by joanyellin » Wed May 11, 2011 02:24 pm
workers comp claim: for paralysis, left upper and lower extremity, brown sequard syndrome, neck, and right shoulder for rsd.
injured right shoulder -torn rotator cuff, labrum tear.
got pre-cert numbers for surgery
insurer is denying claims saying that r shoulder should be paid by work comp, keep sending them info saying r shoulder is not part of claim.
ready to sue if i can.
injured right shoulder -torn rotator cuff, labrum tear.
got pre-cert numbers for surgery
insurer is denying claims saying that r shoulder should be paid by work comp, keep sending them info saying r shoulder is not part of claim.
ready to sue if i can.
Posted: Wed May 11, 2011 02:41 pm Post Subject:
You probably have no cause of action against your health insurance company. "RSD" (otherwise known as "Reflex Sympathetic Dystrophy Syndrome") is known to be triggered by preexisting injuries. Your RSD, if considered a workers' compensation injury, could have been caused by your torn rotator cuff, which could also be attributed to your employment.
Best to attempt to have the rotator cuff injury included in your workers' comp claim, because your health insurance company can reasonably, and RIGHTLY, say, "We don't have to cover it because it's work related". The burden of proof, unfortunately, is on you, not them.
keep sending them info saying r shoulder is not part of claim.
Whose info? Your personal opinion, or that of another medical professional?
Posted: Thu May 12, 2011 03:25 am Post Subject: reply-suggestion to sue?
yoiu are right and we are appealing work comp. also, from having to use a cane to walk, bec L leg is paralyzed and w brown sequard it includes the opposite side; BUT I was in serious pain, had no use of my right arm from a large cuff tear to subscapula muscle- judge told me to get it fixed; he approved treatment but was not conside in notice of decision-- anyway to sue work comp without stopping all payments; treatments that they have agreed to-? I need OT 1x week to get stretched out, a HHA 35hrs/wk and botox every 3 mo for spasm...without these, at the minimum, I am dead, not to mention methadone etc pain pills. FED UP W WORK COMP AND THEY DRAG THEIR FEET, lawyers do not attend hearings then file incorrect appeals, etc. very sloppy. I am one of few cases where injury was not my fault; an MD paralyzed me in work comp apprvd surgery; I never wanted spinal cord stimulator but got pressured into the surgery for pain and best way to return to work which i have always wanted to do, now i can not even walk w cane-leave home going up the walls ready to go postal vs insur companies. Suggestions?????
I see people faking; lying, I am not one of those people- I need to get back to the real world, off the pills, meds and get into PT get straight so i can work and live-work comp keeps fighting me, my lawyer every step bec its cheaper, but ignoring fact they pay and i cannot return to work if i am not self reliant or able to leave home/stay awake for more than few hrs at a time- suggestions??????
Posted: Thu May 12, 2011 05:34 am Post Subject:
I am one of few cases where injury was not my fault; an MD paralyzed me in work comp apprvd surgery
Well, that certainly puts a new spin on all this. Although your surgery might have been the result of a workers' comp claim, the adverse effects of the surgery are not. As a result, you may have a medical malpractice claim against the surgeon who caused your additional injury.
I'm still at a loss. Was your rotator cuff problem caused by your work, or was it the ill effect of some other thing? If your rotator cuff problem is entirely unrelated to your workers' comp claim, then I don't know why you are going after them, and the WC insurance company is fully within its rights to deny payment for any treatments, care, or therapy that is required specifically for it.
If you and your lawyer are barking up the wrong tree, no amount of barking, no matter how loud, or how long, will move the insurance company.
I assume your attorney is doing the right thing for you, but some attorneys are not worth the money that paid for the parchment paper their JD diploma was printed on. They lead their clients on with false hope, and everyone wastes time and money needlessly, and everyone walks away mad.
You also need to understand that if this is a workers' comp claim, other than the possibility of the medical malpractice issue, WC is your exclusive remedy under state law -- meaning you cannot sue your employer for "pain and suffering" or other damages not included in the WC laws.
Posted: Thu May 12, 2011 07:03 am Post Subject:
They lead their clients on with false hope, and everyone wastes time and money needlessly, and everyone walks away mad.
I don't really understand how these attorneys work in the long run! If they're leading their clients with false hope and wasting their money, then I don't see the prospect of a successful career ahead of them.
Posted: Fri May 13, 2011 02:46 am Post Subject:
They end up either learning how to do things right or they wash out, as they should. But, until then, they manage to cause a lot of grief for the clients they represent. We get some of the fallout here.
It's all about learning one's craft. Same is true with insurance agents. Unlike the "skilled" trades like plumbers, electricians, and doctors, there is no required "apprenticeship" during which one learns how to do things. Most agents are given a few scripts and simply told to "Get out there and sell!" without any professional sales training.
Those of us who have adopted a style of professional sales (such as Tom Hopkins, Zig Ziglar, Tony Robbins, or others) learn that we are not "salesmen" in the sense that people think of salesmen, but that we ask questions, listen for answers, and craft solutions to meet needs properly. Salesmen sell you what they want to sell you, or what provides them with the biggest paycheck, with little regard for one's needs.
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