spetersyoda
Junior Member
What is the name of your state? California
Conversation with Lily on Feb. 2nd 2005
She informed me that the doctor appointment I have on Feb. 7th made by the insurance co to determine if my claim is work related is going to be canceled because their company made this appointment and this is not law abiding according to California law, which states that I was suppose to get forms from insurance co. that I must fill out and send to the state of California and then wait for the state to get back to me with a list of doctors that will determine with my injury is work related. At which point I then can choose from this list of doctors and then one will determine if my injury is work related. Well my claim date was on Dec. 7th 2004 so on March 7th 2005 this report from the doctor needs to be in the insurance co.’s hands or they will deny my claim. Lily claims this is a conditional denial until the doctors report can come in from the state chosen doctor after March 7th 2005.
I have a problem with this for as of today the 2nd of February 2005 I have to wait for the insurance co. to mail these forms out to me and at which point I need to mail them as soon as possible to the state of California (the state has ten working days to get back to me with the list of doctors). I estimate that I will receive the list of doctors from the state to be around the 21st of February 2005, which will leave me approximately 9 working days to get an appointment and have the report back in to the insurance co. hands before the denial of the claim. The insurance co should have gotten me the proper forms back in December 2004 thus allowing me plenty of time to get a doctor’s appointment before the march 7th deadline. They had instead made a doctors appointment for me with their own doctor to evaluate my claim that this injury is work related. This doctor’s appointed was to be held on February the 7th 2005 giving plenty of time to close the case. I had asked Lily if she would move the March 7th deadline date back to April 7th because of the errors that had occurred by their company. She informed me they could not.
My concerns at this point
1) Is it legal for them to deny my claim on March 7th because of their errors?
2) Can they deny my claim with a disclaimer that they are waiting for the states doctor report and then reopen the claim?
3) Being they had made the error why can they not change the March 7th date?
All of this has caused me undue stress and concern.
thank you very much
Conversation with Lily on Feb. 2nd 2005
She informed me that the doctor appointment I have on Feb. 7th made by the insurance co to determine if my claim is work related is going to be canceled because their company made this appointment and this is not law abiding according to California law, which states that I was suppose to get forms from insurance co. that I must fill out and send to the state of California and then wait for the state to get back to me with a list of doctors that will determine with my injury is work related. At which point I then can choose from this list of doctors and then one will determine if my injury is work related. Well my claim date was on Dec. 7th 2004 so on March 7th 2005 this report from the doctor needs to be in the insurance co.’s hands or they will deny my claim. Lily claims this is a conditional denial until the doctors report can come in from the state chosen doctor after March 7th 2005.
I have a problem with this for as of today the 2nd of February 2005 I have to wait for the insurance co. to mail these forms out to me and at which point I need to mail them as soon as possible to the state of California (the state has ten working days to get back to me with the list of doctors). I estimate that I will receive the list of doctors from the state to be around the 21st of February 2005, which will leave me approximately 9 working days to get an appointment and have the report back in to the insurance co. hands before the denial of the claim. The insurance co should have gotten me the proper forms back in December 2004 thus allowing me plenty of time to get a doctor’s appointment before the march 7th deadline. They had instead made a doctors appointment for me with their own doctor to evaluate my claim that this injury is work related. This doctor’s appointed was to be held on February the 7th 2005 giving plenty of time to close the case. I had asked Lily if she would move the March 7th deadline date back to April 7th because of the errors that had occurred by their company. She informed me they could not.
My concerns at this point
1) Is it legal for them to deny my claim on March 7th because of their errors?
2) Can they deny my claim with a disclaimer that they are waiting for the states doctor report and then reopen the claim?
3) Being they had made the error why can they not change the March 7th date?
All of this has caused me undue stress and concern.
thank you very much