After it was found out that it was bleeding and had to have surgery to stop the bleeding
and have blood transfusions, and then the doctors stated that it was directly tied and
directly related to the injury they still refused to pay it, denied that it was covered
in any way and so I ended up for multiple months, multiple years actually receiving
bills and everything from the hospitals and from all the doctors groups and all that treated
me since the insurance ended up refusing to pay for it.
The insurance company refused to acknowledge it even following the recommendation that
said that they were supposed to. Their initial reason for denial was that they just said
it wasn’t related and even though proof was provided and it was stated because there’s
only two medical options.
And one of them was that it’s H-pylori bacteria which was tested and ruled out and so there
was only one possible answer reason for the condition that I had and that was documented
and even though the doctors stated that they still refused to acknowledge it.
Til two days before the formal hearing is when they finally agreed to acknowledge it
and stated that “OK, we’ll take care of it. That was nearly two years after the initial
hospitalization that it took them to finally agree and acknowledge that they would take
care of it. And only at the prospect of having to appear before the judge in two days.
I think it would have been highly unlikely that I would’ve gotten a small percentage
of the medical treatment that I needed and received had I not had legal representation
and didn’t have an attorney.
You get to pick your doctor and the other benefit is that you’re not going to have
any legal fees for representation. That all your legal fees are actually going to be paid
by the insurance company at the direction of the Department of Labor.
In spite of having been represented they’ve still at different times denied benefits,
denied treatments of my doctors that were authorized to provide they just almost seemingly
just arbitrarily denied treatment.
This is a very I think it’s a very unique and small section of the law that’s hardly
practiced and that I think very few people are aware of. All the little intricacies that
are involved in it. I think that you need to really be careful and look at somebody
who is familiar with this form of the law. It’s definitely not something that somebody
could just pick up and represent you. The intricacies of this are extremely important
on behalf of somebody that has been injured.