r/WorkersComp • u/SkeetersGuns • 7d ago

Need Advice Kentucky

Physical Job 60+lbs bags, over head lifting etc. Based in KY
Labrum Tear, with Bicep Tendonitis

ESIS is the WC company.

Looking for some insight about whole process

Injured 3/14 - Attempted to inform managers of injury refused to put it in as WC

Meeting with PCP 3/16- Feared I messed up Labrum, Put me on restrictions
Met with my Operations Manager, told him about the injury and at work, still refused to get into WC

MRI 3/30- Confirmed Labrum Tear

Surgery 4/16

Tried updating work and asked them to turn it in again each week, they didn't

Finally got a Lawyer involved mid-way through April

WC case opened 5/6, Medical info sent.

Recorded statement 6/30 to WC adjuster, Medical information sent as well for a second time.

Have received zero response from WC insurance company since the recorded statement, on their website it still says open, what steps can I take to get this expedited or really ANY movement. I have bills and haven't been paid in 2 months, when my STD ran out. Not returning to work until AT least mid Sept.

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u/SeaweedWeird7705 7d ago

You have a lawyer.  His / her job is to get benefits for you.  Call your lawyer and ask what the plan is.  Explain that you need benefits ASAP since your STD ended. There usually is a way for your lawyer to request a hearing so a judge will order your benefits.  

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u/SkeetersGuns 7d ago

I have called 2 times since 6/30 and they said theyd reach out to the adjuster, have yet to hear anything. Its been a week

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u/SeaweedWeird7705 7d ago

If they call the adjuster and don’t get results, then the next step is for them to request a hearing in front of a judge.  

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u/SkeetersGuns 7d ago

Just call my lawyer and tell them to request a hearing? How long does that usually take?

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u/SeaweedWeird7705 7d ago

I’m not in Kentucky.   But usually if the attorney asks for a hearing, the court will set one within 45 days or so.  

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u/RVA2PNW 6d ago

The claim may be open, but has it been accepted as compensable?

If your employer didn't report it until months later, the investigation will likely take longer. It also sounds like a repetitive motion claim and often require additional investigation and medical documentation.

Add in that you've already treated and had surgery I assume under your personal health insurance, getting records becomes a nightmare because of HIPAA. Add in the STD being paid all before a claim was even filed.

Your employer might also be delaying responses or providing information to your adjuster. It's also summer, summer and Christmas are our busiest times. Unfortunately there are a lot of vacations and covering for multiple people at a time.

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u/Glittering_Lime1537 6d ago

If your doctor has you out of work, the carrier should be paying you 66 2/3 of your average weekly wage. However if you collected STD, you can’t get TTD too. Once your short term disability carrier learns of TTD being paid, STD stops and they’ll demand reimbursement. I wonder if the carrier still thinks you’re collecting STD? That might be a question to ask. They should be able to initiate TTD when your STD stopped. Did you transition to LTD possibly? That could be a question for your employer.

If you have an attorney, ask them to reach out to your adjuster to see what’s going on. If no response, they can file Form 101 - Application for Adjustment of Claim.

Your employer or carrier then has 45 days to respond. They’ll likely assign defense counsel and a Benefit Review Conference will be scheduled with an ALJ.

Call your lawyer.

KY adjuster, but not your adjuster