WC - ACL Injury - Questions

[r3techeagle]

My spouse was injured on the job at the beginning of the month which resulted in the right ACL being torn. Workers Comp has covered the initial diagnoses, X-rays, MRI, and the referral to an Orthopedic Surgeon. Surgery is scheduled for 3 July. The doctor performing the procedure has ordered a CPM machine for post-op therapy. We researched online what this machine was for and how it worked. We called the surgeon's office to request an authorization for the device from my spouse's employer's insurance company (AIG). The surgeon's office informed us that the company that manufactures the device is responsible for getting the authorization. My spouse was given literature on the company and we have a contact number. We were told that if we have not heard from the company by the day of the surgery, that we need to call the company prior to leaving the hospital.

At this point, we do not know what to think or do... we have become rather disheartened by the whole mess and are contemplating legal channels. The employer's insurance company has the necessary information for job reimbursement pay... we are just waiting on word of a check.

I know we are in for a long process here, as post-op therapy is 6 months. Our concern here is our we getting in over our heads and should we be considering legal channels just as a precaution. We are both novices with all of this, and have several questions, that as of yet have gone unanswered from the employer's insurance company.

Anyone have any suggestions or inputs? They would be greatly appreciated.

[Still in Limbo]

After what I've personally been through, and many others also have been through with this system, my opinion is if you feel you may need an Attorney then you probably do. The choice is yours of course, but I would err on the side of caution especially with surgery coming up and be protected with a good w/c Certified Attorney. The first Consultation is usually Free, and they don't make any Money unless they win for you in Hearings, or at settlement time if there is one. I don't think you have anything to lose by retaining Counsel, and the peace of mind of knowing you are protected is sometimes worth more than money!! Best of Luck to your Husband, and Welcome to the Boards!!

[Bad Boy Bad Boy]

Injured 1 Month, and surely the Insurance Company knows what is needed for such surgery. Will they act fast on any of the issues you mentioned is another story. But one needs to know, the Insurance Companies have many cases not just one case. In such, paper work at times does take time. Even approvals. Getting an Attorney at this stage, before surgery will and I repeat that will slow the process down more, for all the paper work with an Attorney needs to be filed and such. Talking to Attorney's is free. do it, and learn things first, also doing so, if you need an Attorney, you then can make a choice of who might be better for you.

[1171]

Different states have different rules. In some states there is little an atty can do in the begining of a claim or until it's denied.
What was the outcome of your discussions with the carrier?
Getting an atty will not necessarily get your questions answered; reading a few posts from those with attys will confirm how frustrating and time consuming the legal system can be.
Don't rush into it because you can't back out later. court dates may be far apart and difficult to get especially if they want to play "hardball".

[jayne]

please become one of us we will help you all we can........if things are ok just talk to your state ombudsman.......my husband didnt need a lawyer at all for his entire case on the other hand I needed one from the beginning.............please be careful we have all found the spouse of an injured worker easily becomes an IW from trying to do it all come on down to off topic and enjoy our board we love it here

[rickandkryss]

I think that if anything it does not hurt to at least have a consultattion with a few attorneys. However I caution you to not jump and hire the first one that tells you what you want to hear. There are good ones and then there are those that forgot why they started there career in the first place. Interview multiple attorneys and hire the one that can readily answer your questions and not just point out the monetary part of it...you dont want an attorney looking for a quick buck. I would ask questions like "how long does it take you to respond to phone calls from clients." "Will you be on my case or will your Paralegal?" "How many of your cases end up settle and how many go to court?" Ask questions that will allow you to see the attorneys work ability because when all is said and done it will boil down to how well your attorney did his/her job.

Finally...most important thing to remember...when you hire an attorney don't forget that YOU are paying for a service and there is nothing wrong with demanding you get what your paying for as you would with any other service you pay for. Would you allow a plumber to come in, put gum on a leak and bill you $500? Heck no!