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reservation of rights
#1
Hi everyone,
At first W/C said my back ways not a "body part". I only injuried my back after my knee gave-away and I feel down the stairs. W/C would not cover any care or work-up on my back, that was all paid for out of pocket. Now my lawyer e-mailed me and said he had talked them into letting me see a back surgeon and go to the pain clinic under "reservations of rights". Will I have to pay for this when the cas is over? I know that I will end up with ppd at days end, does W/C still have to pay Bi-weekly benifits until my back is in good enough condition so I can have my TKR? I was a psych nurse and have been let go from my job almost 3 years ago now. I have been told by both my OS and Pt, that I will not be able to return to that kind of work. Does any know the cut off age for retraining?

Thank you all for the help.
 
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#2
Here you go:

http://www.allbusiness.com/business-fina...459-1.html

Insurance policies usually provide for an insurer to defend and indemnify the insured for a loss that is covered by the policy. The insurer’s duty to defend and indemnify is triggered where a complaint alleges some facts that would invoke the policy’s protections.1 If, however, there is some question as to whether the policy covers the loss, an insurer can still satisfy its contractual obligations, and reserve the right to challenge its duty to indemnify. This is called a reservation of rights.
In making the determination of whether the alleged loss is covered, the insurer looks to the allegations in the complaint. If the insurer asserts a reservation of rights, “the insured receives the defense promised and, if coverage is found not to exist, the insurer will not be obligated to pay.”2
Reply's are intended solely for informational purposes. They are based on personal opinions, experience, or research and are "not to be taken as fact or legal advice", otherwise, always consult an attorney or a doctor.
 
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#3
Bad Boy,
Thank you, I think I understand. Will my back be rated? Will I have to pay for any of the work up that they approved?
 
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#4
For now it all depends on how things work out, and your medical records, plus on how the commision is going to handle this now. You just don't know.
Reply's are intended solely for informational purposes. They are based on personal opinions, experience, or research and are "not to be taken as fact or legal advice", otherwise, always consult an attorney or a doctor.
 
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