My Boyfriend was injured at work when his finger was caught between a bag of cement and a pry bar while loading a truck on a job site. He was sent to the Employers industrial clinic, where they did xrays and told him that his finger was broken. They put it in a splint & sent him home on pain killers and told him to return if his condition became worse. The skin had been broken while it was pinched and he developed an infection. The joint on the finger grew to the size of a red grape & he was unable to move or bend it. He returned to the clinic where they sent him to have an MRI and made an appointment to see a hand specialist for possible surgery. The joint in the finger had been shattered with pieces of bone fragement going different directions and it began to curve downwards unnaturally towards his palm like a "hook". The injury was on his dominant hand and he could no longer grasp or work with it. The Doctor said that he could return to work on modified duty if the Employer had something he could do that did not require the use of that hand. The Employer did not have modified duty and so he remained home on temporary disability for about six weeks then the Hand Specialist sent a request to Gallagher for approval to do surgery and recreate the joint that was shattered. Everything was fine until the request for surgery was submitted and all the suddent the Adjuster canceled his claim and denied responsibility for the injury. After that his Employer of ten years wrote him a letter telling him he was fired for refusing to return to modified duty. They claim that they called his cell phone a couple times and he didn't answer. They didn't leave a message and he had no idea that they had modified work available. They claim that failing to answer the phone constitutes abandonment of his job and/or refusal of the modified work they claim they were going to tell him about during that call. They did not send an offer of modified duty, and neither did the Adjuster. They are suppose to send an offer and allow the worker 30 days to refuse or accept it. Ignoring the notice constitutes refusal if not answered within 30 days and if a worker declines they can reduce his disability wages by 15%. The law says nothing about failing to answer a phone constituting abandonment of job, but thats exactly what the Adjuster told the Employer to say when the Doctor said that they should pay for surgery. Apparently the surgery is expensive and they were looking for ways to avoid paying for it? He collected disability for approx 2 months and then was terminated with all health benefits canceled the same day and his workers comp claim was closed. He could not return to work with a finger that curved like a hook towards his palm. He was in a lot of pain from the injury and it got caught on everything including the pockets of his pants. The finger continued to curve more and more as time went on and the joint remained the size of a larger red grape. He hired an Attorney who sent him to another Doctor that put him on State disability. That Doctor sent him to another hand specialist who also said he needed surgery. That specialist sent a request to Gallagher Bassett for approval for surgery and they ignored it. Months went by with him going to the regular Doctor and hand Speciliast on a regular basis. He was waiting for approval for the surgery and did everything to get it to happen. He called the Adjuster, the insurance company and his Attorneys office and nothing helped. The Attorney said she had nothing to do with approving surgery and suggested the Doctor send another report requesting authorization. The Doctor sent another report and put it in bold letters that the patient needed surgery and he demands authorization to proceed. This request was also ignored. HIs State disability ran out after one year of payments and he contacted his Attorneys office to request workers compensation benefits to replace it. They ignored his calls. He tried writing letters and faxing request to his Attorney and nothing helped. Then he received a letter in the mail with an appointment to another specliast that he had never heard of. He thought that they had set him up with a different Doctor to do his surgery and he went to the appointment. He asked about his surgery and was told that he would receive information in the mail. About a month later he received a settlement from Gallagher Bassett for about five grand. He didnt understand what the money was for? His finger was still broken and deformed and he was not permanent and stationary so how could they try to settle and end his case? He had to fire his Attorney to figure out what was going on. When she was dissmissed and the other side had to deal with him directly they told him that his Attorney declined surgery on his behalf and they were under the impression that he no longer wished to have medical care so they were trying to settle and end his case. He told them he wanted surgery and asked about all the other requests for approval which were ignored and they would not answer his questions. They said they never refused his surgery and that he was the one who declined having it in attempt to stay off work and soak up as much in benefits that he could gather. They gave him 45 days to have surgery or loose the rights to do so. Then they said that his Doctors specialist who had requested the surgery approval prior was not on their MPN list. They would not approve surgery outside of the medical provider network. He asked for a list of providers and was ignored. When he pushed the issue they sent him a letter saying the list was enclosed and nothing was in the envelope in attempt to stall him from finding a Doctor who could do his surgery in time to meet the deadline they had given him. The medical evaluator that he was sent to mentioned the name of a hand surgeon in his report that was submitted so he requested surgery with that Doctor ASAP. He contacted the Doctors office himself and set up an appointment. The appointment was suppose to be a "pre op" visit to schedule surgery and instead Gallagher Bassett only gave permission to the Doctor to provide an evaluation with a written report and submit it directly to them. That report took a few weeks and he was running out of time. If it wasnt for the Doctors office who actually read the copies of letters we faxed to them that showed how he had been trying for months to get approval for his surgery then I dont know where he would be right now? The Doctors office set up the surgery ASAP and did it before Gallagher was involved. They used a letter that was sent to my boyfriend by their attorney that claimed how they never refused surgery approval and how it had always been available as an option to him if he had only claimed it. Gallagher Bassett refused to pay him benefits. Then we found out that the weekly amount they had paid prior was incorrect. They refused to provide the list of wages used to compute his benefits and instead just corrected the wages without any notice or self imposed penalty as required by law. He sent in milegage reimbursement requests that were paid in 96 days when the law says that they have 60 days to respond. They are trying to settle his case when his care is not even finished yet. He had his surgery and has metal pins hanging out of his hand and they claim he is well enough to go back to modified duty. But guess what? NOw they claim that his employer does not offer modified duty and so he has no job to return to and is eligible for the retraining voucher instead. Funny how they claim he refused to return to modified work and they have no modified duty program currently. He received copies of the contents of his files at the Attorneys office, Gallagher Bassett's office and his employers office too. There were no papers discussing surgery or anything that said his Attorney had declined it on his behalf. Whats even worse is that they sent the copies of these files as legal certified copies that were true and correct in content and more then half the papers in these files did not even belong to him! They had merged his file with the files of three other injured workers and sent him all their personal information along with his file contents. Talk about protecting personal identification information? They could care less! Two of these other patients have legally leined his settlement for repayment of their medical bills and this was really allowed! We are working to correct and fix this but keep running into all kinds of problems along the way.