Friend needs some advice....w/c demands

[bagpussinamerica]

Hi there. I have been on here for some time now....Montana..L5-S1 herniation...complicated with Tarlovs cyst. Anyhow. This is not for me. My next door neighbour had a car accident last year and hurt her neck and has been going to a chiropractor for the entire time to help her with her injury. This is an accident that is covered by the other drivers insurance co. and was pretty much ok when about three months ago she fell at work. She works in a large hotel as a housekeeper and is 57. She has worked there for 18 years. She was cleaning a bathroom when she slipped and fell and tried to protect herself on her fall. Since then she has had very bad headaches and neck aches. Her chiropractor was worried that all the good work he had put in for the car accident had been undone by this work accident. Anyhow it looks like he filed a claim on her behalf under workers comp. It was denied and so the chiropractors office sent her the bills for this new work. She called w/c and came across a very nasty adjuster who basically made my friend so angry that she decided to forget about the whole thing and just pay the bill. Which she has been doing.

One month down the line....workers comp sends her a letter telling her that she has to attend what looks like to me an MMI meeting with their doctor and they told her that they wanted all pertinant medical records relased to them for review. Now my friend is really angry. She called the adjuster and told her that she was told the claim was denied, she has been paying a huge bill off, and what do they want her to go through all of this for. They told her it was the law. She even offered to sign a paper saying that she would never come to them for this accident in the future just to make this go away. My friend is going through some very difficult times and is having a hard time with this whole thing. I read the letter she got and it is exactly the same type I had when my surgeon first placed me at MMI. So why has she got to go through this if they denied her and she has been paying the bill. I don't understand it myself so I told her I would come on here and ask.

We are in Montana. She filed an accident report at work...but didn't file a claim with w/c herself. Her chiropractor did it on her behalf. The hotel is a large one throughout the U.S. and their insurers are not in this state at all.

By the way...thank God this site is on line again. I worried that with all of this health care reform someone had decided to pull the plug on us!!!!

[jayne]

ahhhhhhhhhh they are just covering their collective arses.....tell her to talk to a lawyer first...wont cost her anything and just may get her bills paid

[bagpussinamerica]

This is pretty much what I told her, but truth be told, she is a strong willed woman and just wants to be left alone. Their re-actions to her and the way they have treated her over the phone has left her with no desire to deal with this group of people in any way shape or form. I just spoke to her again, and again she says, "I just want them to leave me alone. I don't want any more stress."

She does not want any confrontations or problems. She just wants to continue to pay the bill and have them stop calling and being so abusive to her. To be honest, she is having some problems at work too so really can't stand the pressure. She was in tears last week and I have NEVER seen her like that. She is the one everyone else depends on.

[jayne]

and when the car accident insurance stops paying because it was made worse by the work accident? and if they find out it will

[bagpussinamerica]

Excellent point! Well taken. I will pass that on right this second!

[bagpussinamerica]

Well, she is not happy about getting a lawyer. She cant understand why they are bugging her if they denied the claim in the first place. Does anyone have any idea if this actually is the law?

[jayne]

any IC will do anything within their power to keep from paying

[bagpussinamerica]

I understand that, but they already denied the claim and she has been paying the bill herself for over a month......she didn't argue about the denial.....

What I don't understand is...if they deny the claim....w/c that is....then surely she is no longer part of their system if she doesn't pursue it...which she didn't. So if she is no longer part of the system...then why are they telling her she HAS to see their doctor for MMI?

[UndercovrAngel]

Has she gotten the denial of benefits in writing as of yet ?? An adjustor can say anything that they want in regards to the case, but until it is in black and white in front of you, I wouldn't accept what the adjustor has to say.

They may be requesting the MMI appointment to see how much of her new injury can be attributed to her fall at work and how much to the car accident, thus the disclosure of all medical records prior to her fall. The MMI Dr will have to look at previous records, examine your friend and then decide the percentage of injury that he feels can be attributted to the accident at work. If he finds that there is any % that can be from work, then the IC will have to decide whether to accept the claim or deny it. If accepted, they will have to refund all monies spent from time of fall till aceptance of claim that your friend has had to pay out of pocket.

Angel ^j^