Claim denied - Supervisor denies injury report - Printable Version
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Claim denied - Supervisor denies injury report - JalavTX - 09-24-2010 01:50 AM
My first post here..... I'm mad, sad, in pain, broke, scared and a single mom. Injured 3/25/10 at work and verbally reported it, in detail,to supervisor next morning. Cont. to work in pain until unable to stand it anymore. Saw family doc and got release from work 5/10/10. Took all FMLA and was then terminated - still unable to work and still under medical care.
My claim has totally been denied due to not reporting it in 30 days. BUT I DID!!!!!!!!!!!!!!! My supervisor did not file the report as was her responsibility. Now she states that she "doesn't recall me ever reporting it to her at all" - which is a lie!!!!!!!!! My prior co-workers won't stand up for me because they are too afraid of retaliation and or losing their jobs, too.
I have received nothing!! I can never return to my pior work and maybe not any work at all because now both hands are involved including other prior medical problems. I am already out > $1000 in medical bills for this injury. Anyone been through this and is there anything I can do? I have a lawyer now and we're going for the BRC next month. My lawyer says it's my word against hers and she can't say how it will go - I could get nothing at all still.
MORAL OF STORY: NEVER TRUST YOUR EMPLOYER TO CARE ABOUT YOU AND BE SURE THEY FILE THE REPORT YOU REPORTED TO THEM!!!!!!!!!
Thanks in advance,
RE: Claim denied - Supervisor denies injury report - 1171 - 09-24-2010 09:06 AM
your medical records from your family doctor should document how and where the injury happened so it's not just your word against theirs.
you can appeal if the claim is denied by the comp court.
RE: Claim denied - Supervisor denies injury report - Manley2 - 09-24-2010 09:42 AM
What you told the doctor can help your case and your lawyer will work on that. Trust us many employers try to lye and say you didn't report it to them. In my case even with a written report and them treating me they decide once the cost was going to be more then they wanted to pay, they denied it was work related. They lost but this is when a good lawyer is worth having. Once you get hurt all most employers think about is the bottom line and how much is this going to cost. Some are pro-active and try to get you well fast and some try to just get you to just go away. Everybody that walks away is money back in their pocket.
RE: Claim denied - Supervisor denies injury report - JalavTX - 09-24-2010 12:46 PM
Thank you so much for your valuable insight - I really appreciate it.
Manley2, how long did it take for you to get your case won?
My medical records do support that I sustained a work related injury, but the problem is that the report to the carrier wasn't filed within 30 days. I feel that trying to prove the report of injury to my supervisor (within 24 hours) is going to be an uphill battle. My injury was 3/25/10 and the report wasn't done until 5/20/10, the day after I saw the hand specialist the 2nd time and was already taken off work per my family doctor's order (dated 5/10/10).
I'm wondering if it would be more clear to state my case using one of the three "Exceptions to the 30 Day Rule" from the Appeals Panel Decision Manual (http://www.tdi.state.tx.us/wc/idr/apdliability2.html):
1) "the employer...had actual knowledge of the IW's injury; or
2) "good cause exists for failure to provide notice in a timely manner".
Both of these first 2 exceptions would apply to my case. However, the 1st one would be having to go around and around again my my employer.
The 2nd exception would apply if I argued "trivialization", meaning I was "acting as an ordinarily prudent person would have under the same or similar circumstances" and did not give notice until a reasonable time after the "seriousness of the injury is suspected or determined". I did self-treat my injury (since I'm a physical therapist), then saw a hand specialist about 5 weeks after the injury (4/30/10) when I was not improving. On my 2nd visit to him, 5/19/20, I was very clear that my injury was serious enough to prevent me from being able to do my job duties.
Any input on this? Am I overcomplicating everything? I just can't sit and do nothing and let my employers win - it isn't right!!!!!!
RE: Claim denied - Supervisor denies injury report - Manley2 - 09-24-2010 02:09 PM
As for winning my case I will try and explain it. First I'm not settled yet. I got hurt in Nov 2005 and was only treated my the nurses at work for a month before I saw a doctor. After some time and seeing my own doc things got going as far a treatment. WC was paying the bills until my PM doc wanted to try a SCS. This caused them to say my case was not WC. This started them not paying bills and cutting my pay. Lawyer started working on getting this all covered by WC but we didn't get anywhere until we got a hearing after they put me off working saying they had no work with my restrictions. This hearing was in Nov 2008. They had put me off work in Jan 2008 so it took that long to get the hearing. Two doctors had to be depo'd and stuff which their IME doc was a big pain in the rear to it done but judge would not go on without it. Won that hearing but didn't get that answer until like Feb 2009, they appealed that and got that hearing in Aug 2009. Won that but they didn't start paying until the end of Jan this year. Lawyer is working on getting this settled but not sure how long that will take. Had my hearing for SSDI this month and was awarded my disability so not sure how that will delay any of this. Hope that helps answer your question. One thing I can say is NOTHING is quick in this fight. Remember WC is fighting to make you go broke so you will take almost anything they offer. It's hard to hold out but like in my case it helped to think about how I was going to be able to live the rest of my life. Taking a low offer doesn't pay the bills
RE: Claim denied - Supervisor denies injury report - JalavTX - 09-24-2010 05:47 PM
Wow, I had no idea this process could take that long!!! I'm really glad you finally got both the W/C and SSDI benefits. How is the SCI working? (is that spinal cord stimulator?) Your story gives me a better idea of what I could be up against.
I also am trying to think of the long range picture and have also applied for SSDI. I was tempted to "take the deal", but that wouldn't have even paid the bills for a whole month. I admire your preserverence and hope I can hold on as well.
Thanks for your input and insight :-)
RE: Claim denied - Supervisor denies injury report - AQA - 09-24-2010 06:59 PM
Did you by chance tell your treating PCP that the injury was do to work???? Did you by chance list the forementioned on ANY medical documents that the drs. office would have placed in your medical records.
At present, the way I see it is. You can only back track your medical records to the date of injury, but you can not prove it happened at work. How is your attorney getting paid????? If it is the typical method. She must think something is there.
Have you checked out the services of DARS.???? I don't know if they they can help or not, but you may want to check into the services they offer.
RE: Claim denied - Supervisor denies injury report - Manley2 - 09-24-2010 08:22 PM
Yes that is a spinal cord stim and it helps allot. My case has taken a long time but don't let this scare you, yours might not take that long or it could be longer. It's just good to not think in a hurry because that is what they want and this costs you money. I hope your doesn't take too long but you need to be ready. In my case I need help the rest of my life and yes they tried to low ball me at one point, it's hard to keep putting up with it but when you stop and think about what it's going to take to survive it makes you hold out. Now with what I'm still getting life is not going to be easy but I feel a little more secure about it
RE: Claim denied - Supervisor denies injury report - Bernie57 - 09-25-2010 02:34 AM
It seems more and more, Supervisors and HR are suffering from a bad case of memory loss. I was injured in June 26, 2005.
I had torn my rotator cuff at work and my HR Manager filed the paperwork with heart attack! Heart Attack is not an injury. Looks good for the company, for me not so much. It took 8 months for an MRI approval, 10 months for surgery approval. From June 26, 2005 until Febuary mid month 2006, I recieved $0.00. Nothing. Both my PCP & Surgeon requested the MRI & Surgery, as did my IME. I did finally get approval for p/t, but then the Ins. company never sent in any payment and I was told my p/t days were over. I had a lawyer who was not the sharpest knife in the drawer. I finally was recieving a comp check from 4/2006 until 6/2007. I had the surgery but it did not go well. And in 5/2007 the rotator cuff repair did not hold and it re-tore. One month later my lawyer settled for $44.84. What a mess. My surgeon refused to try another surgery since my general over all health was not all that great. So I pleaded my case to NYS.
Feb 2009 they picked up my case and I am now on SSD & Medicare. I now have p/t every week and will for the rest of my life (I am 52)
So... I recommend a good lawyer who is not fresh out of law school. And request a hearing from your State SSD division. In the end I ended up with 9 court dates and 3 IME visits before SSD stepped in. Just do not give up, as you can see, I did. The best to you. Bernie
RE: Claim denied - Supervisor denies injury report - Manley2 - 09-25-2010 09:53 AM
Bernie57 you are so right, just don't give up! That is what they hope we will do and for those looking to get rich this forces them out of the system and stops the trouble, But those out there like us we have to stay the coarse because as much as we want we need to get the treatments to even hope to get better. It's so sad they put us thru all this fight just to get what we need but to them it's business and saving money is all they care about. I will say I'm sure there are companies out there that do the right thing and help out the injured employee's but when it comes to injuries that will be life long or very expensive, the fight seems to be on.