CeeScraps
Pearl Clutcher
~~occupied entertaining my brain~~
Posts: 3,849
Jun 26, 2014 12:56:40 GMT
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Post by CeeScraps on Mar 7, 2019 13:45:53 GMT
So what is the basis for denial? How long ago did it happen? A fx'd patella takes awhile to heal. Does he have other health insurance? I would think if he does they may go after work comp to cover it also. They said because even though it happened at work, it is not a work related injury. Hie did dislocate his knee cap about 8 years ago, so we think that may be the reason. He had not had problems with it since then. It just happened last week. No other health insurance. His company doesn’t offer it unless you are full time which is like 38 hours a week and he stays at 37 or below. Ding, ding, ding....that’s it. Because he had injured it before this would be their basis. Ask you son about the interview they did with him. If he can recall his responses that will tell you a lot. Now, is it right? No. Could a lawyer help I haven’t a clue. Good luck!!
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lurkyloo
Full Member
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Posts: 284
Dec 5, 2018 6:53:08 GMT
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Post by lurkyloo on Mar 7, 2019 13:53:50 GMT
Wow, this is so interesting. I didn't realize laws vary so much. I recently went through my first experience with workman's comp. I work at a higher ed institution. I was on my lunch break and was walking with a group of colleagues into one of the dining halls for lunch (which we pay for, not that it matters to this story). I lost my balance while walking up some interior stairs, most likely due to some rowdy students running up them. My knee hit the metal edge of a step and I ended up needing 15 stitches. I went to our campus health clinic. I was very surprised that this was covered by workman's comp. I was on a break. It was not work related. There was no negligence on the part of the organization. But it was. Ouch! Perhaps your claim was paid because stairs aren’t necessarily supposed to also be knives!
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Post by lbp on Mar 7, 2019 14:39:24 GMT
Just because it happened while he was working doesn't make it workers comp. Especially if this is an injury he had previously. I am pretty sure our insurance would turn this one down also.
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tincin
Drama Llama
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Posts: 5,375
Jul 25, 2014 4:55:32 GMT
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Post by tincin on Mar 7, 2019 14:41:41 GMT
Was he on a break, lunch? walking in/out of work? they won't cover. What exactly was he doing? Actually some places will. If I get hurt in any of those scenarios, if I can point out a reason why it’s the company’s fault, I will get comp. Case in point, last winter a friend of mine slipped on ice in the parking lot and broke her thumb. She received comp.
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Deleted
Posts: 0
Jul 4, 2024 4:49:51 GMT
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Post by Deleted on Mar 7, 2019 15:07:15 GMT
I work for a large PI firm in NY. (You may have seen the owners parodied on SNL recently ![;)](//storage.proboards.com/5645536/images/Q_m8lDOvc_3Le3r1GKdf.jpg) ) Comp often denies initially. Get a good attorney to review the case. Many times once outside counsel is retained the insurance company does pay out. Especially if they get a medical expert to be a witness. Good luck!
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Post by cindyupnorth on Mar 8, 2019 3:07:02 GMT
Thank you all. They are sending the denial in writing and we will be contacting a workmen’s comp attorney, I have a couple leads on good ones. I don’t want to share too much online so sorry if I am kind of vague. He does not require surgery. He is seeing an orthopedist, and did the first time also. 2 weeks is the minimum he is off work, then he goes back to the Dr and may be released for light duty. It’s winter in MN, he has on a full leg brace and using crutches, going out is almost impossible with the ice and snow right now. Needless to say cabin fever is hitting him big. Thanks again. Are you sure he has an actual fracture of the knee cap? or a hairline fx? or just dislocation. That is extremely soon for a fx, and return to work. usually it would be 4-6 wks.
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