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Anyone familiar in dealing with workmans comp?

AnonymousUserAAnonymousUser Posts: 49,578
edited 06/11/2012 - 7:21 AM in Health Insurance Issues
I work for a large city. The city pays all of the medical bills itself and does not have it's own workman's comp insurance. It does however have a company that handles all of the claims. I got hurt at work (ruptured L5-S1)and have seen 4 doctors(1 being the "company" doctor) so far that say I have a ruptured disc and . All 3 specialists that Iv seen say I need surgery and 2 out of 3 say to get an artificial disc. I have come to the point where I have decided to get an artificial disc instead of a fusion. Iv been told by a lot of co-workers that the claims company will deny everything no matter what. So now I don't know what's going to happen. I was told that if they denied it I would have to appeal it until I got approval. Can anyone explain the process to me?


  • Do you have a lawyer?
  • No. Iv heard that they'll take 30% of your workman's comp pay though and I'm not to keen on anyone taking that much.
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  • WC is awful, at least in my experience.
    I should have NEVER gone that route and am a bit upset at the first physician I saw who rec. it.
    WC initially accepted my claim.
    Since then they keep delays(up to 2 months) in my work payments,consistently lose documents ,lie to me and now are denying auth. for surgery.
    These 3rd party insurance cos. that provide the service are irrespnsible IMO.
    Thankfully I have a lawyer now.
    They are going to send you for an IME, so called "independent medical examination".The robot of an MD performing it is essentially hired by the insurance company.
    The whole system is a joke.
    Good luck!
  • Manic mechanic, you definatly need a lawyer. I have been on wc about 10 months now. Yes they lie to you. Sometimes they fight you to get a second opinion. Yes they change DRs appointments without telling you. Lawyers get a small fee to assist you and wc usually has to pay for some of your lawyers fees. Yes drs look at you different when you see them as a wc patient and not with your own insurance. It is because they have to answer to the case manger. Get some representation usually lawyers only charge you if they win your case. Also I would study up on which procedure to use. There are alot of other treatments out there before you should jump into surgery. It is abig decision to make. So do your homework and good luck to you.........Hoot
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  • I worked for a personal injury attorney for quite a few months and read A LOT of paperwork and I would highly advise hiring a lawyer...They're worse than the car insurance companies and THAT'S saying something...Considering I just fought tooth and nail with Progressive! BOOOOO PROGRESSIVE!!

    Seriously, I know they take a percentage but I wouldn't have gotten (well, technically I haven't received it yet) my trial and everything resolved without my attorney...And like I said, I've read a lot of WC paperwork!

    I hope it all works out for you, I'll be keeping my fingers crossed for you!!
  • Manic, What state are you in? The WC laws do vary by state. In any case you definitly do want a lawyer. I am in NY and I do not pay a lawyer, they do take a small percentage from the what the company pays in my case it has been less than 10%, but this is not out of my weekly or mileage payments. I never would have wanted to go up against my co in court without a lawyer, and believe me, if you work for a city they will have a lawyer. There are certainly hoops to jump through, but all the more reason to have a lawyer, it is already been established WC so you can't change that now you have to fight for everything. On a positive note, there have been some significant laws passed in the past 6 months, I am not sure if it is only NY or federal but here, they now must give you an answer in 30 days. Previously wc could hold up treatment for months(I know, in 2004 waited 5 months for approval for epidural injections). As far as doctors I have had no problem. I had surgery at a very prestigous hospital in NYC with the chief of spine surgery. I had gone to him as a second opinion dr and when I saw him was very impressed. I asked him "I am WC if I decide to do this can I do it here and can you do it?" He just said "absolutely" I have never felt like dr treated me different. I wish you the best of luck!
  • Yes Lawyers take some of the money but you will get more with an attorney a than without. Also the WC people will act quicker with an attorney involved than without. They can and will push you around hoping you will just give up. They know a lawyer won't and if they make the lawyer mad then watch out. Proctect yourself the system is set up to work against someone who doesn't know the system. That is what you pay the lawyer for. The know the system. Just make sure to get a good one. Talk some people who have gone through this and get recommendation, don't just pick someone out of the phonebook. Good Luck and take care.
  • Just an update on my WC situation.
    After my favorable "IME" they are now treating me like a human being and actually are co operating OK.

    I think they thought I was faking my illness.....
  • eternity road:
    That is great! =D> Just watch your back, they are always watching. I too am with WC and had to bring them to court to get my first surgery an ACDF 2 levels that was done March of this year. I am now going for surgery two rotator cuff on the shoulder, and with my lawyer at my side, so far so good, almost like waiting for the storm? @) We will see surgery is Thursday, see if they pull a fast one here...Hopefully this time will be smooth, and the way we should all be treated, with respect.
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