NYS Workers Comp Hearing?

Question

My husband was injured on the job 3/07, he received payment up to Aug 07 and found he had injured more than originally thought. He needed major spinal surgery. After surgery (which he would have become paralyzed without) he was told by workers comp it was not authorized and they cut him off. He got a lawyer and in April the judge ordered they pay him partial disability up to the date of surgery until the case could be heard. At the first hearing the company's lawyer stated they were absolutely not paying because their doctors claim this is not a work related injury. My husbands 3 doctors say it is. The judge gave 30 days to the company to get their "evidence" or whatever but they wanted 90-120 and the judge said no only 75 at most. Well today is the hearing. We've recieved the reports from the comp docs who say the same thing, not necessary, didn't happen in accident etc. My husbands docs still hold that yes it did happen and was necessary. At this point, I am just wanting the whole waiting game to be over. People say they always stall on things like this hoping you'll give up because you want it to be over.

My question is, what is the likely hood he will win this? Is it just better to walk away and say forget it or what? Are they going to keep delaying until we say forget it? This is so stressful on us.

Answer 1

Workers comp treatments are NEVER preauthorized.  And they only cover injuries directly incurred on the job.  How did he hurt his spine on the job?  That's the question.  If they discovered, for example, a disintegrating disc during his treatment for the injury, that disc is NOT work related.

You didn't say what the original injury was, or what the surgery was for.  Because of that, it's IMPOSSIBLE to say what his likelihood of winning is.  The doctors are NOT lawyers, so could be confusing something natural that work contributed to, or triggered, with something that's legally compensable.

YOUR LAWYER should be able to give you a likelihood of winning.  

If they really and truly feel that the spinal surgery was needed for a non-work caused injury, they will fight this until a judge says they have to pay it.  If your lawyer truly feels that it IS a work caused injury, he will persist.

Answer 2

No, the judge will likely hold the hearing, review the evidence, take it on submission and issue a decision in the next 30-60 days, or maybe even rule from the bench.  Without seeing the evidence, there is a good chance of success for you.  All judges take the insurance reports w/ a grain of salt b/c they know that the doctors were paid to find a reason for disclaimer.  Whereas, your husband's doctor, as the treating physician is given a presumption of correctness.  Moreover, if you loose, then you go to your health insurance company.