Jesse’s Story of the Day

Jesse helps woman whose medical claim was approved, then denied


Donna Neely works in the incident management office at Western State Hospital and she hurt her back moving boxes.

“I lifted one to slide it over to a table that was next to me, and I felt a pop in my back”, Donna said.

That quickly, Donna had an incident that needed managing.

So she filed a Labor and Industries injury claim.

“So when I got approved I was ecstatic. I was really glad and happy about it. I wanted to start getting better right away.”

Donna went right out and got physical therapy.

Donna said, “They told me like the fourth week is the key where you really start feeling better and start getting better. The beginning of the fourth week, I received a call from some lady at L&I telling me oopsie, we made a mistake.”

It was a very costly mistake. L and I had changed its initial ruling and denied Donna’s claim. Plus, the agency said it wouldn’t pay for the $3,000 worth of medical treatment it had already approved.

“It’s not right. You can’t treat people like that. You can’t say oh, you’re good. We’re going to pay and you’re going to get well. And then say oh never mind. You’re going to stay where you are and we’re not paying nothing, and you get to eat all the back bills,” Donna said.

Tim Church says the state has 60 days to give final approval of a claim. In this case, he says a new employee took over her file and on the 57th day, they denied it.

“For sure, I can completely understand why she was unhappy with us,” Church said.

And that doesn’t make Donna any happier.

“But the bottom line was that L&I was supposed to cover it. It shouldn’t have gone back on me. And I just didn’t think it was fair.”

Donna contacted me and I spoke to L and I, that had decided to stick with its denial of Donna’s claim. But it would pay her $3,000 of medical bills.

“We felt horrible about it, and we still do. We let her know that we were covering the health care that she incurred during the time that she thought it was approved,” Tim Church said.

Donna’s case isn’t over. The state closed its file saying she didn’t appeal in time. Donna believes the state had moved its appeal date since it had approved her payments. We will keep you updated.

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