Good for Texas Mutual for showing some spine. This is refreshing to see a company do this and stop the fraud in the Workers Compensation system. Most carriers would have knuckled under an paid.
What fraud exists when an employee suffers a legitimate OTJ injury and the adjuster blindly denies the claim to increase her Xmas bonus? There is fraud in the system. Unfortunately, it’s the insurance co’s who are guilty.
Hey Police, I have been an agent for a long time and have written Workers Compensation for a lot of clients. I have yet to see benefits denied for a legitimate OTJ injury. Adjustors do not deny claims to increase their Xmas bonuses. If the claim is suspect, they do investigate which is their right to do so. They have prosecuted people filing fraudulent claims and that is the right thing to do.
agent this is a practice in your industry that is common knowledge the adjuster and lets not forget the dirty lawyer in house of the insurance company,and lets not leave out the designated doctor who does ,not follow the rules of the AMA or the commission. to write a false IR report when the evidence is clearly not in favor of the insurance,for you to even post such a bull response to police officer shows you clearly are part of the problem,of the industry.
Bindside, you are an idiot if you believe the crap you are putting out. Legitimate injuries are reported, medical expenses are paid and lost time. The fraud that exists is predominatly the claimant who is trying to milk the system for all its worth. Companies are having to deal with unscrupulous doctors and attorneys all the time. In some cases, there have been rings of these criminals who have been busted for their activities. Your post is utter nonsense.
January 3, 2016 at 12:25 pm
brian says:
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if that’s true… AGENT… then why in the hell was my claim denied? I filed the paperwork in 2-19-15, just 13 fucking days after the injury, and service lloyds insurance in AUSTIN TEXAS stated that “MERE ” pain wasn’t compensable under workman’s comp. It has since been proven that the ROOT of the problem was degenerative joints in my lower back from sitting in a god damn chair for 1500-1700 hours over a 6 month time frame. SERVICE LLOYDS stated that I NEVER filed the paperwork in the allowed 30 day time frame, which is a bunch of fucking bullshit because I have the god damn paperwork they I faxed in to them on 2-19-15 at 17:41 p.m. and the location as to where I faxed them the information which was FedEx… DATED 2-19-15… so I DID IN FACT file and faxed the paperwork on time to the department of insurance MYSELF, they just didn’t do their god damn job.. so don’t fucking try that give us that shit you’re trying to sell us because we don’t want it. AND because this case was “mishandled” from the very beginning… I now have to go in and fix the fuck up that they caused, and have the workman’s comp reinstated because it was their fault they mishandle the case, it was their fault that they lost the god damn paperwork, and it was their fucking fault that I lost this case, so now I’m out for blood. I’m going to file on the department of insurance and service lloyds for bad faith, breech of contract, pain… suffering… and agony, breech of judicial duty, and ANYTHING else I can think of. then I’m going after the fucking adjuster for service lloyds that denied the claim for bad faith, pain.. suffering… agony, breech of judicial duty, and anything else I can file on her. she was NOT medically trained, she didn’t have a doctorate from A&M or anywhere else for that matter, and she couldn’t diagnose a fucking fart, even if it came out of her own ass. I’m going after D&M… Legacy support, AND support service group… the companies I worked for, for pain.. suffering.. agony, denial of medical care, bad faith.. because had my boss said how did you injure yourself… or even what were you doing for this to happen… instead of just sending me home… I would have found out that I have degenerative joints in my lower back and would have been covered UNDER workman’s comp. SO, by the time my lawyer get done with everyone, my lawyer is going to be so far up their fucking asses that they won’t need dental work for the next 10 fucking years.
Brian: very sorry for what you have been through, but due to this case, Texas Mutual Insurance Company v. Ruttiger, you can no longer file for bad faith against the insurance company as the Texas Supreme Court said so by a 5 to 4 vote. Very sorry but that is what happened at the Texas Supreme Court level. One thing you can do is vote against those Supreme Court Judges that decided this decision which was Justice JOHNSON delivered the opinion of the Court, in which Justice HECHT, Justice WAINWRIGHT, Justice WILLETT, and Justice GUZMAN joined. Those Justices are elected and that is a solution you can look at at this point. Again sorry for the trouble you are going through and there are so many more cases like yours because there is nothing to hold the Carriers back for their bad behavior and the Division of Workers’ Compensation doesn’t issue administrative violations as they should, and just recently told a medical provider they didn’t know they could do that!!
Good for Texas Mutual for showing some spine. This is refreshing to see a company do this and stop the fraud in the Workers Compensation system. Most carriers would have knuckled under an paid.
What fraud exists when an employee suffers a legitimate OTJ injury and the adjuster blindly denies the claim to increase her Xmas bonus? There is fraud in the system. Unfortunately, it’s the insurance co’s who are guilty.
Hey Police, I have been an agent for a long time and have written Workers Compensation for a lot of clients. I have yet to see benefits denied for a legitimate OTJ injury. Adjustors do not deny claims to increase their Xmas bonuses. If the claim is suspect, they do investigate which is their right to do so. They have prosecuted people filing fraudulent claims and that is the right thing to do.
agent this is a practice in your industry that is common knowledge the adjuster and lets not forget the dirty lawyer in house of the insurance company,and lets not leave out the designated doctor who does ,not follow the rules of the AMA or the commission. to write a false IR report when the evidence is clearly not in favor of the insurance,for you to even post such a bull response to police officer shows you clearly are part of the problem,of the industry.
Bindside, you are an idiot if you believe the crap you are putting out. Legitimate injuries are reported, medical expenses are paid and lost time. The fraud that exists is predominatly the claimant who is trying to milk the system for all its worth. Companies are having to deal with unscrupulous doctors and attorneys all the time. In some cases, there have been rings of these criminals who have been busted for their activities. Your post is utter nonsense.
if that’s true… AGENT… then why in the hell was my claim denied? I filed the paperwork in 2-19-15, just 13 fucking days after the injury, and service lloyds insurance in AUSTIN TEXAS stated that “MERE ” pain wasn’t compensable under workman’s comp. It has since been proven that the ROOT of the problem was degenerative joints in my lower back from sitting in a god damn chair for 1500-1700 hours over a 6 month time frame. SERVICE LLOYDS stated that I NEVER filed the paperwork in the allowed 30 day time frame, which is a bunch of fucking bullshit because I have the god damn paperwork they I faxed in to them on 2-19-15 at 17:41 p.m. and the location as to where I faxed them the information which was FedEx… DATED 2-19-15… so I DID IN FACT file and faxed the paperwork on time to the department of insurance MYSELF, they just didn’t do their god damn job.. so don’t fucking try that give us that shit you’re trying to sell us because we don’t want it. AND because this case was “mishandled” from the very beginning… I now have to go in and fix the fuck up that they caused, and have the workman’s comp reinstated because it was their fault they mishandle the case, it was their fault that they lost the god damn paperwork, and it was their fucking fault that I lost this case, so now I’m out for blood. I’m going to file on the department of insurance and service lloyds for bad faith, breech of contract, pain… suffering… and agony, breech of judicial duty, and ANYTHING else I can think of. then I’m going after the fucking adjuster for service lloyds that denied the claim for bad faith, pain.. suffering… agony, breech of judicial duty, and anything else I can file on her. she was NOT medically trained, she didn’t have a doctorate from A&M or anywhere else for that matter, and she couldn’t diagnose a fucking fart, even if it came out of her own ass. I’m going after D&M… Legacy support, AND support service group… the companies I worked for, for pain.. suffering.. agony, denial of medical care, bad faith.. because had my boss said how did you injure yourself… or even what were you doing for this to happen… instead of just sending me home… I would have found out that I have degenerative joints in my lower back and would have been covered UNDER workman’s comp. SO, by the time my lawyer get done with everyone, my lawyer is going to be so far up their fucking asses that they won’t need dental work for the next 10 fucking years.
Brian: very sorry for what you have been through, but due to this case, Texas Mutual Insurance Company v. Ruttiger, you can no longer file for bad faith against the insurance company as the Texas Supreme Court said so by a 5 to 4 vote. Very sorry but that is what happened at the Texas Supreme Court level. One thing you can do is vote against those Supreme Court Judges that decided this decision which was Justice JOHNSON delivered the opinion of the Court, in which Justice HECHT, Justice WAINWRIGHT, Justice WILLETT, and Justice GUZMAN joined. Those Justices are elected and that is a solution you can look at at this point. Again sorry for the trouble you are going through and there are so many more cases like yours because there is nothing to hold the Carriers back for their bad behavior and the Division of Workers’ Compensation doesn’t issue administrative violations as they should, and just recently told a medical provider they didn’t know they could do that!!