Can I sue my workmens compensation insurance company if they stop paying my bills? 18 Answers as of May 29, 2013I'm having a huge problem with my workmen's compensation that I settled with them with open medical. I've had 10 surgeries on my left arm, ending up with a fusion of my left wrist and permanent nerve damage. My pain doctor and my orthopedic, just set me up with a neurosurgeon. My comp. Insurance stopped paying all my bills, every single one of them. I have a new adjuster. He will not return my lawyer's or my calls. My attorney has been trying to get a hold of their attorney, and their attorney will not return my lawyers calls either. It's important that they call us, because now the cut me off all my pain meds. I'm on perecet & morphine pills. I went to pick up my meds two days go, and they told me my comp denied all medicines. I am going through major withdrawals. Can we go after the commission for this?
Cleveland & Metz | Charles Cleveland
The answer to your question is no, you cannot sue the workers compensation carrier however you do have several remedies. If your case has been stipulated with an award, your open medical for life should be provided for. If your treating doctors are prescribing medication and treatments that are part of your stipulated open future medical care, insurance company should be authorizing it. Many insurance companies are using utilization review departments to routinely deny care. If your case has an agreed medical examiner or a state panel qualified medical examiner, then there should be no utilization review process in the determination of your medical care. If your stipulation is based on the treating doctors, the insurance company should be following your treating doctors recommendations however this may be subject to utilization review obstacles. If your insurance company continues to deny you care, your attorney can file for an expedited hearing on the issue of medical care. If the denials are unreasonable, you can file for penalties under labor code section 5814. If the insurance companies conduct is egregious, you might be able to request bad faith sanctions under labor code section 5813.
Answer Applies to: California
The Law Office of Stephen R. Chesley, LLC | Stephen R. Chesley
What it appears to be happening is that your claim is being controverted by the carrier. A hearing will be set up wherein all evidence will be presented with regarding to continuing your benefits. If the judge sides with you, he will continue your benefits and have it paid retroactively.
Answer Applies to: New York
Lapin Law Offices | Jeffrey Lapin
If you already have a lawyer you should talk to him or her about your options in getting the workers' compensation insurance company to pay your bills. Your attorney is in a better position to know what to do than me, when I only have limited information and do not know exactly what has occurred in your case.
Answer Applies to: Nebraska
Law Offices of Ronald A. Steinberg & Associates | Ronald A. Steinberg, BA, MA, JD
If your settlement (redemption) leaves the medical bills open, then you certainly can sue. Get a copy of the redemption order and make sure that you left the medicals open. It is not common for an insurance company to do that; usually, a redemption is a full, final and complete release of all further liability. If the order states the medicals are to remain open, then go back to your previous attorney and let him/her earn another fee suing the company.
Answer Applies to: Michigan