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denial letter Northern California
#1
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Hello... I never thought I would need this forum, but thank you in advance. I am an Operating Room nurse in northern California. On Dec 20,2012, I was injured at work but didn't seek treatment right away, because, of course we keep working.... it is expected! I ended up in the ER on Dec 29, 2012, with extreme pain in my upper back. I guess in my agony I forgot to mention to the ER that I was hurt at work. I was in the hosp for 3 days. MRI showed arthritic changes and herniated disc C6-7. After my release I went to the HR dept at work and was given work comp papers. After some time I was told it was under investigation because I didn't seek tx right away and didn't tell them I was hurt at work. They had 90 days to investigate. Well, 90 days later they are denying my claim. Stating old injury and previous tx. Because between Dec 20 and Dec 29 i went to the chiropractor.
I have been off work this whole time doing PT and recently an ESI.
Sorry for the long story. They are saying I need to see an unbiased Dr, etc. Do I need a lawyer?? I was really hoping to avoid that. I just want this to go away and get back to work. If I do need a lawyer how to do I find a reputable one? I am in northern CA. Please help.... I never thought this would happen to me...
 
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#2
did you mention the injury to the chiropractor?
I don't know about an unbiased doctor but california handles disputed medical questions thru the Qualified Medical Examination process
see fact sheet E
http://www.dir.ca.gov/dwc/iwguides.html
to find an experienced work comp lawyer try caaa.org
they have a zip code search engine.
to check on their reputation contact the state or county bar association for disciplinary proceedings.

most employers emphasize quick reporting of injuries in all their employee literature and with required bulletin board postings for just such reasons.
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
of coarse you need a lawyer, it is workers comp,,,
I found a lawyer at superlawyers .com, I am in central ca.
 
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#4
if your close to Sacramento I can recommend a good lawyer I am using right now and am happy with thus far.
 
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#5
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need a thumbs up here, 1171 your always there for a fast answer, kudos to you

(04-16-2013, 12:07 AM)monkeymonkey Wrote: if your close to Sacramento I can recommend a good lawyer I am using right now and am happy with thus far.

 
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#6
You are going to need a lawyer. They have denied you and the only way to get this taken care of is with one. You will be dealing with their lawyer and the only way to do that is with your own. If you told the chiro what happened he will be able to use this to show what happened. There are reporting times for a reason and I don't know what they are in CA but 9 days is not that long. Not telling them in the ER is not good but it is something your lawyer can deal with
 
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#7
Even if unintentionally, you set up red flags to the insurer and employer. That alone would almost guarantee a denial.

Yes, get an attorney. You have been given some good resources from which to look.
Let Go, and Let God......
 
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