Can anybody tell me what to do in a workers comp case?Whan will they pay?

Question

I have a friend that just had surgery on her wrist after a nondisputed workplace injury.She will be out of work about 2mos.She just received a call from workers comp saying they are not going to pay now for the surgery or while she is out of work until they have completed an investigation.The investigation is because she got here hand shut in a door 6yrs ago.Will she get paid while they investigate?What are her recourses in the meantime.How is she supposed to eat since now she's had the surgery and is laid up.This news has her literally throwing up.

Answer 1

She should contact her employer and determine their course of action.

Answer 2

No, they just told her, they are not going to pay her while they are invesigating.  Workers comp is regulated by each state. They have the right to investigate, to see if the current injury is actually related to the prior accident.  That would make it, at best, an injury made worse by the new injury, or at worse, disqualify her, depending on the state laws, and their findings.

Her recourse is to file a complaint in writing with the state insurance commissioner.  Or, she can hire an attorney, which will pretty much guarantee she won't see any money for at least six months - as attorneys slow down the process, drastically.

Regarding how she's supposed to eat  . . . . you're her friend.  Bring her meals.  Or she can dip into her savings, or contact her family members, or church, for temporary assistance.

Answer 3

If there is an investigation such as you describe, this claim is NOT undisputed.  The insurance carrier is checking on the validity of the claim.

They will make no payments until their investigation validates the claim.