insurance workers comp claims ?
how do insurance comp..makes decision on when to not accept a claim ? what can they do if they were not there when you got injured.base on WHAT DO THEY MAKE THOSE DECISONS.AND HOW DOES YOUR ATTORNEY FIGHTS BACK?
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i was hurt on my job and no one was there and you don’t need an attorney i took care of it myself they are paying my medical for the rest of my life they want to settle this but I’m not doing it and they did give me some money for the time i was off work
Decisions are made based on the medical evidence that is presented. Each state is different with time tables of decision. CA first 14 days all medical bills are paid, than after 14 days if the claim has no decision than it becomes deferred. Alaska it’s automatically accepted until medical evidence supports denial. Other states have 30-90 day deferred periods, the adjuster will need to make a decision within the state allowed.
When I work on claims I based my decision on evidence, exposure, validity of the claim, etc. For instance if the claimant smashes his finger while using a hammer during a job than the claim is likely compensable because it was a work injury. But if the claimant was lifting a bag of rocks and injured his back and it’s just a back strain but test shows degenerative changes or pre-existing injuries than the adjuster will need to sort out what is related to the injury. Degernerative changes is not cause by work, it’s something that happens over a life time. However some states make the insured responsible for these, other states don’t.
Other things to factor is major contributing causes or was the injury in the course of employment, or was the injured party a independent contractor. These are just examples, each case is different from each other.
Having an attorney has its ups and downs. They’ll review the file and possible ask the adjuster to accept more conditions, like if your back strain the attorney might ask for the bulging disk in your back. Each attorney is different, some fight for their clients some are in it for the money at the end, PPD/PPI awards.
For information on Calif WC..go to the fact sheets for injured
workers. The info provided here by decentanswer for Calif WC is not
true. IW’s are eligible for up to 10K in medical treatment during
the first 90 days of a claim. Thats the time the carrier has to
investigate and accept/deny. Claims are based on medical evidence
provided by the treating physician. WC is no fault, no one is
questioning a injury, only what benefits you are eligible for. TTD
is paid after a 3 day waiting period. If you are out more than 14
days…the first 3 would be picked up. TTD is also capped at 104
weeks in the 5 years post DOI. WC laws are state specific and vary
widely. Go to your state comp web site for more information