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claim denied - appeal or lawyer up? - jlarson - 03-12-2011

just got my claim denied. Fortunately I have health and disability insurance so my injury can be cared for. Is the appeal process worth the effort, or should I seek legal counsel? Has anyone had a successful appeal?


RE: claim denied - appeal or lawyer up? - Bummer Knees - 03-12-2011

You need to give more information before your question can be answered.

What is your state, work comp is state specific?

What is your injury and when were you injured?


RE: claim denied - appeal or lawyer up? - jlarson - 03-12-2011

(03-12-2011, 10:36 AM)Bummer Knees Wrote: You need to give more information before your question can be answered.

What is your state, work comp is state specific?

What is your injury and when were you injured?




RE: claim denied - appeal or lawyer up? - 1171 - 03-12-2011

considering the severity of your injuries, the extent of the benefits available, your financial situation and your underlying medical and emotional condition, I'd say the choice is a slam dunk and obvious.

anything else we can help you with?


RE: claim denied - appeal or lawyer up? - jlarson - 03-12-2011

California. Left shoulder probs. started day of flu vaccine (given at employee health), then clearing out office (lots of books, boxes) same day, now months later after conservative treatment it is now at tear. I work for a big hospital district. when I went back to employee health ( 2 times in 1 week ) to report the shoulder pain (and show them the very high injection site) they dismissed it as "not due to the vaccine". I have researched this - the dept of health has papers on this kinda injury. I also reported to the WC carrier that I did a lot of upper body slogging that day - but have never had a problem before. The hosp. appointed MD has recommended claim denied , kinda odd that he had not read the med records before he examined me and started moving my shoulder around (, then comments"oh, you have a tear!" after looking at the papers....Anyway, I was gonna be a good sport and trust the process, but now I think I need help. I love my job, my boss is one in a million and assures me that my job is secure if I have to be off more than the 12 week usual Family leave allows ( this surgery is at least 3 months rehab, and employee health likes us back 100%). Any ideas?
(03-12-2011, 11:48 AM)1171 Wrote: considering the severity of your injuries, the extent of the benefits available, your financial situation and your underlying medical and emotional condition, I'd say the choice is a slam dunk and obvious.

anything else we can help you with?

yes, I am anxious about the ramifications of sueing my employer's workcomp carrier. I love my job and plan to retire from this company. I had a wc claim before (elsewhere), and "signed off" on future medical coverage for that injury in order to get a small settlement ( this was probly not a good idea, but I was naive and that's the past). Future medical coverage for this injury is a concern. I am not interested in gaining financially from a law-suit, but job protection (in the case that I can't get back to work in a timely fashion) and medical coverage are concerns. Considering my last experience - I am questioning whether good outcomes (medical coverage and loss of income) are out there.