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themisfitkitten · Jul 30, 2013, 02:52 PM

My husband was injured at work two months ago and has been unable to get any help from his employer or WC adjuster, they will not even get back to him. He filed the claim timely and was treated, had MRI, turns out he has disc herniation in his back.

The WC company sent a claim denial, stating it didn't happen at work. A friend who is an adjuster for another company says that even in the case of a pre-existing condition that was aggravated at work, he is entitled to benefits. All along through his treatment the doctor kept saying the ins co was pushing for him to go back to work if he didn't need surgery, so it seemed that they were still involved with the claim even though he was not receiving comp checks.

At his last WC doctor's appt, the dr wanted him to go to work to see how he could handle doing his regular job and would refer him to a surgeon if he couldn't, but the employer refused to let him come back, saying he could hurt himself again, and that he (the employer) would contact the insurance co, dr's, etc. Since then, my husband has been unable to reach his employer and the pain is getting severe again.

Yesterday he tried to set up an appt with the WC doctor who initially agreed, but then called him back to say the ins co had released him to work already and he therefore couldn't come in to be seen. He met with a lawyer today to work on the appeal, and the process has been started.

Since then he has tried contacting doctors on our health insurance and they all refuse to see him due to there being a WC claim involved. He believes he would be refused by the ER and urgent care providers as well.

What can we do? Is he supposed to continue suffering in severe pain that could result in permanent disability? Please help. I am trying to find any info online I can about denied claims and am only coming up with attorneys and the resounding impression that injured workers have no rights whatsoever.

smoothy · Jul 30, 2013, 03:37 PM

Expect a workman's comp fight to take years before resolution either way.

You can get treated under your own insurance... and you should document every dime spent... because if you win your case... your insurance will be reimbursed by their insurance... and your out of pocket expenses reimbursed.

Trust me I feel for you... and it's a shame how they can drag this out... wife's dealing with this now 2 years and counting... and little progress has been made.

However my best wishes you get a settlement much quicker.

themisfitkitten · Jul 30, 2013, 04:07 PM

Thank you very much. The biggest problem is that the doctors who take our insurance are refusing to even see him while this is going on. I really appreciate your response, however, and all the best to you and your wife, too. No one deserves to deal with this. What a messed up system.

joypulv · Jul 30, 2013, 04:42 PM

Sadly, my experience second hand is that you really have to hire a lawyer on contingency. There are responders here who claim that isn't true, but I think a lot has to do with where you are. What's most important is that your husband receive treatment now rather than later, so everyone needs to be threatened with lawsuits by a 'lawyer letter.' Not just an appeal of the WC case.
I would pay out of pocket for a good orthopedist to review the MRI (and maybe get a newer one) and give a second opinion.

smoothy · Jul 30, 2013, 05:20 PM

I didn't realize I let that bit out... My wife has been represented by a workman's comp lawyer since day one... 2 years later we still haven't actually gotten to a formal hearing yet thanks to dozens of attempts to delay and motions to cancel the claim by the companies lawyers.I can't imagine anyone doing it on their own.

themisfitkitten · Jul 31, 2013, 04:05 AM

Thank you. He did get a lawyer who works on contingency, so we're hoping this sends us in the right direction. I asked him to call his lawyer back this morning to see if he can help with any of this process. I would like to get him a second opinion and possibly second MRI but we're worried we can't afford the out of pocket expenses. We're pretty much tapped out after being on just my wages so long and any time we have tried to get any help I've "made too much money" to be eligible. While some would probably say "if you make too much money for assistance, you make enough to get by," I think other people would realize this is not exactly true. :(

At this point I'm hoping he can find something out from his lawyer... my parents might be able to help us with some of the finances (which he absolutely hates doing), and in about 20 days he'll have hit the 90 day mark from the injury and should be able to see the doctors of his choice. In the meantime I'm going to try to get him to someone if we can... this is all just very frustrating for both of us.

I do appreciate your replies, thank you so much.

<3 tmk