[Renegade]

My husband died at work and the death certificate stated it was an accident that occurred at the work site. We just learned that the workman's comp insurance denied my claim. How is that possible when it was stated on the death certificate as an accident at work?
I just don't understand that. I also think it seem terribly unfair to think if they had done the honorable thing and paid the claim, I would owe my atty. $12,000. Now it appears I will have to pay 33 1/3 - 40% plus expenses simply because the insurance company chose to make it difficult. The whole point of workman's comp and death benefits for survivors is to support the family. This money is supposed to provide for me and my children for life, yet I have to give almost half of it away due to the insurance company trying to avoid payment?
I definitely feel my attorney fees should be paid by them, but I know that is not always the case.
Comments or sugestions?

Thanks.

[Mr. Knowitall]

Having an accident at a work site usually means that the injury or death is work-related, but it doesn't always mean that. Apparently the comp insurance company decided that the accident wasn't work-related.

You already have a lawyer? Did you discuss with your lawyer why the claim was denied?

[Renegade]

Yes, I do have an attorney already. Things have just been so suspicious. I got a call at 5:00 a.m. to come to the emergency room. When we arrived I was immediately told by the coroner that my husband had apparently had a massive heart attack and died. I was in shock but told him I couldn't believe that because he had a stress test a few months ago and his heart was fine. The doctor stated he was healthier than he was a year ago. The coroner sat me down, told me he was 99% certain it was a heart attack and there was NO need to have an autopsy done, then handed me paperwork to sign. Later that day I had a family member call the coroner and tell him I did want an autopsy done. Since that time he has treated me extremely badly, lied to me, and refused to supply any documentation requested by my atty.

Anyway, I called the medical examiner 10 days later to inquire about the cause of death. She said my husband died from blunt force trauma to the head. She said he had a fractured skull and she felt sure he fell. She further stated the coroner had mentioned the floor being slippery when he arrived on the scene. The death certificate states the cause of death as "blunt force trauma" accidental, and probably fall.

I would love to hear your views and comments.

Thank you.

[Mr. Knowitall]

I would venture that the insurance company is taking the position that the fall resulted from the heart attack, and thus was not work-related.

[Renegade]

That will not work because it clearly states in the autopsy report that he did not have a heart attack. The cause of death is blunt forct trauma to the head. The report details that the stent previously inserted in 2002 was in the proper place, and he did NOT have a heart attack. The only significance with his heart was that it was slightly enlarged which is consistent with someone who has a previous heart condition. It mentions his heart condition as a possible underlying cause but not THE cause. She told me point blank that he did not have a heart attack and that she believes the blunt force trauma resulted from a fall on a slick floor.

[Mr. Knowitall]

The fact that the cause of death is a head injury does not of itself mean that he didn't suffer a heart attack.

I'm in no position to be guessing. If the insurance company is firm in its position, realistically speaking, you'll need to hire a lawyer.

[Renegade]

I appreciate your views and comments, but the State Medical Examiner who performed the autopsy told me in no uncertain terms that he did NOT have a heart attack. I quote from the death certificate:

IMMEDIATE CAUSE(Final disease or condition resulting in death) Blunt Force injury to the head

MANNER OF DEATH: Accident

INJURY AT WORK? Yes

DESCRIBE HOW INJURY OCCURRED: Probable Fall

The insurance company is obviously going to try to get out of their responsibility since they have already denied the claim. I just think that should be illegal when it appears to be cut and dried as in the case above.

He sustained an injury to the back of his head that was so severe it fractured his skull and took his life. That is a fact. And had he had a heart attack, merely falling over would make it difficult to sustain that severe of an injury to the head. Plus...... the examination showed no signs whatsoever of a heart attack. They just want to say that because they knew he had a stent put in years ago, and hoped it would get them out of having to pay a claim. I really think that is why the coroner told me I didn't need to have an autopsy done. Even after I told him about the results of the recent stress test and how healthy my husband was.......... he proceeded to tell me an autopsy wasn't necessary and told me to "sign".

[kandi6]

If he was at work, it is assumed he was performing his duties - that makes it work-related. If the floor was slippery, and he slipped, then it's work-related. The ins. company should be sued - include fraud - the coroner should be reported to the Medical Board for lying and attempted cover-up. You have the medical examiner's report to back you up. At the very least, he made a crucial "error". Get an attorney on contingency, and appeal the denial. Who does he work with? Any witnesses? Maintenance reports for cleaning the floor? Prior slip and fall reports in the same area? OSHA inspection reports? Good luck.

[Mr. Knowitall]

I didn't claim to be psychic. If you hold back information, it is not reasonable to expect me to know it.

[Renegade]

I didn't claim to be psychic. If you hold back information, it is not reasonable to expect me to know it.

I didn't realize I held back any information. I thought my first post relayed the information regarding the injury and what the death certificate stated.
I certainly don't want to provoke anyone here, just hoping to gain some insight into the situation.