Workers' Compensation - Massachusetts – Workers' Comp Delays Blocking Medical Care – What Are My Rights?
Location: Massachusetts
Hello. Up until today I've only ever been a silent lurker in this sub but I'm feeling kind of lost in this situation of mine. I've tried to keep as much information vague as I could while still maintaining relevance. Apologies in advance for how long this turned out to be.
I (28F) am a field technician. I was injured on the job in a car accident (not at fault) while driving between work locations. It was a pretty bad accident, but I was lucky enough to get away with only a couple of injuries. Long story short, after a 13 hour stint in the ER they told me to follow up with my primary and sent me on my way. I knew I’d be out of work for a while, but I had a small nest egg to fall back on in the meantime so I wasn’t all that worried.
The next day I called my primary care doctor and found out he had recently left the practice, and the only other doctor there did not take Worker’s Comp claims. None of the clinics or urgent care centers I contacted would take workers’ comp cases either, without prior approval or referral from WC themselves. I returned to the ER in my town about a week later and was referred to a clinic (Let’s call them OC) that would treat me—but only if my workers’ comp insurer (WC) signed a fee agreement.
Shortly after, a rep from WC called me. I mentioned that I was considering legal counsel for a possible third-party claim against the at-fault driver and she replied that if I retained a lawyer, it would be unethical for her to speak to me any further and that she would only speak to my attorney from here on. A day or so later I did eventually retain a lawyer—but only for the personal injury case, not workers’ comp. From that point on, both my lawyer and I called the WC rep daily for over two weeks, with no responses or voicemails. I had to get my HR rep from work to reach out directly and received a reply from the WC rep almost immediately. She told my HR rep that they could not sign this fee agreement until she had completed her investigation. At this point it’s been like 19 days since the accident with no communication from her whatsoever. I called every day and left a voicemail every day, more so to document the lack of follow up on her end.
After three more weeks of this I reached out to my HR person again and she was able to see that my claim was denied about two weeks after my accident. The denial haad a note that said I was unreachable (false) and she also found a letter that was formally filed with the state saying I was denied because I had deviated from my route (also false, and never discussed with me). My HR person was able to get WC’s supervisors involved, and the WC rep contacted me shortly after to report herself that the denial was due to “failure to report in a timely manner.” At this point, I won’t lie, I was pretty angry hearing that, but I was still trying to keep cool. Calmly, I pointed out that WC rep’s lack of communication was the sole cause of this denial and she pretty much just brushed me off and started asking other questions related to my claim, presumably to actually file it properly this time around. She then verbally accepted the claim “without prejudice” and told me the OC fee agreement would be signed that day.
I went over this whole issue with my attorney and she said I shouldn’t rock the boat if they’re cooperating now. My problem is, it’s been a month and four days since WC rep said that she’d sign that agreement “before the end of the day” and the agreement is still not signed, so are they really cooperating? I have not seen a specialist for my injuries to this day and without going into detail, I’m basically bedridden at the moment.
Roughly one week after that call a WC supervisor reached out and told me I would need to sign and notarize a Section 19 agreement. This was the first time this agreement was mentioned, and no one indicated it was a condition for approving treatment. Over the following weeks, I continued to check in with both the supervisor and the original WC rep as they negotiated the fee (or so they claimed) with the specialist’s office. At one point the WC supervisor says that they have reached an agreement and that they were preparing to sign a finalized version. After about a week or so I reach out to the WC supervisor, who hands me off to the WC rep, who then says that she was waiting for the signed Section 19 from me first—implying that the fee agreement was being held up until then, although no one had explicitly stated that before. When I asked for that clarification, the WC rep clammed up again and stopped responding. I’ve asked twice with no answer, and when I asked a different question on an email chain she and her supervisor are both on, she responded right away to THAT question, refusing to answer the last two in the email chain where it is just her and I.
As of now, I’ve been without medical care for about three months. I’ve received no workers’ comp wage benefits, and I’m unable to qualify for state assistance because there’s no formal record of accepted benefits. My injuries are not improving, possibly from lack of care, and I’m growing increasingly concerned about long-term damage. My current attorney has advised against escalating things with WC, fearing they might stop communicating again, but at this point I’ve lost all hope that this company is acting with any sort of good faith and I feel like something else needs to be done. At the very least, I really believe that this level of dishonesty shouldn’t go unpunished by their supervisors or the state if need be. If I didn’t have my savings to fall back on I’d be in a lot more trouble, but even so this money won’t last forever.
My problem is: If I pull the trigger and start playing offense here it sounds like it might be much, much longer before I see any specialist for my injuries. Everyone has warned me that Workers’ Comp is a nightmare but I never expected this much of a problem. The way I’m feeling right now, I’m very close to pursuing legal action against them as well, but every time I mention what I’m going through in my close circle the consensus seems to be “Yeah they suck but it is what it is.”
Does the state take these kinds of complaints seriously? Does it sound like I am justified to pursue legal action if I decided to go there? It sounds to me like they’re withholding care unless I sign this agreement so they can cover themselves first. I need a realistic opinion before I decide what to do next. I try to never act in the heat of the moment but I’m kind of at the end of my rope.
TL;DR Workers’ Comp is doing what they do best. Would I be making it worse if I tried to hold them accountable?
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