|Author||Subject: Re: ALL 50 states no matter where you LIVE people get it figured out>>!|
|Chris M|| Posted At 12:50:31 06/30/2001
You first came into this board saying you were going to expose workers' comp. Since then, in my opinion, you'll spread falsehoods.
If you had bothered to study this issue, you'd know that it is routine for injuries to be denied when they involve needed surgery, more than a few months off work, or when medical bills reach a certain dollar amount. At this moment, at least in Oregon, carriers have 90 days to accept/deny a claim. When the claim is denied, except in rare instances, the worker then has 60 days to dispute it.
Your overall attitude in various posts seems to imply that workers should never hire an attorney although you've softened it up above sort-of. Do you actually think the average worker has the expertise to proceed and has the legal know-how once their claim is denied? I know of only one worker who ever succeeded in such an endeavor and she is a very bright injured worker advocate with a few years of knowing the ins and outs of the workers comp system. From what I've been told by other workers who've tried, ALJ's and the workers' comp board in Oregon eat workers alive when they try to represent themselves.
Your "one-size fix all" answers in various posts in a workers comp system, where laws vary greatly state-to-state, is a receipt for disaster for workers.
Your statement that third parties are NOT at fault 99.9 percent of the time appears to be some number who've pulled out of a hat. Where is your statistical data to back this up?
Retired, you make the following statement; "...as long as you do NOT hire a lawyer the insurance company will only give you what you deserve unless your negligent then you still get nothing...! SO the story goes only ONLY" hire a lawyer if you know for sure someone else caused your injury....!
First off, workers' comp is a no-fault system so worker negligence is not a factor except in very rare instances in Oregon (in practice) such as being drunk, stoned, etc). Insurers can't claim negligence otherwise but then they don't need to because they've found other deviously creative ways to deny/re-close claims to get around "no-fault." Before the "Smothers" decision (and still in all but a few states) the negligence of an employer also had no claim effect due to exclusive remedy.
Second, by what standard do you mean when you say "deserved?" That is an extremely subjective word. Perhaps you should actually "open-mindedly" visit and learn from injured worker sites what carriers' believe is deserved. Visit this sites' "workers' comp fraud" page since "deserved" in the eyes of insurance companies appears to be NOTHING, no medical, no time-loss, no future income loss, no equivalent to pain and suffering. (It doesn't technically exist in work comp at least in Oregon)
Oregon Revised Statutes (ORS) 1999
656.319 Time within which hearing must be requested. (1) With respect to objection by a claimant to denial of a claim for compensation under ORS 656.262, a hearing thereon shall not be granted and the claim shall not be enforceable unless:
(a) A request for hearing is filed not later than the 60th day after the mailing of the denial to the claimant; or
(b) The request is filed not later than the 180th day after mailing of the denial and the claimant establishes at a hearing that there was good cause for failure to file the request by the 60th day after mailing of the denial.
(2) Notwithstanding subsection (1) of this section, a hearing shall be granted even if a request therefor is filed after the time specified in subsection (1) of this section if the claimant can show lack of mental competency to file the request within that time. The period for filing under this subsection shall not be extended more than five years by lack of mental competency, nor shall it extend in any case longer than one year after the claimant regains mental competency.
(3) With respect to subsection (2) of this section, lack of mental competency shall apply only to an individual suffering from such mental disorder, mental illness or nervous disorder as is required for commitment or voluntary admission to a treatment facility pursuant to ORS 426.005 to 426.223 and 426.241 to 426.380 and the rules of the Mental Health and Developmental Disability Services Division.
(4) With respect to objections to a reconsideration order under ORS 656.268, a hearing on such objections shall not be granted unless a request for hearing is filed within 30 days after the copies of the reconsideration order were mailed to the parties.
(5) With respect to objection by a claimant to a notice of refusal to close a claim under ORS 656.268, a hearing on the objection shall not be granted unless the request for hearing is filed within 60 days after copies of the notice of refusal to close were mailed to the parties.
(6) A hearing for failure to process or an allegation that the claim was processed incorrectly shall not be granted unless the request for hearing is filed within two years after the alleged action or inaction occurred. [1965 c.285 s.41a; 1969 c.206 s.1; 1975 c.497 s.4; 1983 c.819 s.1; 1987 c.884 s.14; 1990 c.2 s.24; 1995 c.332 s.39]
Note: See notes under 656.202.
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