| Message |
Author |
|
 Posted: Sat Oct 18, 2008 6:28 pm Post subject: How can an RN working for the insurance company contradict t |
|
|
| I have been struggling with a claim for PI. My husband's bipolar symptoms were aggravated by a NAF auto accident. The at fault carrier is refusing lost wages because they say the symptom exacerbation was not due to the accident--this assessment done by their "nurse" who reviewed the file. The MD (psychiatrist)'s medical notes and prescription indicate (but do not state explicitly) that the auto accident caused the destabilization. The therapist working with him (an MSW) states explicitly that it was due to the accident. How can an RN who knows nothing about him or the case contradict this and get away with it? |
|
pumatracker
New member
Joined: 23 Aug 2008
Posts: 6
Location: Northern Idaho
5.08 Dollars($)
|
|
| Posted: Sat Oct 18, 2008 8:24 pm Post subject: |
|
|
The RN can have their _opinion_. Let me ask you a question... this PT, did they review all your husbands prior medical records and have they interviewed him about all his prior conditions? If not (and I can pretty much guess that they have not seen all the prior records, how can this person _know_ that all of your husbands current condition is related just to this accident? How many years of medical training does this RN have that allows them to know this as fact? Is the RN correct? Perhaps not... my point is that people can say what they want... it does not make it a fact.
In this case I'd give almost no weight to the PT.
Have you spoken to the MD and see of he/she will write a detailed letter with their view on the condition, as it applies to a possible pre-existing condition? That would probably help?
Your state laws also come into play as far as what the at fault party owes on an exacerbation. The states I know of (a few) would not allow a total exclusion, they would only owe for the difference. I'm not sure how accurate what you posted is but if the RN states its an exacerbation, then at least part of the situation _is_ related to the accident (by definition). As such, I'd think that they should at least address part of the loss wage claim. |
|
tcope
Forum Expert
Joined: 22 Nov 2006
Posts: 5193
Location: Salt Lake City, UT
285.25 Dollars($)
|
|
| Posted: Sat Oct 18, 2008 10:37 pm Post subject: |
|
|
| I guess the next step is to get that letter. Thanks. |
|
pumatracker
New member
Joined: 23 Aug 2008
Posts: 6
Location: Northern Idaho
5.08 Dollars($)
|
|
| Posted: Sun Oct 19, 2008 12:25 am Post subject: |
|
|
You didn't expect the insurance companies RN to give an opinion contrary to the best interests of the insurance company did you?
You will need as much documentation - from every specialist - as you can get to support your side.
_________________
Life moves pretty fast. If you don't stop and look around once in a while, you could miss it. - Ferris Bueller |
|
LifeIsGood
Senior member
Joined: 22 Sep 2008
Posts: 580
1.30 Dollars($)
|
|
| Posted: Sun Oct 19, 2008 2:00 am Post subject: |
|
|
| Just what I was thinking life. Kind of like when work sends you to their doc and they believe you can still work light duty. Surely if the PT and a RN can provide documentation than hopefully a partitial recovery is attainable. |
|
fireyone
Senior member
Joined: 07 Jan 2008
Posts: 1993
2.31 Dollars($)
|
|
| Posted: Sun Oct 19, 2008 10:26 am Post subject: |
|
|
| Quote: | | How can an RN who knows nothing about him or the case contradict this and get away with it? |
Wait a sec...all the rn has is HIS docs notes to go by and the doc said... | Quote: | | The MD (psychiatrist)'s medical notes and prescription indicate (but do not state explicitly) that the auto accident caused the destabilization. |
I think this is likely where they are hanging their denial...as the others said talk to the doc not the therapist about writing this out for you and resubmit it or request they re-evaluate it after getting this....
did you post this here before something similar?
_________________
"Never, never be afraid to do what's right, especially if the well being of a person or animal is at stake. Society's punishments are small compared to the wounds we inflict on our soul when we look the other way." Martin Luther King Jr. |
|
Lori
Moderator
Joined: 10 Sep 2007
Posts: 8173
Location: Missouri
287.90 Dollars($)
|
|
| Posted: Sun Oct 19, 2008 11:21 pm Post subject: |
|
|
| CAn it be submitted once it is denied? |
|
fireyone
Senior member
Joined: 07 Jan 2008
Posts: 1993
2.31 Dollars($)
|
|
| Posted: Mon Oct 20, 2008 5:12 am Post subject: |
|
|
I'd go with the rest of my fellow posters, if you really don't want the insurance carrier to walk away from this situation without paying the compensation, you may start collecting all the possible documents you can.
The fact is that anyone can opinionate on any issue and is you feel that you have been wronged the responsibility will then rest upon you to prove the right. If the situation demands, you may consider seeking legal representation as well. |
|
JeremyHolter
Senior member
Joined: 06 Jun 2007
Posts: 1194
210.30 Dollars($)
|
|
| Posted: Mon Oct 20, 2008 9:34 am Post subject: |
|
|
| Quote: | | CAn it be submitted once it is denied? |
Sure it can, what they'll do with it ? I don't know but can't hurt.
_________________
"Never, never be afraid to do what's right, especially if the well being of a person or animal is at stake. Society's punishments are small compared to the wounds we inflict on our soul when we look the other way." Martin Luther King Jr. |
|
Lori
Moderator
Joined: 10 Sep 2007
Posts: 8173
Location: Missouri
287.90 Dollars($)
|
|
| Posted: Mon Oct 20, 2008 3:32 pm Post subject: |
|
|
| At least then the poster has a chance of going back, getting the reqired documentation and representing it. |
|
fireyone
Senior member
Joined: 07 Jan 2008
Posts: 1993
2.31 Dollars($)
|
|
| Posted: Fri Jun 03, 2011 10:15 am Post subject: sqLWTHuVJyBS |
|
|
Contradict claim.. Awful 
_________________
Register Now to have your Insurance queries solved. |
|
www.ampminsure.org
Guest
|
|
