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Workers Compensation

JaxsonRaine
Posts: 3,606
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3/5/2012 11:58:24 PM
Posted: 4 years ago
Ok, a little story. Someone I know was injured at work, couldn't use their hand anymore(dominant hand).

Workers comp claim issued and accepted by the industrial commission and insurance company.

Insurance company says 'we just sent the check out in the mail' 3 or 4 times a week for 3 months. Friend hires a W.C. attorney, who calls the adjuster, who says 'No, we never sent that out, seems to have been a mistake. I'll send it now'. The check(no backpay) shows up a week later.

Then, the insurance company says 'We want a second opinion' so they send the friend to a hand surgeon. The doctor this person was supposed to see wasn't there so another surgeon did the examination and verified the findings. Insurance says to go back to the doc that wasn't there, who verifies the findings as well. Insurance says 'we need another second opinion' and schedules an independent medical examiner, who doesn't perform the test and says he can tell nothing is wrong and this friend is faking it. Insurance cancels benefits retroactively, meaning they don't pay for the days that they hadn't paid for yet.

Friend talks to lawyer who schedules a hearing for 3 months after the last exam. Insurance doesn't send ANYONE to the hearing. Judge postpones the hearing. Another hearing, they don't show up again. Judge awards in favor of the friend 2 weeks later, and insurance company has 30 days to appeal. After the 30 days, they have at least 2 weeks to send a check.

The best part, is there is no recourse against the insurance company for doing all of this, no penalty, and no damages. They can cancel every case, and if someone manages to get by for 4-6 months with no pay to show up to the hearing they will get their money. If not, then the insurance co. wins.

I feel really bad for that friend, who had to sell off every asset they had to get by until they finally got the check.
twocupcakes: 15 = 13
logicrules
Posts: 1,721
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3/6/2012 5:00:04 AM
Posted: 4 years ago
At 3/5/2012 11:58:24 PM, JaxsonRaine wrote:
Ok, a little story. Someone I know was injured at work, couldn't use their hand anymore(dominant hand).

Workers comp claim issued and accepted by the industrial commission and insurance company.

Insurance company says 'we just sent the check out in the mail' 3 or 4 times a week for 3 months. Friend hires a W.C. attorney, who calls the adjuster, who says 'No, we never sent that out, seems to have been a mistake. I'll send it now'. The check(no backpay) shows up a week later.

Then, the insurance company says 'We want a second opinion' so they send the friend to a hand surgeon. The doctor this person was supposed to see wasn't there so another surgeon did the examination and verified the findings. Insurance says to go back to the doc that wasn't there, who verifies the findings as well. Insurance says 'we need another second opinion' and schedules an independent medical examiner, who doesn't perform the test and says he can tell nothing is wrong and this friend is faking it. Insurance cancels benefits retroactively, meaning they don't pay for the days that they hadn't paid for yet.

Friend talks to lawyer who schedules a hearing for 3 months after the last exam. Insurance doesn't send ANYONE to the hearing. Judge postpones the hearing. Another hearing, they don't show up again. Judge awards in favor of the friend 2 weeks later, and insurance company has 30 days to appeal. After the 30 days, they have at least 2 weeks to send a check.

The best part, is there is no recourse against the insurance company for doing all of this, no penalty, and no damages. They can cancel every case, and if someone manages to get by for 4-6 months with no pay to show up to the hearing they will get their money. If not, then the insurance co. wins.

I feel really bad for that friend, who had to sell off every asset they had to get by until they finally got the check.

Yup....thats the law. Welcome to the world of the Insurance Lobby. Heres another for ya.....If you have Health Insurance you waived confidentiality.
Greyparrot
Posts: 14,256
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3/6/2012 6:01:49 AM
Posted: 4 years ago
Taking personal responsible health savings accounts and distributing them out to the collective capitalistic pool may help the poor, but is inneficient of course. Pehaps in the future we could confine just the poor to the crappy system of government insurance and allow the self-sustainers to opt out and use a form of health savings account. They would then be more willing to pay a reduced tax to fund the innefficient, low quality, but available government-managed healthcare for the poor.
logicrules
Posts: 1,721
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3/6/2012 6:03:36 AM
Posted: 4 years ago
At 3/6/2012 6:01:49 AM, Greyparrot wrote:
Taking personal responsible health savings accounts and distributing them out to the collective capitalistic pool may help the poor, but is inneficient of course. Pehaps in the future we could confine just the poor to the crappy system of government insurance and allow the self-sustainers to opt out and use a form of health savings account. They would then be more willing to pay a reduced tax to fund the innefficient, low quality, but available government-managed healthcare for the poor.

Bull....just eliminate insurance and Health care is universally available already, last thing we need is the Cluster known as Government involved more.