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In desperate need of info!!! RE: workers comp insurance neglecting my med benifits
#1
I am new to this, any info and advice is greatly appreciated. I am a 33yr old female I live in TN. 3yrs ago I injured my rt leg/knee on the job which required a total knee replacement, other treatment, therapy, ect. This injury left me disabled. The orthopedic surgeon who preformed the surgery was let go from the insurance's "list" due to him being "non-compliant" in my case. 2yrs ago my knee prosthesis "broke". I have tried for 2yrs to get treatment to no avail. I was awarded lifetime medical on my right leg/knee. I have called the insurance company numerous times... mostly getting transferred to voicemails where I plead for help, even a response, which I never get. The last time I spoke with the case worker was July 2012, in which she promised to have me into an orthopedic dr. within a week, and that she would call me the next day to let me know where to go. I never got a phone call, so a week later I try to get in touch with her again. I am always transferred to voicemail, where I leave message after message with no response.
Where my knee prosthesis is "broke" I take falls all the time (especially down steps) that causes other injuries, and has resulted in multiple ER visits. The dr.s in the ER have even tried to contact the insurance co. with no avail also. I have been admitted to the hospital several times because of the extreme edema and swelling to the right leg due to trying to walk on it injured. I am not one to "sue" but this is getting ridiculous. The dr.s have now told me that where I have greatly had to overcompensate on my lt leg it may now require a knee replacement too. The main question I have is .... What type of lawsuit(s) can I file against the insurance co? What rights do I have as the patient being neglected?

*There was never any dispute over my injuries and the workers comp claim, like I said above, I was awarded full lifetime medical benefits on my rt leg.*
 
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#2
Did you have a lawyer on your WC case? if so he is the one you call if not well honey you gotta get loud and mean.And by that I ask you can you be a witch with a B? take your paperwork where you were awarded lifetime medical and find you a personal injury lawyer you have a Dr who has said their BS has caused damage to your other knee as well as your body.Take copies of your paperwork to the insurance commission and let them know this company isn't doing what the court ordered them to do.Dont forget to send copies to your congressmen and senators( most of them are worthless)but send it anyway along with a cover letter explaining the problem.And then you have local TV stations that love feel good stories,Here its called 5 on your side cuz its channel 5.You keep your story true and to the point and let them know the injuries that have come because they wont honor the court order.Dont forget your the victim but you gotta keep fighting.
........I love cats, I just cant eat a whole one by myself......







 
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#3
Tennessee has has a work comp board that enforce the laws.
you can appeal the carrier's failure to provide benefits to them.
http://www.tn.gov/labor-wfd/wcfaq.shtml#IEA
contact a work comp specialist for help resolving the dispute
If you have questions or problems relating to a workers' compensation injury, call 1-800-332-2667 (within Tennessee) or 615/532-4812.

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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#4
As jayne said if you had a lawyer for this that would be the best place to start if not as 1171 said you can appeal to the board. They sound like one of those places that is not going to do anything unless they are forced to do it. Sad but you have to think of it like this. If you don't keep pushing it doesn't cost them anything to send you to voice mail. You are the one that has to fight for your rights and here is a good place to come and get some help with what to do.
 
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#5
thank you so much for your responses.... here is where I am at now...
I did not have a lawyer in my comp. case, but I have recently contacted one and had an appointment with him... he has stated there is not much I can do because the insurance comp. will almost completely deny that they have promised to send me to a dr. or have ever spoken to me at that, He said the only thing he is going to be able to do is try to get them to comply with the court order of medical coverage. He said I would never be able to recover any loss' From bills and ER visits I have occurred over the broken knee replacement, seeing they prosthesis has been broken for 2yrs and there is a 1 year statue of limitations... the lawyer tried to contact my caseworker at the insurance company while I was in the office which he was transferred to voicemail...."no surprise there". He left a lengthy msg. and demanded a call back.. it has been over two weeks now and still yet has not been able to reach anyone or had any response. I understand that I may not be able to recupe any $ I have had to personally spend out or the thousands of $'s I have occurred in medical collections due to the ER trips from falling from the broken prosthesis, or hospitalizations due to the statue of limitations.
Someone had told me to ask the forum about a tort lawsuit for bad faith against the company, does anyone have any knowledge of this type of lawsuit, could it comply to my case....
I would love to have some feedback from the forum before I bring it up to my attorney, he doesn't seem too compelled on presenting any action toward them, I may have to get a second opinion from another attorney, but I greatly respect the opinions from this forum. thank you!
 
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#6
they are rare and very difficult to litigate.
they are often called "bad faith lawsuits" as many states have an insurance code or contract language that requires the insuring party to engage "in good faith and fair dealing" when resolving disputes.

the biggest difficulty is finding an atty that would be willing to take on such long and difficult litigation. generally you already have to have some very good concrete evidence that such behavior was intentional.

a work comp atty would not likely pursue that type of civil 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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#7
unless you could prove your knee hardware is at fault most likely not. WC IC have to many laws on their side, I did win mine but My husbands IC went up against them to recoup what they spent, so it was IC against IC. Unless it happens to be medicaid or medicare that has been picking up your bills or another IC?
........I love cats, I just cant eat a whole one by myself......







 
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#8
Welcome to the forum!

After 3 years in court I was awarded a total knee replacement. Still it took 6 years to receive treatment for the lumbar spine.

If you have not done so check with the FDA and see if the knee implant you have has been recalled.

Mine is a gender knee by Stryker and the company has a long list of recalls.

Another injured worker on here had her knee replacement 2 years ago, She just learned last week she will need a revision done on that knee.

1171 suggested contacting the work comp board for your state. Don't know if he posted a website link but if not Google your state and department of labor and that should get the information you need.

I agree an attorney is needed in your situation.





...................





(08-30-2013, 04:03 PM)jayne Wrote: unless you could prove your knee hardware is at fault most likely not. WC IC have to many laws on their side, I did win mine but My husbands IC went up against them to recoup what they spent, so it was IC against IC. Unless it happens to be medicaid or medicare that has been picking up your bills or another IC?

 
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#9
thank you all for the info
yes, I can prove the knee replacement is "broken" I have med records for that, that date back 2 yrs since I have been seeking help.... I know that they put the 30yr knee in when they did the surg. reason being my age and the fact that the IC had waited so long to due the surg. in the first place that when they did the knee replacement they had to remove so much damaged bone that the surgeon didn't think I had enough bone left to do another knee replacement if that situation ever arose, which puts me at an odd place now..... how do I find out if the TKA prosthesis" has been recalled or which one I have.
as far as the bills I have acquired in the last 2yrs that the WCIC has refused to pay for has added up in collections because I have no other insurance.... my whole life has come crashing down in the last 2yrs let me break it down simply.....

injured rt leg and back at work---->extensive surgery on rt leg w/ tka , 9 months of phys. therapy to walk again-----> 3 months later knee prosthesis breaks-----> barely able to walk so in turn I am unable to work and have no income at all coming in------>IC will not respond to me or doctors regarding my leg------> all of my med bills r sent to collections because I do not have the money to pay out of pocket and have no income coming in to even try n make payments, therefore ruining my credit-----> I have since lost my vehicle's, my home, my credit, my name, my life, ...... I do not have any help from the gov. no ssi ssd or medicare or Medicaid. we filed for ssi and ssd but we declined because of the fact that the part of me that is "disabled" has a court order to the IC to provide full coverage medical on it.

I HONESTLY FEEL HOPELESS I DO NOT KNOW WHAT BELSE TO DO!!!!!!!
 
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#10
thank you all for the info
yes, I can prove the knee replacement is "broken" I have med records for that, that date back 2 yrs since I have been seeking help.... I know that they put the 30yr knee in when they did the surg. reason being my age and the fact that the IC had waited so long to due the surg. in the first place that when they did the knee replacement they had to remove so much damaged bone that the surgeon didn't think I had enough bone left to do another knee replacement if that situation ever arose, which puts me at an odd place now..... how do I find out if the TKA prosthesis" has been recalled or which one I have.
as far as the bills I have acquired in the last 2yrs that the WCIC has refused to pay for has added up in collections because I have no other insurance.... my whole life has come crashing down in the last 2yrs let me break it down simply.....

injured rt leg and back at work---->extensive surgery on rt leg w/ tka , 9 months of phys. therapy to walk again-----> 3 months later knee prosthesis breaks-----> barely able to walk so in turn I am unable to work and have no income at all coming in------>IC will not respond to me or doctors regarding my leg------> all of my med bills r sent to collections because I do not have the money to pay out of pocket and have no income coming in to even try n make payments, therefore ruining my credit-----> I have since lost my vehicle's, my home, my credit, my name, my life, ...... I do not have any help from the gov. no ssi ssd or medicare or Medicaid. we filed for ssi and ssd but we declined because of the fact that the part of me that is "disabled" has a court order to the IC to provide full coverage medical on it.

I HONESTLY FEEL HOPELESS I DO NOT KNOW WHAT BELSE TO DO!!!!!!!
 
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