claim denied (of course) now what?

[lookmanohands]

Hello to all from sunny yet chilly Wisconsin. Here's my story as brief as possible. I started a new job in Oct. 09 which includes rapid, repetitive motion of my hands/wrists. In Jan. I complained to my manager that my hands were getting sore and stiff after working. Let me add that when we were in training, we were advised to wear wrist splints since it was known that carpal tunnel was prevalent in this industry. I wore splints when I felt I needed them. When my hands started to go numb, and the pain increased, I went to see my family practitioner and he sent me to a sports medicine dr. She gave me more restrictive splints and at that time I said I didn't need work restrictions until I could tell whether or not the new splints would help. She scheduled an EMG for a few weeks later. At that appointment, it was determined that I had bilateral nerve entrapment that was moderate to boderline severe. She recommended that I meet with a surgeon ASAP. When she asked me where I worked and I told her, she replied that it didn't surprise her that I had CTS since I was the 3rd patient from this employer that she had seen that week. I was placed on work restrictions and the co. was able to accomodate me. The next month I met w/the surgeon and due to a change in his schedule, he was able to due the right hand that week. I have kept my employer informed of everything happening and wc claim was filed after the EMG. I also kept the insurer aware of everything. When I called to tell them I was having surgery right away they said the only thing they needed was a statement from the dr. that my injury was work related and that I should send the claims to my health insurance and they would reimburse them when it was determined to be work related. 3 days later, I got a letter telling me to appear for an IME. When I went to that appt. the dr. was asking me ?s about my martial status, what kind of job my husband has, do we have insurance, etc. and not a whole lot about my hands. His exam was brief and I knew walking out of there my claim would be denied. I should also note that in 2004 I had an EMG for shoulder pain(rt side only) and it showed very mild CTS. I wasn't even aware of that since I had no symptoms and the EMG was for the shoulder. Before I even received the denial letter, I called the insurer and told them about the inappropriate ?s asked at the IME. They told me my claim was denied and I requested a copy of the report. It has been over a month and I still have not received that report. I contacted DVR and received the paperwork for a hearing. I just had the left had done last week and when I went to rehab, they told me my claim had been denied. Now my insurance co. is calling and asking all kinds of ?s about is it a work injury, date of injury, etc. So what do I tell them? I don't want my husband to lose his job because we have high medical claims as we have seen that happen to other employees where he works. Do I need to hire an atty. or go to the pre-hearing myself. I'm fairly sure the IME report will state that I had a pre-existing condition or that there is no way that I could have developed this so quickly, but on an average shift, I am handling 10-12 thousand items. Doesn't WC in WI cover "aggravation" of a pre-existing condition? Any way, I'm at my wits end over what to do and desperately need your wise advise. I can't eat or sleep and my stress level is getting as high as my medical bills. If I need an atty., can anyone recommed a great one in WI?

[jayne]

yes you need a lawyer if they have already started giving you trouble.....off hand I dont know if any of our members are from WI but hang on and someone will help...good luck and welcome to the forum... try the off topics for support,fun and games again welcome

[1171]

if you want the claim as workers comp you'll need a medical report connecting your current/recent condition to your work duties.
http://www.dwd.state.wi.us/wc

[lookmanohands]

Sorry, not finding the form via the link. I looked in the forms tab.

[chrischris]

There is no form. 1171 posted the site for informational purposes. To help yourself, you need to be aware of the WC laws in your state.

The doctor that dx'd you should have written in his report that your condition is related to your work. Get a copy, then lawyer up!

[lookmanohands]

Thanks for the clarity. The dr did state that my injuries are work related as well as sending the ins. co. a statement stating the same. They still denied.

[1171]

For lawyer referral check out state bar
http://www.legalexplorer.com/lawyer/lawyer.asp