Hi Beth

[faigele]

i was just noticing one of your previous comments with regard to being concerned about paying for medical tests. you are misinformed about a few issues. one is that, in the wc system, in this state at least, there are to be no out-of-pocket expenses incurred by the injured workers. the insurance carrier pays for medical expenses. secondly, you seem to think you are at the mercy of the wc insurance carrier as to whether or not they decide to accept your claim and therefore accept liability. you are not. this is why i say to get an attorney. he or she will advocate on your behalf and make sure you are compensated properly, as is your right. ok, it may seem like a hassle, and i do tell my clients that having a wc claim is like having a job - certain things must be done, doctor appointments must be kept, etc. but your physial problems may continue and you may end up not being able to continue in your same position. you may be eligible to be retrained, but you need to have an open claim for this. don't think that the carrier is in charge and whatever the adjuster says, goes. not by a long shot. get represented and have someone advocate on your behalf.

 

[Beth3]

Whiskee, you may have an additional problem if you "cancel" your WC claim. If you group health or personal insurance carrier discovers that either of these injuries may be due to your work (which is easy enough for them to do), they will in all likelihood deny payment of your medical bills. All group insurance plans and many private insurance plans specifically exclude coverage for work related injury/illnesses because an employer's WC carrier is liable for those medical expenses. If the WC carrier ultimately denies either or both claims, they will send you a denial letter in which case you may send your insurance carrier a copy of that and then they will process any outstanding medical bills for your condition(s).

 

[Whiskee]

the whole lawyer thing is main reason. i should have checked into wc sites before filing. also hr made it seem simple- file claim and see doctor. i'd rather pay 20% to see doctor of my choice, be treated w/o delay, added paperwork, hr and attorney involvement. if anyone can confirm i can quit my job w/ wc claim? or is it if on disability i cannot quit my job. if i cannot quit my job while on wc, there's an additional reason. i would like to find other employment. i'm not looking for time off, just hasslefree, speedy treatment so i can do my job, but of course my position will change injured or not. i don't know how hr filed the claim cumulative or not. my main concern is the carpal tunnel and finding another job.

thanks,
whiskee

 

[Beth3]

You can quite your job anytime you like - whether you have an open WC claim, whether you're on disability, or anything else. Unless you are working under a specific employment contract with provisions to the contrary, you are ALWAYS free to resign your employment at any time, for any reason.

Quitting your job will have no impact on your present employer's liability for any work related injuries you sustained while there.

 

[Whiskee]

so i can quit my job and accept employment elsewhere at anytime regardless of wc or disability. that's good to know.

Beth, in order to avoid complications group insurance provider, will written comfirmation (informal email) from HR that my claim has been canceled be proof enough that group insurance will cover treatment? Will formal cancellation confirmation be sent to me from HR and WC company?

Thanks,
Whiskee

 

[Beth3]

I don't know. I've never had an employee "cancel" a WC claim after a first report of injury was filed with the carrier. I think you should ask your HR department.

 

[cbg]

You also should ask your insurance carrier. I was contracting as a disability claims processor for a few months last year and I'm not so sure that just cancelling the claim will be enough. The likelihood is that without an outright denial from the workers comp carrier, the claims will sit in limbo. Once you've said that you believe a claim to be work related, saying, "I've changed my mind, I don't think it was work related after all" does not obligate the group health carrier to take your word for it.

 

[Whiskee]

as it stands. i've sent hr an email wishing to cancel claim, but no one's gotten back to me. i've left a message w/ wc carrier i wanted to cancel w/ no response. i can't see doctor of my choice and say it's work related and be treated and be covered w/ HR confirmation that i cancelled the claim? it's been since 4/10/03 w/o treatment. i'll wait to hear from hr. so cbg, you're saying that group insurance will deny payment because it's work related and wc must prove that it's not. so i have no choice but to retract my cancellation and procede with wc claim?

 

[Whiskee]

how about seeing a free clinic since it appears i have messed up on both ends wc carrier and group insurance?

 

[Beth3]

Whiskee, neither cbg nor I can tell you whether you have "no choice." Your State's WC reg's will have some unique provisions and your employer's group health plan will have some as well and cbg and I obviously don't know what those are.

Chances are you can't cancel your WC claim at this point but you're going to have to wait for HR and the WC carrier to get back to you. It was only just earlier today you contacted them about your change of mind.

 

[cbg]

I have no idea whether you have a "choice" or not. I can't tell you for certain whether the group health insurance will insist upon seeing a denial from workers comp or not. I'm telling you that there is no guarantee that the group health insurance will take your word for it that there is no work relationship since you initially said that there was.

 

[faigele]

as the others have said, you are free to seek other employment. however, be aware that any job you accept will need to comply with the work restrictions your doctor has given you.

 

[Whiskee]

i informed hr i wanted to canel, but would have to wait until the adjuster received my claim and let him know in writing so he can deny claim. however, when i tried to make the appt w/ my doctor, they're checking w/ billing to see if they can accept me w/ an open wc claim. so still waiting.

when they check medical records, do they do phone interviews w/ doctor or do they want a complete file? do they want billing records too? hr said i wouldn't be reimbursed for past visits, but if there are any outstanding bills is wc to pay for them? it may seem like i will have to procede w/wc. at what point do i need an attorney? and no upfront costs for them? but still have to pay for one? i don't like that part.

thanks,
whiskee

 

[faigele]

i have checked with the forum rules and do not believe that the following response violates them. whiskee, i think i could answer your questions more clearly if you were to call me at my office. i am not soliciting you as a client as i have no idea in which city in california you are located. i would be glad to speak to you on the phone in order to see if i can be of some assistance. you may email me at my office at fsrowe@wenzel-associates.com. i can then give you my office number and you can call, if you wish.

 

[Whiskee]

wc adjuster phoned me and i expressed my desire not to pursue claim. he advised to place this in writing and then he would send confirmation. i don't think my conditions are caused by work, i think it's because of all the stress from that billing issue i've been dealing with for the past year and a half. i will schedule an appointment with the doctor when confirmation is received. hopefully this will no longer be an issue. i shouldn't have even inquired! no one said that a simple inquiry would lead to a claim. i truly felt roped into filing when it wasn't my intent. i never should have even asked. the adjuster said that it can't be canceled until the claim is opened, then the letter and then the confirmation. seems pointless to me to open and then close. that's where it stands.