Insurance Battles

[RDUczyJr]

I had a right TKR back at the end of April. I had filed a worker's comp claim since I fell at work and I had five previous work related surheries on my knee. I just found out today...the claim was denied and I never knew it. The insurance adjuster led me to believe my bills were being paid. What a surprise. The adjuster now tells me to appeal the claim before a judge. I was hoping not to get invovled in a legal claim. Thankfully my medical insurance is picking up the expenses. My surgeon even stated my need for the TKR was because of the previous surgeries and the most recent fall. I'll probably be back to work before the claim is settled. This insurance business is very depressing.

 

[Gretchendz]

If they think there is a hope of prevailing, often the medical insurer will file appeals with Worker's Comp for you (it's in their financial interest to do so, of course).

But if your medical insurance is decent, you're covered either way. Thank goodness. I always fret for those with little or poor health insurance (and such a growing number in this country.)

 

[Josephine]

My sympathies. I sometimes feel quite despairing the wringers you guys get put through ..

 

[VikingFan]

I think that pretty typical with workers comp. They just rubber stamp claims as 'rejected' until you get ready to walk into a court room. Don't buckle in. If you have your own health insurance then I believe that they are obligated to pay and they might go after WC for you. If not, get an attorney.