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Adjuster says claim is closed
#1
Claim in Cali, i tried to make a doc appt for bilateral tendinitis/epicondilitis with an injury date of 10/3/08 and has an open claim for adjudication and my claims adjuster for that injury (i have 2) told my ptp's office staff that the claim is closed? I havent been seen for this injury for some time because i suffered a serious injury about a year later so this one has been on the back burner. Is CA just talking out her ace or do i have to file expedited claim for treatment; so far she hasnt returned my msg to see where the confusion is.
 
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#2
whether the insurance carrier's case file is open or closed is legally meaningless.
if they are denying treatment and the file is litigated, you should request an expedited hearing.

if they wanted to close out their liability for more benefits legally, they should have filed a petition with the court earlier when there was no activity.
both you and they will need medical evidence that there is or is not a current need for treatment and it is due to the work injury 3 and half yrs ago and not any intervening causes.

if you don't have an atty, you should get one that specializes in workers compensation.



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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#3
(03-05-2012, 06:21 PM)1171 Wrote: whether the insurance carrier's case file is open or closed is legally meaningless.
if they are denying treatment and the file is litigated, you should request an expedited hearing.

if they wanted to close out their liability for more benefits legally, they should have filed a petition with the court earlier when there was no activity.
both you and they will need medical evidence that there is or is not a current need for treatment and it is due to the work injury 3 and half yrs ago and not any intervening causes.

if you don't have an atty, you should get one that specializes in workers compensation.

Thank you this is exactly what i suspected, i will write their counsel a letter today and file for an expedited hearing tomorrow.

Already had an attorney, did zero for me and now he wants $14k for the 5 letters he wrote. Thanks again

 
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#4
if you are representing yourself, you need to formally dismiss the atty and substitute yourself in place.
they will file a lien for fees for their prior period of representation.
you can file an objection with the court prior to fee determination at the conclusion of the litigation.

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
Thank you for info on filing objection, i'm also going to file for fee arbitration w/ bar.
 
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