Question or REd or anyone else in NJ

[mel1980]

Hi red and anyone else from NJ or that can answer the following question:

Ok spoke with the insurance adjuster today after returning from the drs visit,,,,I asked him 2 questions 1) When will start recieving my checks. and he said he is waiting to get the ER report from the hospital from 9/11 in order to process my claim and see if it excepted now the only reason i can think he is doing this is because i was out of work on the following mon tues and wed..I went back to the ER on 9/14 also...Now could this be the case why or why arent they accepting my claim to pay me but ..he said in the next breath that they will not deny me medical covereage for any tests or anything that will have nothing to do with it...

[red1030]

Hi mel, I am very confused about what you are asking. What was the date of your injury? I don't remember this. Also, wasn't you report filed a couple months late? What does that have to do with being out of work on the monday through wednesday etc. Sorry I really can't answer this question. On the other hand if you are asking why he is waiting for a report that provides more information about your injury, then i would say that this is all part of the investigation process. As to when you are going to get your check, they have 14 days in NJ to investigate and then mail you a check. other than that I am lost. Sorry I could not be of more help. Red

[Bad Boy Bad Boy]

Well, going to the ER can bite you, we did try to tell you that. Yes, they want those reports, and not only that, those report state evrything you said at the ER also, and these are things that want to see. They want to see also if going to the ER was for the injury, and injury also. It is their right to do this. Nowhere did you say they denied your claim, so I would think they haven't yet.

[mel1980]

BADBOY wait a second before you try and say going to the er can bite me that was prior to me filling out the injury form and prior to me being on this site.....My DOI is considered 9/20 but was in er for this problem on 9/11 and 9/14 i was there 9/14 mainly for my arm as it was burning and very numb and my PCP was out of town.....No he did not say he denied my clain nor did he say he accepted it...On the otherhand as i stated he did say they will not deny me any medical care or hold up any tests the dr ordered because of this IE EMG test...So i am assumung that is good..Do they normally do things that way

[Bad Boy Bad Boy]

Mel, I was just trying to show you the (Examples) of going to the ER, and how going to much can draw attention to your claim.

But as you see, they are now doing just that. They wish to see all the ER Reports, and it is their right to do this.

Since your date of injury is 9/20 and you been to the ER before 9/20/2007, they going to start and ask questions. They might ask your employer if they knew about your injury before 9/20. Things like that. This is another good (example) to why one always files a first injury report right away. Never ever delay, even a small cut, report it. For people have lost limbs over small cuts, that went unreported.

As you see, in your prior post, where even other people had told you about going to the ER. Even if it was prior to the injury date, and after the injury date. It's a issue that is a very important one to the Adjustor. And now their looking at those reports. It's their right to do so.

[mel1980]

Badboy yes i understand your point very well..And understand that the IC wants to see as well..What i dont understand is why it took 2 weeks for him to tell me this yesterday why didnt he call me and tell me they were waiting on this??? I mea i was suppose to recieve my 1st check today and now thats not in sight till next week..And as far as reporting it goes like i said you know the whole story behind my claim as i have stated in other posts when i went back on 9/14 they insisted i go to an ortho and i did the following tuesday as thats why i was out mon tues wed and went in thursday 9/20 and filled out report

[Bad Boy Bad Boy]

Yes, I know your story, but many don't, so suppling the information for those that don't go back and read, sometimes helps others.

Use of (Examples) is a injured workers tools.

Now, also, as you know this is going to cause a slight delay. I say slight, for hopefully that is all it will be. Also the fact, that your not the Adjustor's only client, for they have many to deal with, even makes the process even slower. Not just for you. Work Comp Insurance isn't going to rush for one person, it's a slow process, even though many injured don't like it, it's something they need to get use too. If you or anyone have a long period of time in a claim, you will see more and more of things in the form of delays. Your still at the starting stage, and sometimes the slowest stage.

[mel1980]

badboy yes i have come to realize it is a slow process the ins adjuster told me that once he gets the report it is out of his hands and goes to upper managament for review i know i have red on the info by state that anything for a 30 day delay is considerted to unreasonable i know i am not the only client as i have to expect a slight delay that is fine but i want to know wheere i stand thats all

[Still in Limbo]

Mel, Bad Boy is Right on the Money, as Usual. Bad Boys information may sometimes not be what You want to Hear, but You can Bet it's been researched, and being given only to Help. Here's my take on this, and I've been at this Three Years, and have been on this Site for a while, as well as on Other Sites, and it looks Pretty Clear to Me, and follows what Bad Boy is trying to say to You. Injury Date 9/20, E.R. Visits 9/11, and 9/14, Prior to filing an Injury Report, and for the effected or Injured Area. Now depending on the Person who reads Your File, it could go Two Different Ways: They Could Approve You, and All will be Well, or: They will consider this not a w/c Claim, because You were at the E.R. seeking Treatment twice Before Filing an Injury Report. If the Second Scenario is the One used, which they may try to not Approve Your Benefits, You will have to Fight all the way for Your Benefits, and that will include going to Hearings to have the Decision over turned. We are only trying to Help, and Prepare You for what may Come, ALL w/c Systems, in any State, while reviewing Your Case for Approval will not deny You Care, in Case the Claim is accepted. It protects the i/c to give You Interim Care, while Your Claim is being Processed. I Hope the First Scenario is Used and You have no Problems at all, but We are also trying to Prepare You for the Second, something that may Very Well Happen!! Best of Luck!!

[mel1980]

ok still in limbo thank you for your helpfullness i am praying that they dont do that..But my question is how can they deny the claim when not one dr i have seen isnt saying its not a work related injury they all agree with the finidngs and agree its from work...So how can the deny that...