and they hate that.
In my case I could write a novel about all the screwups. When it came time to close my case they evaluated me and were going to settle out at 22% permanently disabled. Well meantime back at the ranch I had applied for Social Security disability benefits. They rated me 100% permanently disabled on the first attempt with no lawyer. That almost never happens. Once I got that my lawyer (wife's boss

) called the disability people and at the end of the conversation said "well the social security administration has assessed him 100% perm total. We'll see you in court". Once the Workers comp manager caught her breath again we went from 22% to 100% in less than 5 minutes. That is how corrupt most workers comp systems are.