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2 Insurance Carriers 2 Denials

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lora000

New member
What is the name of your state? Fl

I'm a female in my 40’s from FL with no prior back conditions.
In the past 3 years I hurt my lower back at work twice, first time in March 2015 and after 4 month I was released by the work comp DR to go back to work on full duties with no restrictions.
The second injury was on January, 2017 and I returned directly to my work comp Dr. and instantly received treatment.
Work comp doctor send me for 3 MRI in the past 3 years. The MRI results indicated multiple bulging discs, multiple central canals stenosis, multiple annular tears, inherited as well as fusion disc.
Treatments included 1 cortisone and 2 Epidural, 18 physical therapy sessions and variety prescription drugs. Currently, I have pain in lower back radiating to my left leg and numbness in groin and inner thighs.
The Dr. sent me back to work on light duties but employer did not have work for me and after 4 months they fired me. I'm out of work from April 2017 and still under work comp doctor restrictions.
For the last year and a half the work comp doctor and the insurance company/employer treated my second injury as an extension of the first one.
However, this was changed last month (June 2018) when I received letter from the 2015 insurance company denying my claim that on the date of my second injury the company I used to work for had different insurance carrier. The insurance company argues that the "major contributing cause" was in the second injury so this is not their responsibility.
In the same time I received letters from the 2017 insurance carrier claiming that "there was no injury by accident that resulted from employment and failed to timely report accident" so they denied my claim as well.
Currently, my case is denied by 2 different insurance companies and I'm not getting any compensation and or treatment.
What will be the best way to handle this situation?
Your help is greatly appreciated!!!
 


quincy

Senior Member
What is the name of your state? Fl

I'm a female in my 40’s from FL with no prior back conditions.
In the past 3 years I hurt my lower back at work twice, first time in March 2015 and after 4 month I was released by the work comp DR to go back to work on full duties with no restrictions.
The second injury was on January, 2017 and I returned directly to my work comp Dr. and instantly received treatment.
Work comp doctor send me for 3 MRI in the past 3 years. The MRI results indicated multiple bulging discs, multiple central canals stenosis, multiple annular tears, inherited as well as fusion disc.
Treatments included 1 cortisone and 2 Epidural, 18 physical therapy sessions and variety prescription drugs. Currently, I have pain in lower back radiating to my left leg and numbness in groin and inner thighs.
The Dr. sent me back to work on light duties but employer did not have work for me and after 4 months they fired me. I'm out of work from April 2017 and still under work comp doctor restrictions.
For the last year and a half the work comp doctor and the insurance company/employer treated my second injury as an extension of the first one.
However, this was changed last month (June 2018) when I received letter from the 2015 insurance company denying my claim that on the date of my second injury the company I used to work for had different insurance carrier. The insurance company argues that the "major contributing cause" was in the second injury so this is not their responsibility.
In the same time I received letters from the 2017 insurance carrier claiming that "there was no injury by accident that resulted from employment and failed to timely report accident" so they denied my claim as well.
Currently, my case is denied by 2 different insurance companies and I'm not getting any compensation and or treatment.
What will be the best way to handle this situation?
Your help is greatly appreciated!!!
You can contact an attorney in your area for assistance but you might want to start with Florida's Employee Assistance Office (EAO), Bureau of Employee Assistance and Ombudsman. The EAO can help you file a Petition for Benefits if your claim was denied.

Here is a link: https://www.myfloridacfo.com/division/wc/employee/eao.htm

Good luck.
 

Litigator22

Active Member
Where did you get the crazy idea that the insurance carrier that underwrites your employer's workman's compensation plan holds sway over the issue of your entitlements? That is like asking Mr. fox to design a chicken coup.

Anyway, it is not the role of the insurance carrier to grant or deny your claim. That decision ultimately rests with the Offices of the Judges of Compensation Claims. ( F. S. 440.192)

What you need to do is consult with the Employees' Assistance and Ombudsmen Office a division of the Florida Department of Financial service which is an agency that is created by Florida law to provide guidance in pursuing your claim. (F. S. 440.191) So start here:

Bureau of Employee Assistance
200 East Gaines Street
Tallahassee, Florida 32399-4225
1-800-342-1741

That, or speak with a Florida attorney active in the practice of workers' compensation law
 

quincy

Senior Member
Where did you get the crazy idea that the insurance carrier that underwrites your employer's workman's compensation plan holds sway over the issue of your entitlements? That is like asking Mr. fox to design a chicken coup.

Anyway, it is not the role of the insurance carrier to grant or deny your claim. That decision ultimately rests with the Offices of the Judges of Compensation Claims. ( F. S. 440.192)

What you need to do is consult with the Employees' Assistance and Ombudsmen Office a division of the Florida Department of Financial service which is an agency that is created by Florida law to provide guidance in pursuing your claim. (F. S. 440.191) So start here:

Bureau of Employee Assistance
200 East Gaines Street
Tallahassee, Florida 32399-4225
1-800-342-1741

That, or speak with a Florida attorney active in the practice of workers' compensation law
I provided a link to the EAO already, Litigator - and pretty much the same advice. I agree that the EAO would be a good place for lora to start.
 

Litigator22

Active Member
I provided a link to the EAO already, Litigator - and pretty much the same advice. I agree that the EAO would be a good place for lora to start.
This may be a bit deflating, but I'm not an avid reader of your innumerable (as in 32,000 plus) postings.
 

quincy

Senior Member
This may be a bit deflating, but I'm not an avid reader of your innumerable (as in 32,000 plus) postings.
Not deflating at all, Litigator. But I think you might learn something from reading them.

I noticed you took the time to check out my profile. Your time might have been better spent reading the thread you were responding to before responding to it. ;)
 
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