WC claim denied

Jan 29, 2019

  1. somarco
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    somarco GA Medicare Expert

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    Individual tripped on uneven carpet in the workplace during normal business hours. Fall resulted in broken hip and elbow.

    Claim almost immediately denied upon filing. Have not seen denial letter but have been told claim was refused because claimant tripped over their feet.

    Is alleged clumsiness justification for denial?

    Claimant had visual impairments that require the use of special glasses similar to goggles worn by basketball players. Field of vision is slightly impaired but does not prevent the individual from performing regular duties.

    Claimant asked employer for appeal forms and information on the appeal process. Request for forms denied.

    Plan is self funded municipal plan.
     
    somarco, Jan 29, 2019
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  2. adjusterjack
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    adjusterjack Guru

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    That says it all.

    Claimant needs a WC attorney right now.
     
  3. somarco
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    somarco GA Medicare Expert

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    somarco, Jan 30, 2019
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  4. adjusterjack
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  5. somarco
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    somarco GA Medicare Expert

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    Still looking for feedback from someone who has answers
     
    somarco, Jan 30, 2019
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  6. adjusterjack
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    That's the best feedback you can get from anybody.
     
  7. EugeneM
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    lawyer up...

    no-fault” system, which means that any worker who is injured on the job – regardless of whether that injury has been caused by the injured worker himself,
     
    EugeneM, Jan 31, 2019
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  8. adjusterjack
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    Didn't think of this earlier but (assuming the claimant is employed in GA) he can file a complaint with the Georgia Board of Workers' Compensation.

    Here's a form:

    https://sbwc.georgia.gov/sites/sbwc.georgia.gov/files/related_files/document/ComplaintForm.pdf

    I suggest he attach a First Report of Injury to the complaint:

    https://sbwc.georgia.gov/sites/sbwc.georgia.gov/files/board_forms/wc001.pdf

    Lawyer up as well.
     
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