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Do I have to give Sedgwick a recorded statement before seeing a doctor ?
#1
I was informed by my company Workman's comp specialist that I must give a recorded statement to the 3rd party Administrator Sedgwick or I would not be allowed to see a doctor and the claim would not be allowed to move forward.. Is this legal ? I told them i do not wish to speak to Sedgwick before I see a doctor and retain an attorney if needed. I also recorded the conversation and the specialist was aware i was recording.
 
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#2
As far as I know, I never did that with them... I went to my own doctor, they confirmed job injury and I went from there.. I also got a lawyer too... Believe me, with them, you'll need one.. I also applied for Comp online. Never saw a specialist from them at all.
 
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#3
[quote='1313' pid='165777' dateline='1504738330']
I was informed by my company Workman's comp specialist that I must give a recorded statement to the 3rd party Administrator Sedgwick or I would not be allowed to see a doctor and the claim would not be allowed to move forward.. Is this legal ? I told them i do not wish to speak to Sedgwick before I see a doctor and retain an attorney if needed. I also recorded the conversation and the specialist was aware i was recording.
[

Right, glad it worked for you they Denied my claim and refused to let me see a doctor I just contacted an attorney I feel like there is something shady about having to give a recorded statement before being treated for an injury. This can't be legal ? I mean to say that the claim can't move forward until i give this statement seems unfair
 
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#4
yes it's legal. they are entitled to information necessary to investigate a claim. It may seem unfair but they are not going to pay without information; they don't have to trust you.
you are entitled to litigate your claim from the very beginning you don't even have to file with the employer.
of course your benefits will be withheld until the court makes a decision but thats the choice that comes with litigation.
once your atty notifies them of representation they will likely schedule a deposition and get your statement under oath.
that's the general procedure but there could be minor differences depending on the state. without knowing yours i can't advise further.
Reminder :
........Each state has their own comp system; POST YOUR STATE to get accurate information. Use the search feature to find information from similar questions.
THANKS FOR POSTING.
 
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#5
(09-06-2017, 07:31 PM)1171 Wrote: yes it's legal. they are entitled to information necessary to investigate a claim. It may seem unfair but they are not going to pay without information; they don't have to trust you.
you are entitled to litigate your claim from the very beginning you don't even have to file with the employer.
of course your benefits will be withheld until the court makes a decision but thats the choice that comes with litigation.
once your atty notifies them of representation they will likely schedule a deposition and get your statement under oath.
that's the general procedure but there could be minor differences depending on the state. without knowing yours i can't advise further.

Wow , unbelievable so they can refuse to allow you to see a doctor because you don't give a statement and than make you wait weeks if you cant afford to pay for your own treatment while waiting for a judge to rule? Just seems really wrong ! I mean to ask for a statement is one thing to demand or auto deny the claim without it seems illegal to me . I am in New Jersey
 
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#6
"The employer's WC insurance carrier will evaluate the claim and determine if it's compensable under the WC law. They will contact the injured worker, the employer and the medical provider to make this assessment. If the claim is accepted, they will direct the injured worker to an authorized medical provider for treatment. "
http://lwd.dol.state.nj.us/labor/wc/work...index.html

you maybe confusing workers compensation with health insurance. it's a common misconception when the employer/payer starts asserting their rights.
Reminder :
........Each state has their own comp system; POST YOUR STATE to get accurate information. Use the search feature to find information from similar questions.
THANKS FOR POSTING.
 
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#7
(09-06-2017, 08:12 PM)1171 Wrote: "The employer's WC insurance carrier will evaluate the claim and determine if it's compensable under the WC law. They will contact the injured worker, the employer and the medical provider to make this assessment. If the claim is accepted, they will direct the injured worker to an authorized medical provider for treatment. "
http://lwd.dol.state.nj.us/labor/wc/work...index.html

you maybe confusing workers compensation with health insurance. it's a common misconception when the employer starts asserting their rights.

I understand the employer has rights. I feel they also have an obligation to be truthful about their rights. To ask for a statement is 1 thing to demand a statement to process a claim seems illegal. Also to misinform the injured employee of their rights seems illegal If they said hey we would like a statement but you don't have to give it is one thing to say if you don't give a statement we wont file or review your claim seems to be another situation to me. It seems like they acted in bad faith I'm not a lawyer obviously and i appreciate you knowledge it just doesn't sit well with me
 
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#8
Maybe the "tone" of the conversation could have been better. Nobody likes to be threatened with consequences even if they are a likely result. A good attitude goes a long way in making a difficult situation better.
Reminder :
........Each state has their own comp system; POST YOUR STATE to get accurate information. Use the search feature to find information from similar questions.
THANKS FOR POSTING.
 
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#9
(09-06-2017, 08:39 PM)1313 Wrote:
(09-06-2017, 08:12 PM)1171 Wrote: "The employer's WC insurance carrier will evaluate the claim and determine if it's compensable under the WC law. They will contact the injured worker, the employer and the medical provider to make this assessment. If the claim is accepted, they will direct the injured worker to an authorized medical provider for treatment. "
http://lwd.dol.state.nj.us/labor/wc/work...index.html

you maybe confusing workers compensation with health insurance. it's a common misconception when the employer starts asserting their rights.

I understand the employer has rights. I feel they also have an obligation to be truthful about their rights.  To ask for a statement  is 1 thing to demand a statement to process a claim seems illegal. Also to misinform the injured employee of their rights seems illegal  If they said hey   we would like a statement  but you don't have to give it is one thing  to say if you don't give a statement we wont file or review your claim seems to be another situation to me. It seems like they acted in bad faith  I'm not a lawyer obviously and i appreciate you knowledge  it just doesn't sit well with me

I agree with 1171.

I also had no idea what I was getting into after I was injured at work. It is nothing like regular health insurance. They want to determine if it was actually a work related injury. You can be placed in a somewhat litigation scenario. Some injured workers are even followed by private investigators who film them. You may be deposed and placed under oath by the insurance companies attorney. Giving a statement is nothing compared to other things that can happen (JMO). Just like if you get into a car accident, you have to give a statement to your auto insurance before they will consider paying for car repair or providing medical treatment, and to determine who is at fault.
I am not an attorney.Anything I write should not be considered legal advice.I am writing from my own personal experiences,which is not from any sort of legal background. You should consult with an attorney over legal issues. In California, if you cannot get an attorney you can consult with an I&A officer.
 
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#10
I bet they will not put that in writing knowing you wanted to retain an attorney. To deny treatment because you haven't given a recorded statement before the 90 days to either deny or accept your injury claim is wrong, especially knowing you wanted to get an attorney. The DWC stated the insurer is required to authorize medical treatment within 1 working day, a recorded statement is part of the insurer's injury investigation that they have 90 days to do to either deny or accept your claim.
The adjuster is just trying to pressure you into giving a statement before you retain an attorney who is there to protect your rights.  

CA. DWC
Q. The claims administrator hasn't accepted or denied my claim yet, but I need medical care for my injury now. What can I do?

A. The claims administrator is required to authorize medical treatment within one working day after you file a claim form with your employer, even while your claim is being investigated. The total cost of the treatment provided while your claim is being investigated is limited to $10,000. If the claims administrator does not authorize treatment right away, speak with your supervisor, someone else in management or the claims administrator about the law requiring immediate medical treatment. Ask for treatment to be authorized now, while waiting for a decision on your claim.
 
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