Sentry Insurance uses bad faith tactics is administering their Workers Compensation Claims. I was injured on the job on October 14, 2009, and treated in the Emergency Room twice resulting from a head injury. I was off work for two months and diagnosised with Posttraumatic brain injury syndrome with headaches, dizziness, tinnitus, cognitive dysfunction, and vestibular dysfunction. My claim was assigned to claims adjuster Bob Ballard at Sentry Insurance in Stevens Point, WI.

Mr. Ballard took my initial report of injury and then assigned my case to Constance (Connie) Carter a nurse case manager at the Alaris Group to manage my medical treatment. Connie began playing doctor by deciding what evaluations I needed. She would not approve any treatment that was recommended always stating she needed more information from the doctor before approving treatment. She then went on to complicate the system by stating the doctors where not returning her calls, and even contacting different doctor office locations where they didnt have a record or knowledge of me. The Neurologist that they referred me to recommended referrals to several specialists to evaluate my visual problems, hearing problems, and cognitive difficulties.

When I became more involved by contacting the treatment facilities myself I learned that Connie was delaying approving referrals because she didnt understand what treatment I would be receiving or why they wanted to run certain tests. I made several phone calls, and sent many emails to the nurse case manger, and Mr. Ballard expressing my need for treatment, and dissatisfaction. I started to complain about their time handling and getting referrals completed so I started emailing them to get things more in writing. I was suffering at home during these delays without help. My own healthcare would not cover my injuries stating this is a work related injury.

On Feb 8, 2010, I received a letter from Sentry insurance stated that they were disputing entitlement of Indemnity and medical benefits because: Carrier admits liability for scalp laceration (cut or scrape) and contusion (bump to head) only. No other body parts or conditions are accepted. ALL of my medical records from onset support symptoms related to a Post Concussion Syndrome with symptoms captioned above, and I have no prior medical history related to any of my symptoms.

They also provided my contact information to the Division of Workers Compensation office in my area if I wished to appeal, which I did that same day.

Work Comp scheduled a Designated Doctor (DD) evaluation to determine my MMI (Maximum Medical Improvement) rating. I brought all of my medical records to the appointment, and thank goodness I did as Work Comp did not send any of my medical records or tests to the DD as they were supposed to under Labor Code Section 408.0041. Just another tactic to delay and limit the DD from reviewing my medical history. No penalty for them of course for not sending my records. There is however a $10, 000 to me if I dont attend the exam. I attempted to delay the exam so all my records could be sent, but they advised me the exam had to be completed within 3 weeks, and the DD is a traveling doctor who would not be back in my area within that time frame.

There is no regulation that prevents the Work Compensation Company from practicing and handling claims in bad faith like this. They can decide to limit what they will accept to cover without any medical or legal basis which prevented me from receiving necessary care and treatment. Sentry Insurance practice in administering claims in bad faith is a practice to limit treatment and care, and to further delay care in hopes that I will either improve and go away, or just go away without appealing their erroneous claims position.

I appealed to the Texas Workers Compensation board and they scheduled another state doctors exam to determine the extent of my injuries. Its now May 25, 2010, and my DD exam was just completed. The DD agreed with my Neurologist initial exam and supported my need for further evaluations and treatment. The DD laughed at what Sentry Insurance sent me in a denial letter on what they were going to cover, and stated he will correct this in his report, which he did.

Again there are no penaltys or regulations that prevent the Worker Compensation Company from deciding to limit their liability and adjust my claim in complete malicious and utter bad faith.