Insurance Carrier giving me the running around

[fit4teen]

Hi, I work in New York City and live in Long Island, new to the world of worker comp as I’m sure many of you are, this story may be familiar or not, but I’m becoming very frustrated with this whole ordeal. I fell and injured my leg at work on 5/5/10. When the injury occurred there was vendor there that saw what happen and helped me up. Neither my supervisor nor HR was available at the time of the incident so I sent an email stating that I fell and injured my leg or so I thought.

Now I’m having other issues which I tried to explain to the insurance carrier such as my toes tingling every day, painful walking, point limping mostly. After going for a 2nd opinion, I was told that I need to get an MRI (foot/ankle/left hip), EMG, physical therapy, etc. because of where I'm feeling the pain. The insurance carrier told me I cannot have this done because I said the injury was to my left leg. These after effects have become more and more severe to the point the entire left side I cannot sit for long periods of time nor stand. I’m in constant pain. Since my job requires walking alot does not help my situation.

After reading the board, I realized I cannot use my personal insurance to get the proper care I need without waiting for approval because this would be considered “fraud”. Is this correct? Is there any way around this? My health comes first and this injury is worst than I thought. I knew W/C would be a problem when the first doctor I went to his “gatekeepers” refused me medical treatment because I did not have the w/c information, such as policy/claim number when I finally got that information after a day of waiting from HR. The doctor sent me back to work the next day despite my complaints of tingling in the toes, pain and limping after I explained that I worked in Manhattan and take the Long Island RR. Now you see why I went for a 2nd opinion.

I’m sorry this is so wordy, but I want to get better and it seems that it is getting worst because of lack of treatment. Does anyone have any suggestion on how I can get proper treatment without committing "fraud"? Desperately need guidance. Thanks in advance.

[jayne]

if your workplace is saying its not a wc issue then you may use your personal insurance however please inform your Dr when and when the accident happened they will say weather or not it could have happened as a result of a job injury and then your personal IC will go after the WC IC

[fit4teen]

Thank you for replying. My company knows this is a wc issue. It's their insurance carrier that is giving me the problem.

[jayne]

I understand but the denial from WC is needed for you to go with your private IC

[fit4teen]

Thank you for the info.

[Bad Boy Bad Boy]

What this means, or is being said.

You take the letter you got, saying you are being Denied. Copy it, make a few copies. Then call your Private Health Insurance. Explain to them you been injured at work. You are being denied treatment for your medical needs. Ask them, if you supply the letter of denial, will they cover you, and help you get proper medical care till things get hashed out at a later date.

They mostly will say okay once they get the denial letter, and they place a Lien on your Comp Claim, so they can recover what they paid out on you.

Kind of simple if you have the denial letter. hen get a Attorney if you don't have one, and let they attorney fight for your rights, taking the stress off you.

[fit4teen]

Thank you, Bad Boy.

[Bad Boy Bad Boy]

I can only hope the information here will help you. As you should have proper medical treatment when you become injured on the Job.

After your claim is denied, you have the option to appeal the denial. If you decide to stand up against the insurance company and dispute the denial, then you will have to go before an Administrative Law Judge (ALJ). It is the ALJ’s job to hear the facts of the case and then make a decision.

If you don't have an Attorney for Workmens Compensation, I would suggest you get one. You need to remember, the Work Comp Insurance uses them, and so should you.