Visitor Question

Auto insurance denying claim due to workers’ comp?

Submitted By: L (Denver, CO)

I was on my way to work (at a job I was forced to “willfully resign”) when a vehicle hit me. The workers’ comp forced me to see an incompetent MD. I had one visit only, then sought care on my own and paid out-of-pocket. The bills were getting to be too much, so I applied to use my personal vehicle medpay coverage, but they denied it due to the workers’ comp claim.

I left the company I was working for at the time, due to the amended “return to work” order they submitted after approving my two week time off. In short, they changed the return to work date for the day they already approved me to be out, therefore when I did not return I was considered willfully resigned – totally unethical.

Now I am seeking care again. I have a previous back and neck injury from an auto accident for which I stopped treatment in Dec. 2013. I had received no therapy or follow up treatment for that previous injury until the accident in July of 2014.

Can medpay continue to deny my claim, stating it’s a workers’ comp case? I don’t have the job anymore. I have self paid for all my care. The auto insurance has paid on my vehicle, but nothing else so far. Do I need an attorney? I’m a little lost here. Thanks.

Disclaimer: Our response is not formal legal advice and does not create an attorney-client relationship. It is generic legal information based on the very limited information provided. Do not rely upon the information in our response, or anywhere else on this site, when deciding the proper course of a legal matter. Always get a personalized case review from a local attorney.

Answer

Dear L,

You should be able to get your med pay to cover your medical and/or therapy treatment. To do so simply contact the med pay insurance company.

Presuming your prior workers’ compensation claim is closed, before contacting the med pay insurance company ask the workers’ comp company for documentation making clear your claim has been closed. Once you have proof your workers’ comp claim has been closed, contact the med pay insurance company again.

Find out the specific person you have to send the documentation to for review. Try and get that person’s full name and contact information. Be persistent. Once you have that information send it to the adjuster or insurance company representative. At that point, the insurance company should begin to cover your injuries and resulting medical, and/or therapy treatment.

If you are unable to get your med pay insurance company to make payments, you will need to contact a personal injury or workers’ compensation attorney. Fortunately most of these attorneys do not charge for initial office consultations. Bring along every document, letter, and any other information related to your medical and/or therapy treatment.

The attorney will advise you whether or not you have a viable claim, and if so, what will have to be done to get med pay to begin coverage.

The above is general information. Laws change frequently, and across jurisdictions. You should get a personalized case evaluation from a licensed attorney. Find a local attorney to give you a free case review here , or call (888) 647-2490.

Best of luck,

Published: December 12, 2014

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