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Workers Comp nightmare

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Unread 04-19-2012, 04:53 PM   #1
Joy6
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Default Workers Comp nightmare

Hello,

I am in the state on NJ. I am new to these boards and need to seek some advice from anyone that can shed some light or have been in my shoes.
I was involved in a motor vehicle accident with my boss at work a couple months ago. We were t-boned by another driver who ran a stop sign and I hit my head on the side window and blacked out briefly. I immediatly went to the ER and they did not perform the proper tests like an MRI, X-rays and let me go home.

I was to dazed and confused to suggest otherwise. Within a few days of the accident I felt like I went into a dazed and tired existence. I had horrible headaches, fatigue, I was so angry and just couldn't shake the feelings. I tried to go back to work and ended up having a panic attack when a worker had to explain something to me 6-7 times before I could really get what she was saying.

I told my mom and she said that I sounded like I may have had a concussion. I called the WC claims adjuster and she sent me to one of their doctors who diagnosed me with a concussion and referred me to a nuerologist. I went to the nuerologist and he ordered an MRI and X-rays for my neck, and he took me out of work.
They came back normal but because I am still having alot of those symptoms he made a referral for a nuero-psychological evaluation.

He said that WC does not always like to pay for this testing but was sending me anyway. Up until the evaluation I was not having problems with WC, I received a TTD check for lost wages as well. Well this past Friday, I did not receive my TTD check for the past two weeks. When I called WC, they said because I had reached a "cap" on what they are going to pay me out.

I told them that I am still out of work and receiving ongoing treatment...I wanted them to explain more but the rep just referred me to the claims adjuster since they had made that decision. I immediatly called my WC attorny and he said that the answer I got was basically nonsense.

He said I am entitled to 70% of my wages as long as I am out of work. He does not want me talking to the claims adjuster and he said he would call her. He told me today that she is not returning his phone calls. I am still waiting to hear what the next steps are to get them to respond. I also received a call today that my report from the nuero-eval was ready and the clinical director would be submitting it to the insurance company so they could authorize a more in depth evaluation.

He said that I will be feeling this way for a minimum of 3 months post-accident and at that point they will see what symptoms I am still having then and decide the best course of treatment, but he is going to give me therapy in the meantime to help cope with the day to day problems I am having.

Needless to say I am already a mess and for WC to be giving me these problems is making things worse. They already denied to pay for one of my medications and now they are not sending money for lost wages.

Are they allowed to do this? and why would they stop sending checks out of the clear blue?? I have not been released to work yet and I don't really know when that will happen. I hold a stressful mgmt position and my symptoms would totally interfere with me doing my job. Are these tactics??

Its not like they are not going to recover all of their costs from the the driver who hit us insurance so why the hassle? It was a bad accident and I would automatically think that would entitle me to a higher level of care. Thanks for any advice or info
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Unread 04-19-2012, 05:08 PM   #2
Jo*mar
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You might share your post on our Traumatic Brain Injury and Post Concussion Syndrome forum - others there may be going thru similar wc issues.
It is a fairly active forum -
http://neurotalk.psychcentral.com/forum92.html

If you have an wc atty they should do all or most of the official claim communicating for you.
Seems that wc should have sent a letter before stopping the payments.

Be sure to follow any restrictions by your doctors re the claim, esp if a higher paying case/claim they (wc) might be watching your activities.

[Are these tactics??]
YES!
They hope you will give up and just go back to work..even if you feel horrible.

See the useful sticky threads for more info on wc and how things proceed.

http://neurotalk.psychcentral.com/thread1117.html
http://neurotalk.psychcentral.com/thread124924.html
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Unread 04-19-2012, 06:17 PM   #3
Joy6
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Thanks...it is very sad that things are like this. I just want my basic benefits until I can function at a job again. If this didn't happen at work I wouldn't be having these problems. It's so early in my claim that I am still at step one with treatment. I will go to that forum as well.
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Unread 04-25-2012, 02:27 PM   #4
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Your level of treatment is dictated by medical findings, not the severity of the accident. You have an attorney, and once you are represented, he is your best resource for all of your questions.

It sounds like your claims person is trying to force you to pursue them for every benefit you are entitled to, and that is just wrong. However, that is a battle for your attorney now. I would expect that he would begin to push for your benefits to resume and for treatment consistent with your injuries.

I would also ask your attorney if you are entitled to sue the driver directly, but do remember that auto insurance policies are limited to paying out within the limits of the policy. Apparently NJ has two insurance options, and one does not automatically include a bodily injury liability coverage unless it is chosen as an option. It also appears that the minimum coverage is between $10,000-15,000 per incident, which could be easily maxed out. And there is always the chance you were hit by an uninsured driver or one who has let their insurance coverage lapse. Another question I would ask the attorney is if your employer's auto policy might cover you, or even your own under-insured coverage. However, most insurance is paid as reimbursement, meaning you pay the bills and submit them after-wards to the insurance company.

But, truly, your first step may be to familiarize yourself with how worker's compensation works in your state. Not only are you then better able to tell if your attorney is working hard for you, but it also helps you separate what you think should happen from what the law actually provides. Much frustration with w/c is due to lack of understanding of how comp was deigned to work, and unrealistic expectations on the part of the injured worker.
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Unread 05-07-2012, 12:47 PM   #5
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This why some physicians refused to take WC. That sounds disgraceful to the patient but the bottom line is WC is a terrible pain in the butt for everyone who deals with them in one form or another. They are difficult to get a precert from for a med, test or procedure as they don't return calls. Once you get a precert, they are notorious for no pay/slow pay. There are other ins. companies that pull the same thing. It is sad to tell a potential new patient that their ins. isn't worth the paper it is printed on and they will need to pay cash, up front, or find another physician who is part of a large group that is willing to chase the companies for their money or absorb the loss.
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Unread 05-09-2012, 02:35 PM   #6
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Quote:
Originally Posted by spine95 View Post
This why some physicians refused to take WC. That sounds disgraceful to the patient but the bottom line is WC is a terrible pain in the butt for everyone who deals with them in one form or another. They are difficult to get a precert from for a med, test or procedure as they don't return calls. Once you get a precert, they are notorious for no pay/slow pay. There are other ins. companies that pull the same thing. It is sad to tell a potential new patient that their ins. isn't worth the paper it is printed on and they will need to pay cash, up front, or find another physician who is part of a large group that is willing to chase the companies for their money or absorb the loss.
At least in CA, a doc may not treat a WC injury and have them pay out of pocket. It does force patients to choose a doc from a small pool. There are also rules about switching your primary treating physician, which makes things all the more complicated.

For the OP, I forgot you had an attorney. Once you retain one, they generally instruct you to have no direct contact with the insurance company. (Even for routine and trivial matters.)

Has your attorney given you contact info for his/her paralegal and/or assistant? 99% of my contact with my attorney's office is with his assistant. She is most definitely overworked, but she is always dependable for the important matters. Not receiving TTD is an URGENT matter. If they can't resolve this matter within a few days (from whatever source is the most convenient) then your attorney should schedule a conference, hearing, etc.
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Unread 05-11-2012, 06:10 PM   #7
Spiney95
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Quote:
Originally Posted by LIT LOVE View Post
At least in CA, a doc may not treat a WC injury and have them pay out of pocket. It does force patients to choose a doc from a small pool. There are also rules about switching your primary treating physician, which makes things all the more complicated.

For the OP, I forgot you had an attorney. Once you retain one, they generally instruct you to have no direct contact with the insurance company. (Even for routine and trivial matters.)

Has your attorney given you contact info for his/her paralegal and/or assistant? 99% of my contact with my attorney's office is with his assistant. She is most definitely overworked, but she is always dependable for the important matters. Not receiving TTD is an URGENT matter. If they can't resolve this matter within a few days (from whatever source is the most convenient) then your attorney should schedule a conference, hearing, etc.
Of course you are correct as guidelines vary from state to state. Have a good weekend.
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Unread 05-12-2012, 12:01 PM   #8
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In 2003 (Oregon) my claim (multiple RSIs) was denied.
My atty wrote a letter to treatment providers that more or less stated my denied claim is being appealed.

So based on that letter I was still able to get PT/testing/treatments by using my pvt ins as a secondary payer, but the bills were placed on hold, so no bills went out until the hearing or case closed.

Before the hearing date atty asked me to collect all billing due notices and send/fax them to the office..so they could get them listed in the claim for payment.


I don't know if any of that will help in your situation , but I guess there are ways around some of the problems. I didn't need any surgery & no meds so only ongoing PT was the issue for me.
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