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  1. #1
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    Jul 2018
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    Default Can Workers Comp be Denied for Reasons Unrelated to the Injury

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

    Can IC deny benefits to slip and fall injury because of there was no medical evidence for psychiatric issue?

    Was it a mistake or were they hoping that it slips through and hope the employee just go away?

    Has anyone seen this before?

  2. #2
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    Feb 2008
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    Default Re: Denied for Unrelated Reason

    gonna need more details on how the slip and fall occurred vs medical evidence of psychiatric issue? because a slip and fall is not a psychiatric issue? This question doesn't make sense so i suspect you mean something else but I can't begin to guess what it is. Or someone at IC got a medical code/details wrong...someone needs to go back to them...Where's HR in this or the claims adjuster?

  3. #3
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    Default Re: Can Workers Comp be Denied for Reasons Unrelated to the Injury

    Quote Quoting Fallguy
    View Post
    Can IC deny benefits to slip and fall injury because of there was no medical evidence for psychiatric issue?
    If you are not physically injured, or are hoping to continue benefits once the physical symptoms have adequately resolved due to a claim of psychiatric injury (depression, stress, etc.), then the psychiatric examination is relevant. If an examination shows no sign of psychological illness that can be attributed to the injury, or finds that such a condition exists but does not prevent a return to work, then the insurance company is going to expect you to return to work.

    We will need facts about your situation in order to comment on it.

  4. #4
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    Jul 2018
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    115

    Default Re: Can Workers Comp be Denied for Reasons Unrelated to the Injury

    It says no medical evidence to support lumbar spine. There was no witness and inconsistency in reporting accident. Labor code 3208.3 we are denying base on no medical or evidence of injury.

    Thereís no job to return to. I read something about labor code 132a. It says employer can not terminate base on misconduct where the claimant is treated differently than others.

    Does this mean that if the reason for termination was violate by others but were not terminated, then this code would apply!

    Thereís many cases where no one ever gets discipline or any verbal warnings. Is there a statue of limitations?

  5. #5
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    Feb 2008
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    Default Re: Can Workers Comp be Denied for Reasons Unrelated to the Injury

    you are mixing a whole lot of different issues together and honestly your "details" and questions aren't making much sense. Can you give some details on exactly what has happened? Rather than giving a detail here or there?

    Was someone terminated because they made a WC claim of injury that was later denied? That would be retaliatory in general, but again details would matter. If it rose to the level of fraudulent, for example. But making a WC claim doesn't protect an employee from ever being terminated....just can't be terminated because the claim was filed.

  6. #6
    Join Date
    Jul 2018
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    115

    Default Re: Can Workers Comp be Denied for Reasons Unrelated to the Injury

    I apologize, i was never really good at writing.

    It was a work related injury and terminated after their doctor release for modified duty.

    The claim was initially accepted because the doctor was from their list. After termination then claim denied for no medical support to show injury is work related.

    So the question was, can the IC ask for medical proof of psych and ignore the medical records from the doctor in their network? how can a claim for a back injury be denied for not having proof for another condition?

    I hope thatís makes a little more sense.

  7. #7
    Join Date
    Oct 2016
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    3,344

    Default Re: Can Workers Comp be Denied for Reasons Unrelated to the Injury

    The insurance company not only can but in 99.9% of the cases will require proof of the injury and that it was job related.

    This is especially true on a case claiming psychological damage. I'm willing to bet that the doctor you saw that was in their network wasn't a psychiatrist.

  8. #8
    Join Date
    Feb 2008
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    1,146

    Default Re: Can Workers Comp be Denied for Reasons Unrelated to the Injury

    I"m still trying to figure out how a slip and fall/lumbar spine injury is related to a "psych" injury? Are you trying to claim the psych injury is work related also? If so, you need medical records to prove there is a psych injury.

  9. #9
    Join Date
    Jul 2018
    Posts
    115

    Default Re: Can Workers Comp be Denied for Reasons Unrelated to the Injury

    No, thatís why itís so confusing. Just the back injury. My conclusion is itís either a mistake or the adjuster did it and hope that no one catches it. Iím just wondering if anyone had this experience.

    What steps can you take to get claim approved or if thereís any options.

    It seems like it might fit Lc 132a but Iím not sure and my understanding is that lawyers donít pursue this because itís not worth it.

  10. #10
    Join Date
    Oct 2016
    Posts
    3,344

    Default Re: Can Workers Comp be Denied for Reasons Unrelated to the Injury

    Fallguy, you are the one that brought up a "psych" injury. Are you saying there isn't a "psych" injury?

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