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ESIS vs Coventry...HELP
#1
Exclamation 
I was in a plane crash in Afghanistan while working on a government contract. I am the only survivor. I have had numerous surgeries, with many more to come. I have been labeled CATASTROPHIC.

After two years of working with the wrong doctors and medical team, we have finally gotten the perfect group together from doctors, nurses, claims adjustors, therapist, and case nurse managers.

Recently ESIS reassigned me to a new claims adjuster who is completely incompetent. When my case nurse manager requested a new one, they fired her and reassigned me to a new case nurse manager as well. She does not work for ESIS, she works for Coventry. Can they do that without my consent? I do not want a new case nurse manager. It has taken me years of grueling struggles to finally get the right team together. I do not want to start over with anyone who is actually trying to help me. Can they do this?
 
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#2
the employer controls who they hire and assign to manage their claims; the worker does not get to choose who the employer hires or what contractors they use.
I believe ESIS is a third party administrator contracted by your employer to handle adjustment of its comp claims.
you can complain to your employer; they have more clout with the 3rd party claims administrator.
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
The Airline is no longer in business. This is a federal workers comp claim, not state. It is covered under the defense Base Act. They do not work for the airlines, they are no longer in business.
 
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#4
My question is can ESIS reassign my case to another case nurse manager who works for a different company without my consent, since my case nurse manager works with me, not them?
 
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#5
you are in error; the nurse case manager is not your employee and does not work for you. the workers compensation costs including those for the administration of claims is born by the employer not the worker.
ultimately your employer for workers compensation purposes is the US government.
as their employee you do not control who they use to manage their comp claims.
you can complain to the US government about the change; specifically the Office of Workers Compensation Programs handles administration of Defense Base Act injuries.
http://www.dol.gov/owcp/dlhwc/lsdba.htm
you can also contact your congressman with your concerns.
the law does not require worker consent for the employer to change adjusters or case managers.
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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#6
That's what I wanted to know.
 
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#7
glad we could clear that up. comp is complicated and wrong assumptions can make the process frustrating.
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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#8
MJ it sounds like you are aware of your situation, but wanted to give you heads up about nurse case managers in general (not all). You were lucky with the previous one, being so helpful. Many of these nurse case managers do whatever they can to limit the cost of a claim. This of course is not always in the best interest of the injured worker. Same thing with the claims adjuster.

If you are having any issue with obtaining medical treatment, or dealing with your claims adjuster and nurse case manager I suggest hiring an attorney.

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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