denied

[pansy]

ive never been on wc before so this is new to me, can wc really pay some of your hospital bills but not all, they called me at home at 7:00am and told me that my claim had been denied because i didnt meet their critera in the jursdication but they would pay all the bills that they had okd up to that point even my therapy im in wv but work in va

[Still in Limbo]

Hi pansy, and Welcome to the Forum!! Some States have in Their System Pre-Approval of Claim Coverage while they are Reviewing Your w/c Claim to See if it will be Approved. Unfortunately for You, it Seems they have Denied Your Claim, and are telling You that any further Treatments after Today will not be Covered. You May want to Look into the Appeals Process, I'm not from Your State, but I'm Sure Someone will be on Shortly to give You Further Guidance! I Hope this Explanation Helps You Better Understand where You are in Your Situation, and Best of Luck!!

[1171]

yes they can pay the bills incurred and/or authorized up to the point of the denial.
if for some reason you'd rather they didn't pay any of the bills you should put your request in writing with a copy to the doctors and hospitals.

[pansy]

Still in Limbo Wrote:Hi pansy, and Welcome to the Forum!! Some States have in Their System Pre-Approval of Claim Coverage while they are Reviewing Your w/c Claim to See if it will be Approved. Unfortunately for You, it Seems they have Denied Your Claim, and are telling You that any further Treatments after Today will not be Covered. You May want to Look into the Appeals Process, I'm not from Your State, but I'm Sure Someone will be on Shortly to give You Further Guidance! I Hope this Explanation Helps You Better Understand where You are in Your Situation, and Best of Luck!!

i did file an appeal to have a hearing they have not set a time or date yet i do have a lawyer looking at my case, had a mri which wc approved as a matter of fact they requested it, i have a bulging disc and a annular tear i have a comp dr that they refered me to and he said i may need surgery only as a last resort

[pansy]

what does it mean when they say you dont meet the criteria in there jursdication

[kate]

I noticed in your post you said you're in WV but work in VA. What state is the WC filed with?

[Still in Limbo]

It's Good that You are on Top of things, but even though the MRI shows Disc Bulges and an Annular Tear, they must be saying that it's not Work Related, thus the Denial! Their Jurisdiction may just be Their Wording for Their State. Try and Prepare Your Self Monetarily if Possible for a wait, Depending on the Case Load in Your Area, a Hearing for Review of Your Claim May take a while. This System is Very Frustrating, with many Twists and Turns, so with the Denial, Counsel would be Your Best Bet, they can Navigate the System better than the Injured Worker, and You can bet that the Ins. Co. will have Attorney's Working on Their End! Again Best of Luck!!

[pansy]

kate Wrote:I noticed in your post you said you're in WV but work in VA. What state is the WC filed with?

va

[kate]

The reason I asked is because generally, the state where an injury occurred will have jurisdiction; most states will also assume jurisdiction if an employment contract was initiated in that state or when a state is the principal place of employment. But all states are different and your employer must have coverage to be paid under that state's laws. Each state also has different criteria for what is accepted as a work related injury.

I don't know if this was the type of jurisdiction they are talking about. If you are talking to an attorney ask them. They would be used to seeing that type of wording.