Thread: Grrr...mad! LONG

Back in 1995 dh hurt his knee at work, therefore, Workman's Compensation paid for it. A few years ago his knee started accumulating fluid and he had it removed 2 or 3 different times at the doctor's office. His boss paid for those doctor's bills instead of running them through WC, not sure why. Then this past fall, dh was having pain in his knee and a griding noise. He went to the doctor and he recommended therapy on his knee, which he did for a couple months. Ran this through WC again since the doctor said it was from the original injury. Of course, WC denied it, saying the time window was too long and the case had been closed. Dh's boss said that they'd appeal it and if WC still didn't pay, that he'd cover the bills since the doctor said it was from the original injury. Well, after going back and forth with the doctor's office and WC, WC denied it AGAIN because some idiot at the doctor's office submitted the wrong information to WC saying it was brusitis...or however you spell it...even though the doctor said it WAS from the original injury. NOW dh's boss is saying it isn't his problem and he shouldn't have to pay it (after saying earlier that he WOULD cover it if WC denied it again)! We barely have the money to get by month to month (yesterday was ds 17th birthday and he got very little), let alone enough to pay these bills! Had he known no one was going to cover all these bills, dh would never have gone to therapy. Oh, and somewhere in there WC said that one of the letters from the doctor's office (before the brusitis thing) didn't state that all this came from the original injury so dh called the doctor's office to see if they could re-submit a letter to WC giving them the correct information. Well, they COULD do that for $150 (or some outrageous amount) OR he could come in and have the doctor examine his knee AGAIN for "only" $90. So he also has that $90 bill on top of everything else, instead of the doctor just going back through his file and submitting the right information (this is when the brusitis letter came into play).

I don't know who I'm more mad at...WC for denying the claim, the idiotic lady at the doctor's office for saying it was something it wasn't, or dh's boss for first saying he'd pay the bill and is now saying he won't.

Your husband's boss probably didn't turn the claim into workman's comp because claims raise the price of their policy.
15 years has past & there is no way on earth that wc will pay for this. If you have health insurance, they should cover at least part of his this.

Originally Posted by sunniekiss

Your husband's boss probably didn't turn the claim into workman's comp because claims raise the price of their policy.
15 years has past & there is no way on earth that wc will pay for this. If you have health insurance, they should cover at least part of his this.

The thing is, we just switched insurance companies and both the old and new policies have a ridiculously high deductible just so we can afford the premiums. I want to just drop our insurance altogether, but I'm worried something major will happen then we'd lose everything. The doctor and therapy bills are high, but not as much as our deductible so we'd end up paying the whole thing anyway. This, along with other things around me, is just stressing me out so bad and I don't know what we're going to do. I guess if no one pays any of these bills, we'll just have to pay what we can each month for the rest of our lives lol. DH suggested only sending the doctor's office $1 a month till it's paid off since they're (at least in our opinion) the reason this is so screwed up.

What kind of relationship do you have with the doctor himself? It's time to take all your paperwork to the doctor himself. If he says he doesn't handle any of "that kind of stuff" ask him to please look over it with you together and explain why it is so important.

I work at an occupational medicine clinic and deal with L&I all day long. He needs to open a new claim called an occupational disease claim. This type of claim is used for injuries that are due to repetive actions (kneeling, squatting, sitting on knees, etc.)

It doesn't sound like the Dr. screwed up with the diagnosis though. Bursitis is fluid on the knee, and sometimes it does require draining. However you can get bursitis from doing actions like I said above.

You can't use your medical insurance? Are the copays too high?

Originally Posted by SLance68

That is not true. We had a former employee that had a knee injury and his case stayed open for 17 years. It does not affect your rates after the initial 3 years. After that it gradually reduces over a period of 5 years. So if your rate multiplier was 1.50 (1.00 is where they start with a new company and I have seen them as low as .95) it will start reducing until it is back at 1.00 if you have no other claims.

The problem is not the W.C. company it is the Dr's office that screwed up the claim. The Dr's office is responsible for this problem and should be held accountable.

Sandy I know what you are saying but we don't know how many claims this employer has filed with workman's comp. so there could be a very good reason for him not wanting to report it. I am sure you KNOW how much comp. insurance costs.
The employer made a decision a few years ago years ago to not run the second claim through comp. If an incident report was not filed by the employer, this is not the fault of workman's comp or the doctor's office. The doctor's office must have been under the impression that there was a claim filed by the employer through comp.
There is now no way in haven that comp is going to pay for all of this since I will wager $1,000 that paperwork was never filed with them. I would doubt the office even still has a copy of an incident report.
What your best option, if the owner refuses to pay for this, is to request an appeal & ask for a new doctor to review your dh's case.
To be truthful the owner should be paying for it. Then the op has to ask if it is worth her dh losing his job over it.
I don't know sweetie, I wish you luck with this. If you decide to try to pay this off on your own, PM me & I can help you.