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Der weibliche Mensch – Seite 6 – AMELI ZURICH - Blog Archive
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WHAT DOES IT MEAN WHEN MY WORKERS’ COMPENSTION CLAIM IS DENIED?• Many people do not understand what it means when their workers’ compensation claim is denied.• Please note that this is just a quick explanation and not meant to be a comprehensive explanation of what a denial means in every case. However, this is applicable to the average workers’ compensation case. • You usually become aware that you claim has been denied when you receive a “Notice of Denial of workers’ compensation benefits” in the mail. (SHOW SLIDE 1 “DENIAL OF WORKERS’ COMP BENEFITS (While me still taking)• Please understand that this is VERY common. I tell a majority of my clients, especially if they have filed a workers’ compensation cumulative trauma claim, that their claim will be denied at the beginning. • For a quick refresher of the two types of workers’ compensation injury claims you can make, please see my other YouTube videos. Back to me• This Denial means that you will not be getting any workers’ compensation benefits at the start. You will likely start to receive benefits as the case progresses, if not, at the conclusion of the case. However, every case is different. • Please remember that most insurance companies, especially workers’ compensation insurance companies, are extremely cheap. • For example, if you file for injuries to your hands for repetitive typing for 10 years, they will likely deny your workers’ compensation claim. Even if it is this straight forward. This is because they do not want to pay you anything and are hopeful that you will give up and go away. Do not give up!• When your claim is denied, this simply means that you have to show that your injuries are due to work, at least in part. This is commonly handled and done AFTER you file your workers’ compensation claim.• Again, in the example of you filing for injuries to your hands for repetitive typing for 10 years, it is always better if you have seen a doctor in that 10 year period, BUT if you have not, this is okay. Many people are unable to, or do not want to see a doctor for whatever reasons. • However, while this might be one of the many reasons they denied your claim, you can simply go to the doctor, usually through an attorney and show that the injuries are in fact connected to work. Again, this can be done AFTER you have filed the workers’ compensation claim.______________________________________________________• If the claim is denied, you might be wondering how you see a doctor. • Your attorney will find a doctor for you that will treat you on a lien. This doctor will then start connecting your claimed denied injuries to your employment and the process begins. • The insurance will want to get involved as treatment begins because this reporting or “medical evidence” by the doctor will show that the claimed and denied injuries are in fact connected to your employment. • At this point, the only option for the insurance, is to go to a PQME or an AME to try to prove otherwise. This is a non treating, neutral expert doctor. • A PQME is a Panel Qualified Medical Examiner that is given to us by the workers’ compensation system.• An AME is an Agreed Medical Examiner. This is a doctor that your attorney and the defendant are comfortable with using and feel that will give a truly neutral opinion. • You must always be careful with an AME, because an AME’s opinion is final in the case. • This is in contrast to a PQME, who’s opinion goes against your treating doctor. If the two doctors disagree, then if necessary, this would proceed to a workers’ compensation trial. • If you have an AME doctor, this is your whole case in that medical speciality. Whatever they say, goes. We can fight their opinions, but their FINAL word is what a Judge will agree with 99.9% of the time. Your primary doctors opinion really does not matter next to an AME. • Once you have the PQME and/or AME on your side, and they have finalized their opinions, then this is USUALLY when the insurance company starts to pay benefits. Some insurance companies still fight, but they ultimately lose a majority of the time. • Once you have final opinions from the AME and/or PQME in all the applicable medical specialites, this is when settlement usually happens. • If disagreements continue, a workers’ compensation trial is set. This involves only a workers’ compensation Judge, no jury. This takes place at the workers’ compensation appeals board. ____________________________________________• If you claim is denied, please understand that you are not alone. Many cases are initially denied. Please make sure that you fight for the workers’ compensation benefits that are rightfully yours. ... See MoreSee Less