Should Worker's Comp Pay

[vickie6866 4]

I want everyone to chip in if I am right or not. I had a lap band for three years. Pulled the port loose at work, it erroded and infected my internal band leading to removal of my band several weeks ago. My doc says after one failed band he will not do another. He said I could do a sleeve as a revision. Worker's comp has been headache from beginning. They refused to pay in the beginning and caused me to lose my band because of an open hole in abd for weeks on end. I have been in surgery three time to correct the problems including removing my band, they paid for all this. They are now refusing to cover the cost of the sleeve. I feel like they are responsible because their bad treatment lead to me loosing my band. I don't know if I should just give up(personal insurance is a no go for the coverage), or see a lawyer and try to fight them.

Edited August 30, 2010 by vickie6866

[thinoneday 445]

I want everyone to chip in if I am right or not. I had a lap band for three years. Pulled the port loose at work, it erroded and infected my internal band leading to removal of my band several weeks ago. My doc says after one failed band he will not do another. He said I could do a sleeve as a revision. Worker's comp has been headache from beginning. They refused to pay in the beginning and caused me to lose my band because of an open hole in abd for weeks on end. I have been in surgery three time to correct the problems including removing my band, they paid for all this. They are now refusing to cover the cost of the sleeve. I feel like they are responsible because their bad treatment lead to me loosing my band. I don't know if I should just give up(personal insurance is a no go for the coverage), or see a lawyer and try to fight them.

Good luck, keep us updated on your progress!

[Carrie 4]

Wow talk about a unique scenario. I could however totally see that happening especially if you were like me and had a giant port.

I don't really know how much our opinions count. Personally I've always been told insurance is there to put you back where you were before hand. In your case that's not possible based upon medical issues, not that you are refusing another band or anything. So the next closest in price is the Sleeve which apparently you are interestd in. Personally I would write a letter to the appeals department and have it in writting in their hot little hands. I'm not sure how WC differs from traditional insurance but they should be willing to make your loss minimal which in this case is giving you a sleeve because you can't replace the band. After they get the appeal letter, as they should at least have an appeal process, THEN if they don't agree see about suing them.

Please keep us posted as this is a very interesting situation. I was debanded 4 days ago and I had my band since 2005 and my port was huge, so I could totally see such a thing happen.

[Stacy160 201]

I was about to ask how in the world you got WC to pay for bariatric surgery to begin with, but then re-read what you wrote and now I get it. That's an interesting scenario, and I can definitely see why they'd fight having to pay for a sleeve, but I can also tell you that, having worked at the WC center for General Motors at one time, probably 95% of all lawsuits brought against the company by the employee are won, and that includes completely ridiculous ones like "I can't work because I'm an alcoholic because my job made me that way," or "I can't work because of the mental problems caused by my job..." yeah, totally serious.

I'd say if the job caused removal of the band, and now you can't have another band, you'd stand an excellent chance of having your WC pay for a sleeve, maybe even without much threat from a lawyer (although you may still have to initiate that process). Hmmmm, interesting. Keep us updated!