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denied workmans comp
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<blockquote data-quote="RustyPMcG" data-source="post: 781051" data-attributes="member: 30339"><p>It's irrelevant if they're self-insured or not. It doesn't matter whether the insurance company is doing the insuring, or just administrating the claims. Workers comp rules come from the state, and the insurance companies and administrators have to follow state laws and regulations.</p><p> </p><p>When an appeal involves large medical bills, and significant lost wages, an attorney who specializes in workers comp cases should be consulted. The only real question left at this point is how much of the leg work should be done by the employee, and how much should the attorney and his/her staff do. </p><p> </p><p>The range can be anywhere from just getting advice from the attorney, and then doing all the work one's self, to just handing it all over to the attorney, and letting them do all the work. </p><p> </p><p>One thing to remember is that none of this is personal. It's all about money, and money is not personal. Stay logical; keep emotions to a minimum. Find the applicable state laws and regulations. Gather the proper documentation. Anticipate what laws and regulations the other side will cite, and what documentation they'll bring, and be able to show why their law and/or regulation isn't the applicable one, or why their documentation doesn't support their position. </p><p> </p><p>The people who make the decision hear sad stories all the time, and they've seen people in horrible conditions. Trying to appeal to their emotions without having a logical case supported by law will just get pushback. They've got their own problems, and they're dealing with other people with problems all day long. They do not want to take your problem home. They will put up an emotional wall if you don't give them a case built on the law. </p><p> </p><p>"Who" doesn't matter. The insurance company, whether acting as an insurer or administrator doesn't matter. UPS doesn't matter. The center manager doesn't matter. People in offices in Atlanta don't matter, either. None of it is personal. It's just the law and money. That's all.</p></blockquote><p></p>
[QUOTE="RustyPMcG, post: 781051, member: 30339"] It's irrelevant if they're self-insured or not. It doesn't matter whether the insurance company is doing the insuring, or just administrating the claims. Workers comp rules come from the state, and the insurance companies and administrators have to follow state laws and regulations. When an appeal involves large medical bills, and significant lost wages, an attorney who specializes in workers comp cases should be consulted. The only real question left at this point is how much of the leg work should be done by the employee, and how much should the attorney and his/her staff do. The range can be anywhere from just getting advice from the attorney, and then doing all the work one's self, to just handing it all over to the attorney, and letting them do all the work. One thing to remember is that none of this is personal. It's all about money, and money is not personal. Stay logical; keep emotions to a minimum. Find the applicable state laws and regulations. Gather the proper documentation. Anticipate what laws and regulations the other side will cite, and what documentation they'll bring, and be able to show why their law and/or regulation isn't the applicable one, or why their documentation doesn't support their position. The people who make the decision hear sad stories all the time, and they've seen people in horrible conditions. Trying to appeal to their emotions without having a logical case supported by law will just get pushback. They've got their own problems, and they're dealing with other people with problems all day long. They do not want to take your problem home. They will put up an emotional wall if you don't give them a case built on the law. "Who" doesn't matter. The insurance company, whether acting as an insurer or administrator doesn't matter. UPS doesn't matter. The center manager doesn't matter. People in offices in Atlanta don't matter, either. None of it is personal. It's just the law and money. That's all. [/QUOTE]
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