Denial of Benefits, Please advise

[Deanna8282]

What is the name of your state?What is the name of your state? Florida

I am a Registered Nurse and was diagnosed with a latex allergy in August of 1999. My symptoms include hives, intense itching, and wheezing when in contact with any rubber latex products. I was instructed by my hospital's workman's compensation department to be evaluated by a board certified allergist. The allergist concluded that I must cease bedside nursing and limit environmental exposure to any latex/rubber products. This has been a challenge to do but, I have made lifestyle modifications. I quit bedside nursing, removed all rubber products in my home, car, essentially my entire environment. And, am quite diligent in my efforts to minimize exposure when outside my home (going to a tire shop or toy store has been off-limits) including removal of any rubber products when working (computer mouse pads and even pencil erasers cause a reaction).

A medication called Zyrtec has saved my life. Zyrtec is an anti-histamine that I take daily at bedtime. It is the only medication that surpresses my symptoms. Because of this medication, I am a productive human being and still continue to work in nursing, albeit, more of an administrative capacity. Every month I re-fill the presciption and yearly I see the allergist who continues the prescription. This month (June 2004), I received a bill from the allergist for "physician's services" for an evaluation done in February 2004. I was told by the physician's office, "workman's compensation denied the claim as not a covered benefit". I tried to re-fill my prescription and was told by the pharmacy that my prescription card had "expired" in May. I have since called the hospital workman's compensation department and they state, "your physician no longer feels that your symptoms are a result of your latex allergy". I told the adjuster, that I am quite bewildered by this since the physician re-filled the prescription and did not tell me his suspicions. I preceded to request a letter of "denial" but never received one.

What is my recourse? Will an attorney take my case? I do not wish to receive any monetary awards other than for the hospital to continue providing the medication. Will it be worth an attorney's time and trouble? I have notified State of Florida's employee assistance office and am awaiting their response. Please advise. I apologize for the length of this post. Thank you in advance for your time.

Best Regards.

 

[Beth3]

In the course of almost all WC claims, there comes a point in time where the liability for the WC carrier ends. You had a pre-disposition to develop this allergy. To the extent that your job contributed to that, they are liable. But they are not liable for a life-time of paying for your medication or doctor's visits.

If I were you, I'd call your employer's WC carrier directly and speak to the claims analyist handling your claim and find out straight from them what has taken place and why you weren't notified that your claim had been closed and/or they would no longer pay for your medication (which should now be covered under the group health plan your employer offers.)

You may be entitled to a PPD (permanent partial disability) settlement or some other compensation under your State's WC regulations to compensate you in part for any future medical expenses you have, so you should ask the WC carrier about that. If you can't get an answer or it doesn't make sense to you, then consult with a WC attorney. Assuming my assumptions are correct (and I'm not guaranteeing they are; I am not familiar in particular with Florida's WC reg's or all the particulars of your claim), a one-time consult to get clarification may be all that's necessary.