Can a workers compensation insurance carrier close a case as inactive due to statute of limitations when there are pending reimbursements to be made for previously authorized treatments ?
Insurance carrier took 7 months to approve the claim during which I used private insurance for treatment. The insurance carrier after 7 months approved work injury and agreed to pay for all medical treatments and reimburse providers, private insurance and myself for copays. They approved treatment with my treating physician and I continued seeing him. Insurance carrier never cordinated direct payments with the provider. They offered a settlement and we agreed informally to settle once all the pending reimbursement for copays and payments from private insurance are cleared. I submitted the bill on time and continued my medical treatment with the same provider. This was in 2018, I followed up regarding reimbursement for a while and lost communication during pandemic. Now insurance carrier says the statute of limitation has expired and I am no longer eligible for any benefits including reimbursement for previously approved and submitted medical bills.
The visits with neurologists were approved by them and I never received any notification when the visits approval were rescinded. I am still being treated for the same injury by the same doctor. Insurance carrier has said there is no legal remedy in this case. I have requested dates when the statutes of limitation expired according to them but they are less than forthcoming to respond. Any assistance you can provide will be greatly appreciated.
Can a Workers' Compensation Insurance Carrier Close a Case as Inactive Due to Statute of Limitations?
It is possible for a workers' compensation insurance carrier to close a case as inactive due to statute of limitations, even if there are pending reimbursements to be made for previously authorized treatments. Statutes of limitations are time limits within which legal actions must be taken, and once they expire, the carrier may no longer be obligated to pay for benefits.
Recourse for Injured Workers
If a workers' compensation insurance carrier closes a case as inactive due to statute of limitations, injured workers may have the following options:
- Appeal the decision: In some cases, an appeal may be filed with the workers' compensation board or state agency overseeing workers' compensation claims.
- Seek legal representation: Consulting with an attorney specializing in workers' compensation may provide more options and guidance.
- Contact state regulatory agencies: If there are concerns with the handling of a workers' compensation claim, regulatory agencies such as the Department of Insurance or Department of Labor may offer assistance and resources.
It is important to note that each state has its own workers' compensation laws and regulations, which can impact the options available to injured workers. Additionally, the specifics of a particular case can also influence the outcome. Injured workers should seek guidance from qualified professionals to help navigate the complex workers' compensation system.
This response is not legal advice and is provided for informational purposes only.
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