I have been having carpa-tunnel problems for a while now since I work in a office all day long and use the computer/mouse up to 10-11 hours most days.
At first is one of those things that you think will go away but little by little got worse and the pain became more noticeable in my hand. Based on personal experience worker comp cases are usually denied or hard to get. I used to be in HR before so I have been in the employer side fighting and coordinating with the insurance carrier, so that is why I know. Companies always try to fight it so they do not have to pay.
Well, unfortunately it was my turn to be sick and was on the other side of the equation . I needed for Workers comp to help me cover my medical treatment. Sedgwick is the carrier that my employer chose and it has been a horrible experience. Since I know how they work , I tried to get my medical treatment started and went to an orthopedic doctor becuase I did not wanted to wait and wait to get an answer from Sedgwick before I got an approval to get treatment. It has taken 3 months or so before I get even something going (just to get some official correspondence) and I filed my claim with them 3 months ago.
I have been assigned to 3 different adjusters, 2 of them being really incompetent. You call them, leave VM and email them in a very professional and courteous manner and they never get back to you. In fact, a couple of times one of their adjustors a Tonya in the Lake Mary location, accidentaly answer the phone (they never do) so when I mentioned my name and case number, cut me off and sent me to some other voice mail (like I would get an call back !). I called right away a few times right away and did not answer, I tried once more and was cut off again and xfr with no further explanation.
I was able to get her supervisor phone #, never heard back from the superisor either. The phone goes into VM automatically every single time.
I complained to my employer and only when someone here in HR told them to call me, they did.. just a quick message..., but again when I call back never, never answer the phone.
This oddyssey has been happening for while now. Very furstrating to get an answer, nobody is available. Until now (becuase I copied in my follow up email a big manager here), the adjuster did call, and gave me the most stupid excuse... that becuase I was pregnant 2 1/2 years ago and study on my own at home, that this is causing my carpatunnel and that they will denied it!!
How can this be? Somehow a baby causes my hand to go bad? come on! and even if it was related to pregnancy, I never had any issues while pregnant, my symptons started much later.. I only wanted to get a reimbursement for my out of pocket expenses since I took care of my condition with my regular insurance than waiting to get something from them approved. It is not like I am asking them to pay thousands of dollars.. the most it would have been a few hundred dollars..
They are so cheap!
This is just an FYI about Sedgwick and that they can be less than proffesional when dealing with their claims. They will come up with any stupid excuse to avoid paying anything. Good luck if you find yourself in a similar situation.
It is a shame that large employers hire these third party administrators to just save themselves some buck. Before coming up to such stupid arguments they should have medical proof (which they don't on my case). I am sure thinking about seeking legal counsel on this.