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+--- Thread: Carpal Tunnel/Repetitive Stress Syndrome in TN-Workers Comp Issue (/showthread.php?tid=6347)
RE: Carpal Tunnel/Repetitive Stress Syndrome in TN-Workers Comp Issue - jayne - 01-13-2009 09:16 PM
use your insurance while fighting it just be sure your IC knows its a WC claim that has been denied if your doc says work injury get a lawyer
RE: Carpal Tunnel/Repetitive Stress Syndrome in TN-Workers Comp Issue - kate - 01-14-2009 12:07 AM
Tizz Wrote:Ok here's an Update....
Next thing is her asking me all these strange question's like-Do I smoke,
What color is my hair,How tall am I,How much do I weigh etc. Whats
up with that? What do those things have to do with me filing a claim??
Those are typical (not strange) questions in an insurance claim. In fact most companies have a set questionnaire that they give to the adjusters and they must ask the questions and document the answers.
They don't always apply to every case, but, height weight mean something depending on the type of injury. So does smoking, drinking, etc. If you have to have surgery, smoking slows down the healing process.
I had an claim where the gentleman was 5'8" and 400 lbs with a knee injury. That is significant because of how someone who is extremely overweight heals with a knee injury. He was only in his 30's but because of his weight, smoking, drinking, etc. they couldn't do surgery and he couldn't heal with the weight on the knee. Therefore, an injury that may have been healed in 6 months, never healed and he was permanently disabled.
And in most cases, it doesn't even have any relevance. But the IC has to try to figure out what the claim may cost them in the long run and as the above situation describes, based on some of the answers, it can make a huge difference.
Physical description, Hair, eye color. any tattos, body piercings, etc., usually has several reasons.
1.) for the IC and adjuster is if they have to do surveillance, it's easier to identify the person on the video. However, they can get the description from the employer in most cases.
2.) There have been cases where someone sent someone else in their place because that other person did have injuries but no insurance and the "IW" really didn't have injuries but sent the other in their place for treatment and RX's.
3.) There have been people who have gotten treatment because they knew a friend had a WC claim and pretended to be the IW and then the IW appeared to be fraudulent because it appeared that they sent someone else in their place to get a larger settlement.
Again, that is a typical "First Contact questionnaire and most adjusters just go through every question regardless of whether it pertains.
I actually had a "trainee adjuster" go through the questionnaire and one question was "Do you have any dependents? Answer: NO
Few questions later, "Do you pay child support?" Answer: YES.
They never put together that if you have NO dependents, who are you paying child support to?
Don't overthink and stress about some of these details.
Just be honest about everything. Don't make up an answer to a question just because you feel pressured to say something. If you don't know, say so.
Otherwise, just answer the questions and don't get to concerend about the "ulterior motive" There isn't one. They've been given a set of questions to ask you because they have to.
RE: Carpal Tunnel/Repetitive Stress Syndrome in TN-Workers Comp Issue - Tizz - 01-14-2009 11:51 AM
Thanks Kate for the info!!! That makes sense to me
now regardless of how strange etc.
I called WC in my state of TN today because I was never given a panel of Dr.'s and the adjuster told me that if I was seen by a Dr. before the claim was denied or otherwise that I'd have to pay them.
Well the WC lady told me today that regardless,I should have been
given a panel of Dr.'s to see, so she was calling the adjuster herself
to tell her that is the law etc. and to get me that list of Dr.'s.
In the meantime,I have an appointment with my Internal Meds Dr. today because now I have a lump that has come up on top of the injured hand right on a vien.
Thanks for the info!!
RE: Carpal Tunnel/Repetitive Stress Syndrome in TN-Workers Comp Issue - jayne - 01-14-2009 12:00 PM
your adjuster isnt gonna be happy......lol
RE: Carpal Tunnel/Repetitive Stress Syndrome in TN-Workers Comp Issue - Tizz - 01-14-2009 12:05 PM
Well she was wrong to tell me what she did regardless!! The WC people know the law regarding whats supposed
to be done etc. I don't care if the adjuster is not happy as long
as my rights are taken care of the way they should be.
RE: Carpal Tunnel/Repetitive Stress Syndrome in TN-Workers Comp Issue - jayne - 01-14-2009 12:09 PM
go get em................if you dont stand up for yourself no one will...cept us of course
RE: Carpal Tunnel/Repetitive Stress Syndrome in TN-Workers Comp Issue - Tizz - 01-14-2009 12:17 PM
Thanks LOL I need all the help I can get right now.
Im now concerned about these 2 lumps/raised spots on the top of my injured hand, I hope its not a bloodclot or something. Im also going to see her for something else.
I got a letter from the adjuster today that was finally left for me,Its
a letter asking me to release medical info. My question is this??
I don't have to authorize any medical information pertaining to
anything other then my hand injury,Correct?? This leter states
"Please list the names of all doctors you have seen soncerning medical
problems relating to your HAND(S)." So this means that this will be
the only medical information they can get,right?? And its only pertaining to this injury am I correct??
Thanks
RE: Carpal Tunnel/Repetitive Stress Syndrome in TN-Workers Comp Issue - Tizz - 01-14-2009 08:12 PM
Update:
After speaking with Tn WComp today and after I told them I
wasn't offered a panel of 3 Dr.'s and also told that I couldn't
see a Dr. until my comp claim was either accepted or denied,
They told me the adjuster was Wrong in telling me that. She then asked me for the adjuster's name and number and she would call them herself.
Not long after she did, I got a phone call and email giving me
the names of Dr.'s I could see. I already had an appointment with
my own Internal Med Dr. which said my condition had gotten alot
worse and she ordered 11 different x-rays of my hand,arm,wrist &
elbow. I have an appointment tomorrow at a designated Dr.office at a
Centra Care and I guess we will see what happens after that.
The WComp lady also told me to fax copies of my own Dr.s diagnosis
to the adjuster along with the medical release form.
RE: Carpal Tunnel/Repetitive Stress Syndrome in TN-Workers Comp Issue - Tizz - 01-15-2009 09:50 PM
Here's Another Update:
I went to see 1 of the Dr's I was given a choice to see after I
got off of work. He didn't take me off of work which is ok with me,
but he did say NO use of right hand what so ever. I can't do much
with my left hand but 'll try. He also referred me for an EMG. He
gave me Meloxicam and a New Brace to wear.
Now th trouble is going to start with AIG's Insurance Adjuster,The
1 that told me I couldn't be seen by a Dr. until the claim was
denied or accepted. I am almost willing to bet that when they call
her to get the referrel to have the EMG done,she's going to say NO.
So if that happen's,then what do I do? Do I call the WC lady
I spoke to about the other issue with the adjuster??
Ok,Now on the paperwork the Dr. gave me,It says
Anticipated Date of MMI 1/29/09... What does that mean exactly??
I won't see him again until I have he EMG.
Ok,For those of you that have had Carpal Tunnel....What is an EMG
and what takes place when they do 1??
Thanks
RE: Carpal Tunnel/Repetitive Stress Syndrome in TN-Workers Comp Issue - kate - 01-15-2009 10:35 PM
There's a chance that since the adjuster had already been chastised for doing the wrong thing, she may approve the EMG, just so she doesn't get in trouble again. But, should she deny the EMG, I would call the state (the WC lady) again.
Many times, in companies where they handle claims for more than one state, they put an adjuster on files in states they aren't familiar with and the adjuster makes decisions based on the states they are used to without knowing the laws in the new state. Really not the adjusters fault if they are not trained in the state laws but that is still no excuse. The supervisor should know the adjuster doesn't have the knowledge and take care of it.
Just make sure you follow up. I think you'll do fine.