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Fallguy

Denial process

39 posts in this topic

Finally, thank you.  I can understand that they found inconsistency based on how you write here. You are not going to be able to successfully move this through the appeals process without a lawyer. You can't swing a dead cat without hitting a work comp lawyer that handles these cases with no up front money. Google your "YOUR CITY California Workers Compensation Lawyers" and call a few. 

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2 hours ago, RetiredinVA said:

The statement of the American that the 

The statement in the medical report that the injury is industrial is certainly not binding on the carrier.  It is not the function of the medical providers to determine whether the injury was job related or not.

 

What evidence or information would bind them? If all medical evidence including qme supports the injury as industrial related. 

     

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7 minutes ago, PayrollHRGuy said:

Finally, thank you.  I can understand that they found inconsistency based on how you write here. You are not going to be able to successfully move this through the appeals process without a lawyer. You can't swing a dead cat without hitting a work comp lawyer that handles these cases with no up front money. Google your "YOUR CITY California Workers Compensation Lawyers" and call a few. 

 

Thats what I can’t understand. I’ve only talk to one person and she’s no longer working for the carrier. On the day if the accident, the lead worker reported the accident. I never spoke to the adjuster that denied it. I never spoke to HR other then emailing him the note that had me out one week. Unless he’s trying to say I didn’t contact him but how can I contact someone I don’t know or have access to.

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1 hour ago, PayrollHRGuy said:

The adjustor who denied likely tried to contact you both by phone and mail and was unable to.

 

But you have a lawyer now.  Where in California are you that the nearest WC lawyer is three hours away? 

 

I only received his letter that he’s taking over the claim. This was a few days after I told them I was terminated. Then two months later the doctor gave me a fax copy of denial letter dated one day after his letter that says he is in charge of my claim.

       I’m not sure it matters now but can a claim be denied before I filed a claim? 

     There are plenty here but they won’t take it. I was gonna share the reason but you wanted to delete it. It’s a little complicated because I didn’t know about any benefits by the time I realize it, my claim was already denied.

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True, I read that the employer has to file one on my behalf. I just thought they had to also send me one and explain the coverage. I’m not complaining because I can at least appeal it

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You are correct that your posts are very unclear about what happened, when, and what you are trying to accomplish. A claim was filed because a claim can't be denied that doesn't exist. If there isn't sufficient medical documentation to support that there is an injury, that the injury was causally related to the accident, or that the medical treatment requested was not appropriate for the injury or something covered under WC, then the claim would be denied. If there were inconsistencies in what was reported or the medical records had a different story than was reported, the claim would be denied.

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On ‎9‎/‎28‎/‎2018 at 7:25 AM, Fallguy said:

ive had several different post

 

That's the problem. You open so many threads nobody knows what you are talking about and nobody has the time to go through your posting history to try and figure it out.

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On 10/4/2018 at 3:09 PM, adjusterjack said:

 

That's the problem. You open so many threads nobody knows what you are talking about and nobody has the time to go through your posting history to try and figure it out.

 

My apologies. I’m fairly new to the workers compensation world and i intended to only ask a few questions. I realize that one or two questions leads to ten more. 

      If I can give any advice to new injured workers, I would say be patient, adjust your day to day of living accordingly. Hire an attorney right the moment you know that you will miss some time from work. 

       The most important lesson I learn from my experience is, do not be surprise if the insurance carrier denies your claim. It doesn’t matter if you have 5 doctors that supports your injury. Do not talk to the adjuster. There job is to deny your claim especially if they change the adjuster. This just makes it easier for them to have an excuse if you can make it past 2-3 years.

 

thanks 

      

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On 10/6/2018 at 1:43 PM, Fallguy said:

 

My apologies. I’m fairly new to the workers compensation world and i intended to only ask a few questions. I realize that one or two questions leads to ten more. 

      If I can give any advice to new injured workers, I would say be patient, adjust your day to day of living accordingly. Hire an attorney right the moment you know that you will miss some time from work. 

       The most important lesson I learn from my experience is, do not be surprise if the insurance carrier denies your claim. It doesn’t matter if you have 5 doctors that supports your injury. Do not talk to the adjuster. There job is to deny your claim especially if they change the adjuster. This just makes it easier for them to have an excuse if you can make it past 2-3 years.

 

thanks 

      

 

REALLY BAD ADVICE HAS BEEN PUT IN BOLD.

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2 hours ago, PayrollHRGuy said:

 

REALLY BAD ADVICE HAS BEEN PUT IN BOLD.

 

 

I can what you mean after I reread those sentences. The messages doesn’t give any reason to support it.

 

I’ll take back the word “advice”. I’m not an expert and I was speaking only from my personal experience so to give anyone advice would not be the smartest thing to do.

 

I should have said, don’t be surprised if your claim is denied. You would probably have a better chance to successfully appeal your claim if you get help from someone who will look out for your best interest. The adjuster may not always look out for your best interest because he has to do his job. That job is to cut cost where the law allows it.

 

good luck 

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