Hello There, Guest! Login Register
Index    |     Search    |     Members    |     Help

Thread Rating:
  • 0 Vote(s) - 0 Average
  • 1
  • 2
  • 3
  • 4
  • 5
workers comp adjuster
#1
Texas // I filed a workers comp claim, although I knew I'd most likely lose my job over it, which I did. I filed complaints with everyone I could, & have an appt with an ombudsman next friday, so hopefully I'll get some results. The adjuster denied my claim because he said my injury didn't happen at work, & my boss said I never reported it to him (untrue). Well, obviously it's in dispute, but I just found out yesterday that the adjuster either didn't record my statement, or didn't tell me he was recording it. I talked to another adjuster with the same company & he told me that they were required to inform you they were recording, & that they were required to record it, no exceptions. It's obvious that he didn't follow protocol, he just denied it, for whatever reason. Does anyone know if I can file suit against him for intentionally holding up my claim? And if I win my claim, am I just gonna start getting weekly checks, or will I get a lump some as a settlement, & if it's a lump sum, given the way I've been treated, should I accept if it's reasonable, or hold out because they screwed up? Ive been mistreated throughout this entire process, & I have a fraud complaint against the adjuster. I really need the money because I've been paying all the medical myself, but I really want them to be held accountable...any suggestions would be greatly appreciated, thanks in advance.
 
Reply
#2
(11-01-2012, 09:51 AM)marcoleman Wrote: Texas // I filed a workers comp claim, although I knew I'd most likely lose my job over it, which I did. I filed complaints with everyone I could, & have an appt with an ombudsman next friday, so hopefully I'll get some results. The adjuster denied my claim because he said my injury didn't happen at work, & my boss said I never reported it to him (untrue). Well, obviously it's in dispute, but I just found out yesterday that the adjuster either didn't record my statement, or didn't tell me he was recording it. I talked to another adjuster with the same company & he told me that they were required to inform you they were recording, & that they were required to record it, no exceptions. It's obvious that he didn't follow protocol, he just denied it, for whatever reason. Does anyone know if I can file suit against him for intentionally holding up my claim? And if I win my claim, am I just gonna start getting weekly checks, or will I get a lump some as a settlement, & if it's a lump sum, given the way I've been treated, should I accept if it's reasonable, or hold out because they screwed up? Ive been mistreated throughout this entire process, & I have a fraud complaint against the adjuster. I really need the money because I've been paying all the medical myself, but I really want them to be held accountable...any suggestions would be greatly appreciated, thanks in advance.

I would suggest you get an attorney to answer your questions. Make sure you get an attoney who is a workmans comp attorney only. I would not want one who does other type work. But that would be your best route at this time. If you do not have one already, get one asap and let them direct you on your options. Good luck.. But I would get one immediately.
Cervical Fusion 2003, c5-c6. Herniated and damaged Disc L1- L4-L5 S1. Lumbar Spinal Cord stimulator implant 09-2008. Cervical ACDF revision with hardware c4-c5-c6-c7 Sept 2009.
SSDI approved 3-2010. NOW OFFICIALY RETIRED
 
Reply
#3
how do you know which adjuster is truthful?

there are such things as "bad faith" law suits against carriers but they are rare and expensive to pursue. it's very difficult to find attys willing to take them but you can try.

you can chosse to negotiate a buyout or obtain a decision in court.
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.
 
Reply
#4
Thank you both for your responses, I talked to 2 attorneys so far & both of them suggest sitting by & waiting because there isn't enough "damages" yet to get a big settlement. It's frustrating, because although I'd love a nice big check in the mail, it's really about them being held accountable. All of them. I've got kids that depend on me & if my wife hadn't gone back to work full time, we'd be on the street right now & for what, so insurance premiums won't go up? It's just crazy, I'm grateful there's a system in place, but it's set up to fail the person who's injured. Everything is "They have 3 weeks to respond, then we have 90 days to investigate, then there might be a hearing, etc."...crazy.
 
Reply
#5
(11-01-2012, 11:33 PM)marcoleman Wrote: Thank you both for your responses, I talked to 2 attorneys so far & both of them suggest sitting by & waiting because there isn't enough "damages" yet to get a big settlement. It's frustrating, because although I'd love a nice big check in the mail, it's really about them being held accountable. All of them. I've got kids that depend on me & if my wife hadn't gone back to work full time, we'd be on the street right now & for what, so insurance premiums won't go up? It's just crazy, I'm grateful there's a system in place, but it's set up to fail the person who's injured. Everything is "They have 3 weeks to respond, then we have 90 days to investigate, then there might be a hearing, etc."...crazy.

many states are rolling back worker rights. Texas is just one.
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.
 
Reply
#6
@1171, I just saw your post."How do you know which adjuster is being truthful", made me laugh. I never considered that, so thanks. I did file a complaint for fraud on the original adjuster, & I got back a response from state saying they would investigate, so maybe they can figure it out. They also (insurance) sent me a form asking me to sign a release of my ENTIRE medical history, & the OIEC told me absolutely DO NOT sign it & when I told the adjuster that he said "well, don't be surprised if I have to deny your claim because you won't release your history." I told him I had no problem sending the stuff pertaining to this case, & he got all snippy with me. I just don't see how whether I had my tonsils taken out as a kid is any of their business, sounds like they just want ammo, & I'm not giving them any!!
 
Reply
#7
(11-02-2012, 08:49 AM)marcoleman Wrote: @1171, I just saw your post."How do you know which adjuster is being truthful", made me laugh. I never considered that, so thanks. I did file a complaint for fraud on the original adjuster, & I got back a response from state saying they would investigate, so maybe they can figure it out. They also (insurance) sent me a form asking me to sign a release of my ENTIRE medical history, & the OIEC told me absolutely DO NOT sign it & when I told the adjuster that he said "well, don't be surprised if I have to deny your claim because you won't release your history." I told him I had no problem sending the stuff pertaining to this case, & he got all snippy with me. I just don't see how whether I had my tonsils taken out as a kid is any of their business, sounds like they just want ammo, & I'm not giving them any!!


I agree with you on this, but the fact is they will get it... They want to see if you had previous injuries that would match whats injured now.. And even if this was a fact it still could be covered due to a aggravation..

 
Reply
#8
Well, I've had "tendonitis" in a DIFFERENT tendon, but on the same arm in the past, so it's definitely gonna be a fight, but I'm thinking that even that may be considered an "occupational disease", but I'm not sure. I'm going back to see my family doctor on Monday, hopefully he can give me some insight. I live in a relatively small town, & my employer's well known in the "upper-class" community, & the doctor I've been seeing for my torn bicep-tendon told me the other day that he thinks I'm all healed up (without even looking at my arm, or asking me how it felt), & when I told him the back part of my arm was still killing me, he said it was from an old neck injury, probably damaged nerves...I'VE NEVER HAD A NECK INJURY, he's either lost his mind, or he's playing for the other team...probably the latter of the two, but I told him I'd be getting a 2nd opinion. Ridiculous!!
 
Reply
#9
Let me tell you a little secret that is well know to us INJURED WORKERS and LAWYERS there is no BIG CHECK in workers comp someone is telling you a GREAT BIG LIE. most injured workers lose everything they have worked for waiting to get fixed so if you are waiting for a big check you are waiting for a ship that will never come in cuz it sank a long long long time ago...works mans comp does not pay for pain and suffering they only pay for time lost from work big boy and they do everything they can to get you back to work even if its picking up cig butts in the parking lot of the local supermarket to keep from paying you a penny more than they have to.they will have cameras on you night and day watching for you to make a mistake.
........I love cats, I just cant eat a whole one by myself......







 
Reply
#10
No, believe me, I understand there is no big check. I was referring more to a lawsuit against my employer for fraud, but I doubt there's any check coming for that either. I know very well about losing everything I worked for, it's happening as we speak.
 
Reply
  


Possibly Related Threads...
Thread Author Replies Views Last Post
  California give essential workers comp presumption.... 1171 0 526 05-07-2020, 12:50 PM
Last Post: 1171
  Should essential workers automatically qalify for comp if theyhave covid-19? 1171 3 955 04-27-2020, 05:13 PM
Last Post: 1171
  Workers Comp, BC/BS and Medicare wguage52 27 9,405 04-10-2020, 05:48 PM
Last Post: 1171
  house arrest while out on workers comp msb2020 2 479 01-12-2020, 07:56 PM
Last Post: 1171
  Achilles Repair. Workers comp question... Go Cowboys! 3 753 09-26-2019, 08:59 PM
Last Post: California_Help
Question Workers Comp settlement in NJ eclark16 9 1,572 09-20-2019, 12:42 PM
Last Post: eclark16
  Work comp adjuster changing doctors CA kibby 12 1,730 06-13-2019, 12:37 PM
Last Post: richard_girling
  Workers Comp Disputing Medical Bills gamora77 1 1,048 03-15-2019, 11:22 PM
Last Post: 1171
  Built a map of workers comp. John_Richardson 1 1,608 02-28-2019, 08:48 AM
Last Post: TerryLewis
Shy Work related/induced stress & workers comp heartworkerNC 7 5,799 02-20-2019, 08:16 AM
Last Post: TerryLewis

Forum Jump:


Browsing: 1 Guest(s)