Workman's comp injury and non payment

[Mrschattie1]

My husband and I are in need of some advice on a Workman's compensation injury from a year and a half ago. We live in the state of Wisconsin.

My husband was injured by a fall at work and was seen by the workman comp. approved physician. That doctor referred him to a osteopathic specialist. After xrays and an MRI on his knee it was the opinion of this specialist that he needed surgery to resolve the problem. Workman's compensation was notified of the surgery as well as our personal insurance. We gave all of our information (in regards to our own medical insurance as a back up just in case) to the doctor. The surgery was performed.

Several months after the surgery we were notified NOT my workman's compensation insurance but by the doctor's office that the claim had been denied. We went around and round with the workman's comp insurance company but to no avail. They will not cover it. EVEN tho, we were told that this was a necessary surgery. We are not doctors we follow the advice of the professional.
After a month of trying to get some action from workman's comp. we decided to go ahead and have the issue resolved by having the doctor bill it to our own insurance. BUT, our insurance denied payment because the bills were not submitted in a timely manner. We need to know how we go about getting this matter resolved at this point. The total bills amount to over $3000.00 which we can not afford to pay, and furthermore do not feel we should HAVE to pay since this injury WAS work related and all the information we had at the time was that HE NEEDED to have this surgery in order to be able to work again. This debt is affecting our credit report at this point. PLEASE someone tell us what our next step is. Thank you.

 

[I AM ALWAYS LIABLE]

<BLOCKQUOTE><font size="1" face=" Arial, Verdana, Helvetica">quote:</font><HR>Originally posted by Mrschattie1:
My husband and I are in need of some advice on a Workman's compensation injury from a year and a half ago. We live in the state of Wisconsin.

My husband was injured by a fall at work and was seen by the workman comp. approved physician. That doctor referred him to a osteopathic specialist. After xrays and an MRI on his knee it was the opinion of this specialist that he needed surgery to resolve the problem. Workman's compensation was notified of the surgery as well as our personal insurance. We gave all of our information (in regards to our own medical insurance as a back up just in case) to the doctor. The surgery was performed.

Several months after the surgery we were notified NOT my workman's compensation insurance but by the doctor's office that the claim had been denied. We went around and round with the workman's comp insurance company but to no avail. They will not cover it. EVEN tho, we were told that this was a necessary surgery. We are not doctors we follow the advice of the professional.
After a month of trying to get some action from workman's comp. we decided to go ahead and have the issue resolved by having the doctor bill it to our own insurance. BUT, our insurance denied payment because the bills were not submitted in a timely manner. We need to know how we go about getting this matter resolved at this point. The total bills amount to over $3000.00 which we can not afford to pay, and furthermore do not feel we should HAVE to pay since this injury WAS work related and all the information we had at the time was that HE NEEDED to have this surgery in order to be able to work again. This debt is affecting our credit report at this point. PLEASE someone tell us what our next step is. Thank you.<HR></BLOCKQUOTE>

My response:

What is your next step, you ask?

I'll answer your question with a question:

What has your Worker's Compensation attorney said about this matter . . . you know, the one you hired?

IAAL



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[LadyFable]

<BLOCKQUOTE><font size="1" face=" Arial, Verdana, Helvetica">quote:</font><HR>Originally posted by Mrschattie1:
My husband and I are in need of some advice on a Workman's compensation injury from a year and a half ago. We live in the state of Wisconsin.

My husband was injured by a fall at work and was seen by the workman comp. approved physician. That doctor referred him to a osteopathic specialist. After xrays and an MRI on his knee it was the opinion of this specialist that he needed surgery to resolve the problem. Workman's compensation was notified of the surgery as well as our personal insurance. We gave all of our information (in regards to our own medical insurance as a back up just in case) to the doctor. The surgery was performed.

Several months after the surgery we were notified NOT my workman's compensation insurance but by the doctor's office that the claim had been denied. We went around and round with the workman's comp insurance company but to no avail. They will not cover it. EVEN tho, we were told that this was a necessary surgery. We are not doctors we follow the advice of the professional.
After a month of trying to get some action from workman's comp. we decided to go ahead and have the issue resolved by having the doctor bill it to our own insurance. BUT, our insurance denied payment because the bills were not submitted in a timely manner. We need to know how we go about getting this matter resolved at this point. The total bills amount to over $3000.00 which we can not afford to pay, and furthermore do not feel we should HAVE to pay since this injury WAS work related and all the information we had at the time was that HE NEEDED to have this surgery in order to be able to work again. This debt is affecting our credit report at this point. PLEASE someone tell us what our next step is. Thank you.<HR></BLOCKQUOTE>

I was curious...Did you ever get a letter from the W/C carrier (handling your husbands case)approving the surgery? just because the doctor/surgeon might have recommended the surgery doesn't mean the W/C carrier has to approve it. They are just like every other insurance company where surgeries must be pre-approved. I'm sorry that you and your husband are going thru so much right now. I would suggest contacting an attorney and see what they say. Good luck.

The above statement is merely my opinion and does not constitute the laws governing your state.

 

[shorty21668]

hello this is shortys husband i am going through a w.c case now they denied mine right off the bat but i aquired an attorney in witch he took it to the workers comp. commisioner and the commisioner granted the case i have had 3 back sugerys so far and have to go for a 4th keep your lawyer on it workers comp. is some slick willies and never rely on their doctors because they work for w.c. and will try and push out the door before you are ready i hope this advice helps

 

[MRSABLE]

<BLOCKQUOTE><font size="1" face=" Arial, Verdana, Helvetica">quote:</font><HR>Originally posted by LadyFable:
I was curious...Did you ever get a letter from the W/C carrier (handling your husbands case)approving the surgery? just because the doctor/surgeon might have recommended the surgery doesn't mean the W/C carrier has to approve it. They are just like every other insurance company where surgeries must be pre-approved. I'm sorry that you and your husband are going thru so much right now. I would suggest contacting an attorney and see what they say. Good luck.

The above statement is merely my opinion and does not constitute the laws governing your state. <HR></BLOCKQUOTE>


I AM GOING THROUGH AN ORDEAL WITH WORKERS COMP AND I NOTIFIED THE WC COMMISSION IN MY STATE PERSONALLY AND EXPLAINED TO THEM MY SITUATION. THE WC COMMISSION EXPAINED MY RIGHTS AND WALKED ME THROUGH THE PROCESS. THE INSURANCE CARRIER HAD TO MAKE ALL MONIES RETRO AND REPAY MY PERSONAL INSURANCE CARRIER AS WELL. I NOW HAVE A GREAT ATTORNEY THAT HAS BEN ON TOP OF THINGS AND HE ALWAYS MAKES SURE THAT MY PAYCHECKS ARRIVE ON TIME EACH WEEK. I PERSONALLY KNOW WHAT YOU ARE GOING THROUGH AND I VERY SORRY FOR YOUR INCONVENIENCE. IF YOU HAVEN'T SPOKEN WITH YOUR WC COMMISSION, YOU MAY WANT TO DO THAT. WHEN I CALLED, I FOUND OUT THAT MY COMPANY'S WC INSURANCE POLICY HAD EXPIRED. I WAS THEN TOLD HOW I COULD PROCEED WITH MY CLAIM. GOOD LUCK AND I HOPE EVERY THING WORKS OUT FOR YOU AND YOUR HUSBAND. YOU WILL BE IN MY PRAYERS.