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  1. #1
    Join Date
    Mar 2009
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    Default Can I Sue the W/C Insurance Provider for Denying a Claim Which Lead to a Death

    My question involves workers compensation law for the state of: Alabama

    My mother feel at work in Oct of last year and suffered a severe head injury. The W/C claim was denied because the fall was labeled as idiopathic. While trying to fight the ruling my mother passed. What I am being told is it was related to the Nursing home not being equipped to handled a patient in her condition. She was placed in this home because it was the only that would take her with medicare pending as she had no order means in which to pay for the service. So while I'm sure there is probably a case of malpractice against the home I am more angry at the W/C insurer for denying the claim. So if it where to come out that they were responsible for her medical expenses could they be sued because they didn't pay when they should have?

  2. #2
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    Default Re: Can I Sue the W/C Insurance Provider for Denying a Claim Which Lead to a Death

    Unfortunately there's no causal connection between the denial of coverage and the subsequent mistreatment at the nursing home. You can talk to a malpractice lawyer about the case against the nursing home.

    As for the insurer, you've not told us anything that would suggest that the determination was incorrect. Falling at work does not of itself mean that the fall was work-related. I would hope your mother was working with a worker's compensation lawyer on her claim prior to her death, to try to establish whether or not benefits were due.

  3. #3
    Join Date
    Mar 2009
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    2

    Default Re: Can I Sue the W/C Insurance Provider for Denying a Claim Which Lead to a Death

    Quote Quoting Mr. Knowitall
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    Unfortunately there's no causal connection between the denial of coverage and the subsequent mistreatment at the nursing home. You can talk to a malpractice lawyer about the case against the nursing home.

    As for the insurer, you've not told us anything that would suggest that the determination was incorrect. Falling at work does not of itself mean that the fall was work-related. I would hope your mother was working with a worker's compensation lawyer on her claim prior to her death, to try to establish whether or not benefits were due.
    I was working with a Lawyer on her behalf because of her inability to do so at the time of her death. I believe the fall was work related because we were told she fell off a step stool. This was later reversed by the employer later in the day. I also have written/signed letter from the Neurosurgeon that basically says that injuries of this severity don't happen from people that are standing flat footed on the ground and in fact its her expert opinion that my mother fell from an elevated height.

    Nobody saw her fall so is it just automatically assumed that its idiopathic? I mean she was at work straightening up a wall of toys that reached a good 4 feet above her head how is that not the workplaces fault or rather how does the injury not stem from the workplace. Say there wasn't a ladder/stool, well maybe she had to reach up lost her balance and fell and if there was a ladder then clearly its work related.

    I understand that there is a lot of fraud these places have to deal with but I thought workman's comp was there to protect the employer from the threat of litigation. When things like this happen that could be argued both ways it quickly becomes apparent that issuers will do everything in their power to slither out of their responsibility.

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