Q: I was injured at work-I got a 90 day letter from the state-workers comp hasn't returned my calls. Will they stop paying?
I reported an injury nearly 3 months ago. The first doctor thought I just tore a muscle, but my symptoms got worse. It was later I found out that I have a cervical disk herniation. I'm working full time, light duty. I got a letter in the mail from pa workers compensation stating coverage may stop after 90 days & we're closing in on that. I called my claims rep & they haven't called me back. I have a follow up in a few days with my ortho & im showing little improvement. I'm concerned that they won't pay for any more treatment, as I can't perform full duties at work & I can't afford any of this. I'm also worried that because I wasn't diagnosed correctly by the first doctor that they'll try to deny my claim even though I've had an MRI & I've been in physical therapy for 2 months. How likely is it that they will deny my injury?
A: It is impossible to accurately answer your question without seeing the documents, but I am assuming what you received is a Notice of Temporary Compensation Payable. If this Notice is not withdrawn within 90 days it converts to a Notice of Compensation Payable. Conversion means that the workers' compensation carrier would remain responsible for the injury they recognized in the Notice of Temporary Compensation Payable until you either agree you have recovered or a judge finds they are no longer responsible, so obviously conversion would be good for you. I understand the approach of the 90 day marker is nerve racking, but drawing the adjuster's attention to the fact that the time they have left to deny your claim is rapidly running out may not be the best strategy.
As to your actual question, it is really impossible to say how likely it is that your claim will be denied. It depends on many factors including, but not limited to, the mechanism of injury, the doctor's opinions after the injury, any pre-existing conditions, and whether or not the actual injury was witnessed.
Finally, I would strongly suggest that you talk to a local workers' compensation lawyer. The initial consultation will be free of charge, and the attorney would be able to review the specific facts of your case which would allow for a much more exact opinion than what you could hope to obtain on a Question and Answer cite.
Glenn Neiman agrees with this answer
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