Denied and Termed

[Babebahn]

Isabo Wrote:Hello everyone!!!

This new forum looks great!! I havent posted in a while but I've been reading!! Princess had me parinoid with her IC lurker!!! But I feel so isolated and alone..

IC denied my claim. The weird thing is they don't deny my injury they just denied my disability?? I haven't gotted any bills yet, will they still pay for my treatment? When I took the denial letter in to my Doc and asked the same question she just said we'll try it that way. PT I can't afford the co-pay of 30 per visit plus I've had my yearly 10 visits.

Since I was termed my hubby picked up the insurance (we work'ed at same place) will I have problems with pre exzisting condition?

My temination papers said voluntary/ failure to return from leave. Does this sound right to you? The doctor had me off.

I'm off to the Doc this Friday he said this time we'll make a decision. I don't know if this involves manipulation under anestisa sp? or surgery.

recap on injury:
no-dominate left shoulder inpingement /frozen shoulder. Signs of inpingment in right. medium labor job lots of overhead lifting.

Thanks,
best wishes to all of you

Isabo:
Do you have an attorney? There are some pre-existing that sometimes cause a problem BUT your physician will inform you about these things as will your attorney.

[jayne]

binders I have 3 accordean files jammed full and more on the way even a call to the lawyer is noted as well as a daily diary to record my day and the different levals of pain as I now have daily migrains and I am logging in what I was doing 30 min to an hr before each headache to find different triggers

[red1030]

Hi Isobo....I think I am a little confused. Did the IC deny your claim from the beginning? Was there a report completed and then filed with the state about the injury within the guidelines? You said you were denied on 3/20 and then termed on 3/29. Just like Princess said there may be some confusion if the company did not recieve your note from your doctor saying that you are to stay out. If the time out takes you beyond the EFML time as described by Bad Boy then they can do this. If not, then there would be some reason. I know that PA same as New Jersey hires "at will" but even then there is a reason, because most companies do not want to pay unemployment. If the reason is a doctors note whether W/C denies you are not, you should have the full 12 weeks before most companies would term you. EFML is a federal law. If this time frame is beyond the EFML then that is why they termed you. In my husbands case, they denied his claim after 6 weeks. Sounds similar to you in that, in the beginning they said they could not find anything. Then when he saw his own doctor because they denied him, the MRI that IC ordered clearly states that he has 3 herniated disc in his cervical region. Even knowing this they continued to deny him coverage. I picked up his care on my disability benefits. It has been almost 11/2 years and he is still waiting for a court hearing. The IC did pay for everything until he was denied, but nothing since that time. He was termed from his job because he refused to return after the EFML time was completed. He had a doctors note and still has not recieved a release to return to work.

Also, hospitals are very slow to get the bills out. However, the healtcare providers probably continued to send the bill to the IC and as history has it HMO's do not pay for up to 12 months following a hospital stay. They may be expecting them to pay and once they call and realize that that is not going to happen then the bills will come your way. Best of luck.