What do you do if the company dosent support the entire claim?

[wcrazed1975]

Hello i am a 33 year old male fROM Dallas TX that has only been on the job for a month and had a accident at work.I reported it as soon as it happen and was asked if i want to go see the company Doctor.I replied let me continue working today and see if it persist and if it dose then i will go, the pain in my left shoulder and neck burned and felt like something tore so after a couple of hours i couldnt take it anymore.I returned to the store manager and let her know that i wanted to go to the doctor, that the base of my neck and left shoulder were burning and felt is if something tore,so i went to the doctor.I work 2 full time jobs after a recent lay off to make what i am use to making and now i am off both jobs from doctors orders, against what i tried to do which was work light duty. tHE INJURY HAPPEN ON 5/19 AND I WAS PULLED OFF ON 5/30 THE ADJUSTER APROVED A c-SPINE FOR the injury from the orthopedic surgen and a neck x-ray from the company doctor and is now telling me that they wont cover the neck injury only the shoulder because the company dosent feel that the injury floowed from the neck, there words. What do i do if they dont cover the neck on this injury? I am new to this and already going crazy with the calls and letters from the WC. Any Advice?

[red1030]

Hi wcrazed and welcome to the forum. Your situation sounds very similar to what happened to my husband except he had been on his job for 3 years and was the department head for his team. He thought he also had a shoulder injury and it turned out it was a neck injury. W/C would not support the neck so they would not do any testing etc. Then he had some testing on his shoulder and they could not find anything. He was on W/C TTD for about 2 weeks. He was miserable and in so much pain, could not lift his arm etc. Unfortunately another company bought his company and the day he was hurt was the first day that the new company was in and I believe this is why they denied his claim as well...... He just settled after three years..it didn't even cover the current medical bills that we accumulated..however, he is ok now, needs surgery of the neck but refuses.

Also indicate the state you are in and others may be along who can give you more assistance. My only recommendation is that you obtain a very good lawyer now. Find a lawyer who is certified in W/C issues and also then go online in your state and if your state provides infomation about w/c court hearing check out who the lawyers are that won their cases...might give you an idea of where to start looking. Good luck and best wishes...also welcome to the forum and check out the "off topic" forum...we have a lot of fun there.........Red

[1171]

I'd discuss the situation with the office of injured employee counsel
http://www.oiec.state.tx.us/

[wcrazed1975]

1171 Wrote:I'd discuss the situation with the office of injured employee counsel
http://www.oiec.state.tx.us/

Thanks 1171 i will check into it.I was told by my doctor to wait and see what happens because when wc finds out that you have hired and attorney they play hard ball and began to deniy everthing, what do you think?

Thanks
wcrazed1975

[wcrazed1975]

red1030 Wrote:Hi wcrazed and welcome to the forum. Your situation sounds very similar to what happened to my husband except he had been on his job for 3 years and was the department head for his team. He thought he also had a shoulder injury and it turned out it was a neck injury. W/C would not support the neck so they would not do any testing etc. Then he had some testing on his shoulder and they could not find anything. He was on W/C TTD for about 2 weeks. He was miserable and in so much pain, could not lift his arm etc. Unfortunately another company bought his company and the day he was hurt was the first day that the new company was in and I believe this is why they denied his claim as well...... He just settled after three years..it didn't even cover the current medical bills that we accumulated..however, he is ok now, needs surgery of the neck but refuses.

Also indicate the state you are in and others may be along who can give you more assistance. My only recommendation is that you obtain a very good lawyer now. Find a lawyer who is certified in W/C issues and also then go online in your state and if your state provides infomation about w/c court hearing check out who the lawyers are that won their cases...might give you an idea of where to start looking. Good luck and best wishes...also welcome to the forum and check out the "off topic" forum...we have a lot of fun there.........Red

Hi red1030 and thinks for the advice so did your husband stay at his job or did he move on? Every since the accident my fellow managers have acted like i dont exsist i realy feal that since Texas is a no falt state and that you can be fired with in the 90 day probation peroid for anything that they will let me go, but the claim has been filed so i still will be covered for atleast the shoulder part of the accident. At 33 and never having a work injury i am still new and not sure were to go from here the doctor just took me off work a couple of days ago and i am now beganing to worry about how i am going to pay my bills house, car,ect.This can be a little over bearing but i have went threw alot of the threads and see that other people really are worse off than i am so i must say that my is insignifagant in compareson.I truley belive the good lord wont put me threw anything that i cant handle so i remain optamistic and let him help me threw.i just cant help worring see the fact is that i also have lupus and live with a little pain at all times and sometimes it can be very over bareing,and i call my mom and she says keep the faith.

Thanks for the advice and kind words and i hope your husband is doing well and opps to get the surgery if it what he needs.

Thanks again wcrazed1975

[Deb]

Hi wcrazed,

I sent you a PM. I hope it helps you with your case. Please keep us posted.

Deb

[Lilly]

Hi crazed ,
Whatever happens...do not get too discouraged, and NEVER give up the battle.
WC probably knows (through past experiences) that adding the neck may possibly cost em big time! This is why the denial.

Make the phone cal 1171 suggested & see what they say. Otherwise, hire a great WC lawyer (NOT one off tv ads) and too bad if WC wants to play hardball....the lawyers know that same game & play it just as well!
Take care & good luck, Lilly

[wcrazed1975]

Lilly Wrote:Hi crazed ,
Whatever happens...do not get too discouraged, and NEVER give up the battle.
WC probably knows (through past experiences) that adding the neck may possibly cost em big time! This is why the denial.

Make the phone cal 1171 suggested & see what they say. Otherwise, hire a great WC lawyer (NOT one off tv ads) and too bad if WC wants to play hardball....the lawyers know that same game & play it just as well!
Take care & good luck, Lilly

Thanks Lilly i am really worried about the expenses of hiring an attorney but what ever it takes to stay out of some of the situations that the forum have gone threw.

Im just ready for it to all be over already and from what i see it has just began for me.Well i guess what make us weak will also make us stronger!

wcrazed1975

[Lilly]

Hi again,
In case you don't know....
Most WC lawyers do not charge an initial fee...they take their payment in form of a percentage of the monies they obtain for you.
if ever you have questions...you can call around and get info over the phone and it costs you nothing.
Lilly

[Deb]

By the way in the state of Texas we have the service of an Ombudsmen for those that do not have an attorney. Just another option for you wcrazed.

WHAT IS AN OMBUDSMAN?

An Ombudsman is a specially trained employee of the Office of Injured Employee Counsel (OIEC) who can assist you if you have a dispute with your employer’s insurance carrier free of charge. Each OIEC ombudsman has a workers’ compensation insurance claims adjuster's license and has completed a comprehensive training program designed specifically for OIEC ombudsmen. Ombudsman services are provided at no cost to injured employees.

The ombudsman can answer questions you have regarding your dispute (by calling 1-866-EZE-OIEC 1-866-393-6432). And, upon request, the ombudsman can:

Help you prepare for benefit review conferences;
Help you prepare for benefit contested case hearings;
Attend benefit review conferences and benefit contested cases hearing with you and communicate on your behalf with the parties, and;
Help you prepare appeals and answer carrier appeals to the appeals panel of the Texas Department of Insurance, Division of Workers’ Compensation.