Posted: 2/21/2010 4:44:00 PM EDT
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I had an on the job injury in September which resulted broke my tibia. It was a tibial plateau fracture which did extend into the knee. Since then, My fracture has healed but I am having knee pain. The Doc says miniscus tears are common with this injury and recommends an MRI to see. I say fine, but want to make sure Workman's comp will pay for the MRI. I call the nurse assigned to my case and ask her to get approval for it. She calls me back tonight and says.....well, it if turns out related, they say they will pay for it, and if it turns out non-related, I have to pay for it. I do not have any personal health insurance, so it will be out of pocket. Does this sound right? I mean it's not like I had knee pain before I broke it. I did have a broken patella in 1992, and the nurse saw the scar a while back and asked about it. Who does one contact to get an opinion if workman's comp and the injured party don't agree. |
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Quoted: I had an on the job injury in September which resulted broke my tibia. It was a tibial plateau fracture which did extend into the knee. Since then, My fracture has healed but I am having knee pain. The Doc says miniscus tears are common with this injury and recommends an MRI to see. I say fine, but want to make sure Workman's comp will pay for the MRI. I call the nurse assigned to my case and ask her to get approval for it. She calls me back tonight and says.....well, it if turns out related, they say they will pay for it, and if it turns out non-related, I have to pay for it. I do not have any personal health insurance, so it will be out of pocket. Does this sound right? I mean it's not like I had knee pain before I broke it. I did have a broken patella in 1992, and the nurse saw the scar a while back and asked about it. Who does one contact to get an opinion if workman's comp and the injured party don't agree. This is pretty standard really. You are assuming it is from the injury. The insurance company hopes it is not. As Aimless said a WC attorney will have info but will most likely cost $$ for some advice. They are also salesmen and some go right to asking you to hire them. I would also speak with the doctor about billing information and let them know up front what the story is. The insurance company may have closed your claim so the billing people will have to speak with the insurance company to reopen it. |
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Actually, I think I found a state agency that might be able to answer this question. The NC Industrial Commission apparently administers the state WC laws, arbitration, and disputes, according to the website. I think I will call tomorrow. Actually, I just want to know if my WC administrator is being fair/typical about this. If it turns out they are, I'll opt for the MRI and pay for it if it's not related because I'd really like to know what's wrong with my knee. |