my primary ortho put me out total disability for 6 months and i dont think they wanted to hear that this totally blindsided me when they called i feel that they dont want to pay me my monthly benefit anymore i was a server andi hurt my right trap muscle down to my romboids what should i do ?anyone that feels those muscles on me knows somethings up. ive been going to a chrio. for a while but im not getting better just the same. my car was totaled i was t boned by a dodge ram and i was in a sports car ive always been healthy I have no history being sick or anything but all I know is ins. companys dont like paying money out at all can I explore any other way I want to go back to work but theres no way i can support any weight with my shoulder not healed please let me know what i can do
2007-03-12 11:05:19 · 8 answers · asked by eaglehas1 1 in Business & Finance ➔ Insurance
Your policy has a condition in it, that you cooperate with reasonable requests. This is a reasonable request. If you do not submit to the independent exam, they can cut off all payments and close the claim, for your violating the policy conditions.
Don't worry, the indpendent docs are honest. Most likely they'll back up your primary.
2007-03-12 15:19:33 · answer #1 · answered by Anonymous 7 · 0⤊ 0⤋
You have the option of not going. However, they will quit paying you.
If you expect them to pay for an injury, they have a right to have that injury examined by an independent specialist. You've been off work now and they've been paying you for 6 months. They have a right to find out what they are paying for. If you are legitimately injured, then you shouldn't have anything to worry about.
The problem is that there are a tremendous number of fradulant claims. Claims fraud is a multi-billion dollar industry. You may be totally ethical but they don't know you and they don't know if you are or not.
I will also tell you this. (Since I used to be a claims adjuster), there are a lot of chiropractors that are not ethical. Nothing against the chiropractic industry as a whole, but most of the claims I handled in the past that were later proved to be nothing more than running up medical bills to collect a larger settlement, were being treated by chiropractors. Certainly not all of them as MD's have their share of doctors that will run up claims just to collect more fees too. I'm sure your chiropractor is a terrific doctor. I'm just telling you there is a distrust because of past experience of bills being run up with no legitimate injury.
So, Insurance companies have a distrust of chiropractors and they want to have you examined by an MD, probably an orthopedic surgeon.
Get the exam. See how it comes out. As I said, if your injury is legitimate, you have nothing to worry about, do you?
2007-03-12 11:35:01 · answer #2 · answered by Faye H 6 · 0⤊ 0⤋
Do as your ins co directs you. They want a dr that has no benefit to either side to consult and give his take on your condition. This is their way of getting a second opinion, talk it out with the dr, have a thorough exam and communicate what you feel and where. Let him know that your injuries limit your abilities that you once were capable of at the kind of job you have. Once that's done, if you feel, it's not enough always have a heart to heart talk with an actual agent, not someone over the phone. Consider your legal/health options after that.
2007-03-12 11:32:08 · answer #3 · answered by realwrekonizereal 3 · 0⤊ 0⤋
What they're doing is protecting their insured people from fraud. Sadly, because there are so many unscruplous people out there -both patients and doctors - the legit ones have to suffer.
Go see their doctor - if you're truly injured and in pain, chances are, he'll agree with your doctor and you'll REALLY get what you need then!
A chiropractor isn't always the answer - my friend had a shoulder injury from a car accident that flared up an auto-immune disease that she'll need lifelong care for. She ended up seeing another doctor who put her on the proper treatment and she's fine.
2007-03-13 06:11:30 · answer #4 · answered by zippythejessi 7 · 0⤊ 0⤋
So I gather this accident is not your fault. Is your insurance company paying from your medical coverage or from uninsured/underinsured coverage? Otherwise I would think the other driver's insurance should be handling your medical. If they are making payments to you they have a right to send you to another doctor for another opinion. It seems to me that you have no other choice than to go to whomever they send you to. If the findings on the independent do not agree with your doctor's findings they will have you see a 3rd party.
2007-03-12 12:41:31 · answer #5 · answered by hummingbird 3 · 0⤊ 0⤋
if they want u to go to their dr. then go. may be see a chiropractor they might help better .. i was hit by a car too but i was not in a car i was walking
2007-03-12 11:10:43 · answer #6 · answered by cookie H 1 · 1⤊ 0⤋
Sorry but you have to if you want to keep getting money. This is not an unusual request.
2007-03-13 07:27:51 · answer #7 · answered by mamatohaley+1 4 · 0⤊ 0⤋
You must comply to continue your benefits. You don't HAVE to go to him permanently, but you must see him nonetheless, at the company's behest.
2007-03-12 11:21:29 · answer #8 · answered by Anonymous · 0⤊ 0⤋