Workers comp.insurance problems can you win?

Question

thank you all for taking time to make your opinion .. i have attorney .broke ankle in 2 places .insurance denieds my claim. why would they denied base on there findings ,but even there on specialist made a report saying that they should treat my injury as industrial .will hes opinion help my case too.

Answer 1

haha, yeah his opinion will help.  Sounds like your insurance is a bunch of b******s.  Take em through the ringer, if THEIR specialist claims it's their fault, I think you have a sound case.

Answer 2

How could they deny a broken ankle?  They are stalling.

Your attorney should be able to get this resolved soon.

If not, get a better attorney.

Yes.  You can win.

Answer 3

They would deny if they thought the injury didn't happen at work, or happened while you were at lunch, or if it wasn't caused by a work related incident (like brittle bone disase).

Specialists for injuries, are NOT workers comp case law specialists.  Ya don't go to a doctor for LEGAL advice.

Answer 4

You need to provide more information regarding your injury, were you off the premises at lunch, were you driving to or from work?  There is not a dispute you broke your ankle, there is a dispute that it happened at work.  If you waited to report it, you employer feels that it did not happen at work, then it will be denied and the burden of proof will be up to you to prove, that  it happened at work. So please provide more details regarding the injury.  Preexisting conditions still do not cause a denial, you are not telling us everything.  And yes you can win your case, it will be up to an administrative law judge to decide.

Answer 5

It's tough to really know what happened.  I'm not sure what the story is but yes, you can win in all work comp claims.  When your claim is denied you have the right to appeal the decision.  In this case I'm sure you are appealing their decision.

I'm not sure why it was denied, it might have been denied for a number of reasons.  Perhaps the injury didn't happen at work. However I bet that your injury happened at work but there was other major contributing factors such as pre-existing problems such as brittle bones or another contributing factors could be diabetes, over weight and such. Perhaps your injury did happen at work, but you might not be considered a subject employee, i.e, temporary employee, independent contractor.

I'm not sure what the story is.  If your company doesn't question the claim and it was legit than your adjuster has another story.  But you can win, when you appeal the claim you and the insurance company has the burden of proof.