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I'VE BEEN DENIED! WHAT DO I DO NOW? :( I NEED THIS.
#1
I really need a sounding board and some help.
 
My partner has been in a lot of pain with sciatica and disc issues but he didn't recognize and exact "incident date" and no report was filed. He missed some work, got an MRI, and went to a chiropractor/disc specialist. Because it was an injury over time they did not accept his claim. But he can't go to work (but he has to because of bills) and he cannot afford the treatment he needs to get well. 

We've been denied for our claim and we don't know where to go from here. HELP! I feel we should file an incident report and reclaim ? is it possible to try to get a new claim approved if you've already tried. His employer and doctor are both in his corner. 

Thank you so much.
 
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#2
if you read some other posts on this board, you will see that each state has it's own set of rules for workers comp and there is no one answer for every claim in the country.
if "His employer and doctor are both in his corner." then each should have filed a report of claim with the insurance carrier.
if the carrier has denied the claim based on those filings, then every state has an appeal process.
most states require that the carrier issue a written denial and include how the employee can appeal.
did that happen?
did your partner follow that process?
was the appeal denied?
the process is different in every state. I can't provide more information without knowing who/what issued the denial and in what state was the denial from.
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
(07-29-2016, 02:50 PM)In many states all an injury needs to be considered a work related injury is that work contribute merely 1% to your partners overall condition and its a wc claim. The total act of the injury doesn\t have to happen at work.  Its like saying a 50 yr old painter climbs a ladder to do a job but gets tangled in some tie down ropes and falls off the ladder and breaks his neck, but his employer says in his medical chart (which is online today) says he is being treated for DDD DEGENERATIVE DISC DISORDER THIS is the injury that retired me from the work force and put me on SSDI now for 19 yrs and permanent WC. So the employer says it was this disability that made him fall off the ladder when it was clearly a work accident when he got tangled up on tie down ropes It would help me help you if you would say what states rules we are playing by     BUG NJWC Specialist sweetbee Wrote: I really need a sounding board and some help.
 
My partner has been in a lot of pain with sciatica and disc issues but he didn't recognize and exact "incident date" and no report was filed. He missed some work, got an MRI, and went to a chiropractor/disc specialist. Because it was an injury over time they did not accept his claim. But he can't go to work (but he has to because of bills) and he cannot afford the treatment he needs to get well. 

We've been denied for our claim and we don't know where to go from here. HELP! I feel we should file an incident report and reclaim ? is it possible to try to get a new claim approved if you've already tried. His employer and doctor are both in his corner. 

Thank you so much.
 
Reply
#4
just to clarify what bug posted.
generally a state's comp laws identify an injury by type; usually as specific, repetitive/cumulative, or Occupational disease.
not all types are covered in every state.
the degree of contribution or causality of either or any of the types is a separate issue and also varies by state. some require it be the primary cause others the major contributing factor, and many other thresholds often defined by case precedent. that's one of the reasons your state is important in providing an answer to a comp question.
you did not post the reason for the claim denial so it difficult to say whether the denial is supported by your states statutes.
falling off a ladder is a specific injury. repeatedly climbing ladders without a fall could be cumulative or repetitive trauma. either of those types of injury would still have to meet a threshold of causality specified by your states comp laws.
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
Keep pushing!!

I just got a hearing on my worker injury status in California. Took SIX WEEKS!!! but it did happen! Should be open and shut but over SIX weeks to get someone to look at it!

Best of Luck
Sad  CDC Guideline 2016 Prescribing Opioids for Chronic Pain will be the death of me.
[url=http://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm]http://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm[/url]
 
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