I hope i am doing everything right with my Claim

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I hope i am doing everything right with my Claim

Postby masondelux » September 16th, 2008, 2:34 pm

Little history I fell in November shattered my foot,Broke both my shoulders last November. I have a Lawyer but recoup is slow. Lots of rehab that I don't think is doing anymore good. I still have a seperated collar bone that needs some surgery but needed to have surgery on my neck which isn't accident related of course! But I needed it done so they could get a tube down my throat for my collar bone surgery. I have insurance for the neck surgery and am able to collect AFLAC since it was considered a sickness. I can't collect their disability from what I understand. My Lawyer told me to contact him as soon as I am stable so I havn't been bothering her. There was nobody to sue since we were on our own scaffold. So I am collecting my check and waiting. My question is am i doing this right? I have heard I can go after the general contractor or owners of the building? My rehab people told me they can close my claim if I don't go to rehab? My doctor says they need to wait till my neck heals 3 -4 months? I have also seen a car in front of my house video taping even when I was in a wheel chair.LOL Saif calls and ask if i went back to work at least once a month now. Even when I was in a wheel chair they called. Should I consult another lawyer to make sure mine is doing everything they can? Is there a cap on how much money can be used between my surgeries and rehab and settlements? My Lawyer pretty much said I was sqrewed without a 3rd party to sue. But I would get something.

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Postby Webmaster » September 16th, 2008, 8:41 pm

First, you need to inform your lawyer that SAIF is contacting you. When a worker is represented, the insurer is not supposed to contact them.

In a workers' comp. claim it's virtually impossible to successfully sue an employer and unlikely you could win against a third party. Ask your lawyer though since there are exceptions.

Your doctor should be sending in reports to the insurer stating you're unable to work even with light duty. It's quite possible he/she is but the insurer is calling you since even an innocent statement to make to them, allows them to twist it and use against you. The tactic is part of the standard harassment policy too.

I've never heard of a total cap in workers' comp. treatment and seriously doubt there is. There is a cap in voc retraining costs.

Call the Ombudsman for Injured Workers and insist they put in your file that SAIF is illegally calling you. You should contact them whenever you think SAIF has done something wrong. Doing so creates a record of wrongdoing. Contact info is at http://egov.oregon.gov/DCBS/OIW/index.shtml.

You should also be keeping a detailed log of everything involving your claim since memories fade with time. Read http://www.injuredworker.org/advice.htm for other advice.
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Postby masondelux » September 17th, 2008, 9:18 am

Thanks for the reply. I will start doing everything you suggested. I have met several people that have been injured on the job and went back to work with injuries and disabilitys on construction jobs. I don't want to end up like them.Something needs to be done to protect us while (saif) Safco makes profits from sqrewing us.

thanks for the advise. Mason
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Joined: September 16th, 2008, 2:01 pm
Location: Dundee


Postby yourbestfriend » August 21st, 2009, 7:38 pm

First, you need to read your retainer. Many attorneys allow the insurance carrier to contact their client because, quite frankly, they don't have the time or desire to talk to you.

Suing your employer, absent a particular kind of denial and negligence on the part of your employer, is a waste of your time. Who owned the scaffolding? If it was the employer, same answer.

The insurer is trying to reduce cost by getting you back to work. I seriously doubt they have time to call you for the heck of it or some other nefarious purpose.

There is no cap in for medical, time loss and permanent impairment.

The ombudsman's office is a good resource. It is not illegal for the insurer to contact you unless your retainer agreement specifically states so. Even then, I'm not aware of any criminal penalties unless the insurer misleads you resulting in a loss of benefits.

If you have time on your hands, keep a detailed log and laugh about it later.
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No criminal charges doesn't make it right

Postby Danellle » April 16th, 2010, 9:56 am

In reply to "yourbestfriend", just because there are no criminal charges for doing something unethical doesn't make it acceptable.

In my experience, the insurer has absolutely NO interest in helping you get back to where you were before the accident. Their sole interest is money, and they will use anything possible to deny they are responsible for part or all of your injury.

My attorney told me not to respond to the insurance company and that they would try to contact me even though they are not supposed to, but all communications should go through your attorney. If your attorney doesn't have time to talk to you or the insurance company, maybe you should interview other attorneys.

This website is immensely helpful. Sometimes you need to look through a lot of posts to find help, but the Webmaster gives very good advice, so listen to him ;)

Masondelux, I hope you CAN laugh about this later (not sure many injured people do - I know I'm not), and hope you get the medical help you need to feel your best.
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