2007-10-18 10:17:04 · 5 answers · asked by chris52374 1 in Business & Finance ➔ Insurance
april 27th i reported my injury to my employer that my shoulder was hurting and i couldnt lift my arm. the work i do requires me to lift heavy cast iron engiine parts over my head on an assembly line doing production work. the doctors said that i have bursitius. and the workmans comp guy said that its not considered a work related injury. my doctors have not said otherwise, and has said that i may need surgery. but i put that off and he said more physical therpy.
2007-10-18 10:57:32 · update #1
i have a lawyer and i have mediation in november.
2007-10-18 10:58:14 · update #2
Well you have every right to appeal your workers comp denial, like the adjuster (insured) you also must prove that the injury did occur at work. The adjuster would have to prove that the denial isn't related to work. Questions rise when there are injuries, was there a witness? When did you tell your supervisors about this injury? Do you play any activities outside of work?
So while your in mediation your attorney will ask for an amount to cover enough for lost wages, surgery and therapy. However be prepared about what might happen in mediation, you might not get the big settlement you want but both sides will eventually come up with something assuming there is no evidence that comes about.
The best thing to do right now is try to settle for a decent amount. If your number comes high and theirs comes low you'll have to consider getting something in the middle. Drag this on and on and all the money you'll get will end up with the attorney.
Good luck
2007-10-18 14:42:53 · answer #1 · answered by A decent answer 5 · 0⤊ 0⤋
You are doing the right thing if you disagree with your denial, however most adjusters would deny a claim without a specific incident. The definition of a work comp claim is an accident or injury arising out of and in the course of employment. A gradual onset of pain may very well be a work comp claim, however you will probably be asked about outside activities, do you have any preexisting conditions, and so on. Preexisting conditions are not a basis to deny a claim, however. If you have an attorney and are in arbitration, you are proceding in the right direction.
2007-10-18 12:30:36 · answer #2 · answered by Don Drapers woman 6 · 0⤊ 0⤋
If you think the reason is invalid - like they say it's not work related, then you have to hire a lawyer. They'll take 1/3. If you can't find one on contingency, then it's because THEY don't think you have a good case.
If you think it's a valid reason - like the illness that happened at work wasn't CAUSED by work (like a heart attack), then you resubmit the medical bills through your health insurance.
2007-10-18 10:49:30 · answer #3 · answered by Anonymous 7 · 0⤊ 0⤋
You may appeal the decision. Insurance companies are FAMOUS for not paying benefits when they can get away with it. Just make sure your claim is legimate and not an attempt to "get over" on the system.
2007-10-18 10:25:47 · answer #4 · answered by Barbara A 5 · 0⤊ 0⤋
Why have you been denied? We need to know what happened first.
2007-10-18 10:46:57 · answer #5 · answered by TedEx 7 · 0⤊ 0⤋