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Workers Compensation Claim Denial

worksintheoryworksintheory Registered User regular
Hello H/A.

My wife recently filed and was treated for a work related injury. About a month after this she received a letter from the doctor claiming no injury report had ever been filed. After running that up the chain on command with her employer she is now being told that her claim in being denied for not being work related.

We have already consulted an attorney who has said that due to the relatively minor nature of the injury and because of her employer's reputation in the industry that he would not be interested in the case and said we probably wouldn't find any other lawyer willing to take the case either.

We are exploring ways to file an appeal within the company and have also started the process of filing a complaint with the state agency that regulates workers comp.

I'm mostly making this post to see if anyone has any other insight into the nature of these things. I'm familiar with being jerked around by insurance companies but I've never dealt with workers compensation specifically before.

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    So It GoesSo It Goes We keep moving...Registered User regular
    Just because one attorney gave you that analysis doesn't actually mean no other attorney would be willing to take on your case, so I'd advise getting a second opinion. If the injury was minor and the financial loss to you was not great, it may not be worth hiring an attorney, but most will do low cost or free consults at least.

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    LostNinjaLostNinja Registered User regular
    edited November 2017
    I work for a work comp insurer, but on the safety/prevention side, not with active claims.

    The first thing that pops to my mind when I hear that "not work related" response is that the injury needs to have occurred while your wife was conducting duties associated with her job. Another note is ergonomic injuries are often difficult to prove work related.

    It could also just mean the employer is being a butt about it. If fighting it just keep in mind it won't endear your wife to her employer.

    This won't be helpful to you now, but it's generally best to have the incident report and work comp process started before seeking treatment barring a traumatic injury that requires immediate medical attention. I think you generally need this employer permission before seeking treatment.

    Coming forward after the fact puts the employer in an awkward place where to file the claim they need to file an OSHA incident report (which would have needed submitted within 48 hours of the incident), they wouldn't have had to file that if no treatment besides on-site first aid had been administered. Submitting this late opens them up to a fine.

    LostNinja on
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