Western Guaranty Fund Service

February 8, 2018RE: Complaint of [redacted] * [redacted] (Work Comp Claim)Dear Mr [redacted] ,I am writing on behalf of the Nebraska Property and Liability Insurance Guaranty Association (NPLIGA), which is a member organization of Western Guaranty Fund Services (WGFS), an assigned servicing facility for the statutory guaranty associations of seven states, including the Nebraska association We are responding to your letter to WGFS of January 30, 2018.WGFS has claim handling duties for NPLIGA’s workers’ compensation claimants, such as Mr [redacted] , who were injured during the time that [redacted] provided excess insurance coverage for a self-insured employer for whom Mr [redacted] was working when he suffered severe and permanently disabling injuries on the job This insurer has been judicially declared insolvent and dissolved from doing any more insurance business NPLIGA is a non-profit association that, under Nebraska law, is assigned the duty of providing workers’ compensation benefits for workers that otherwise would have been insured by [redacted] From our perspective, Mr [redacted] seems to have had a hard time understanding the workers’ compensation system under which he receives his benefits, and he is frequently impatient and uncooperative with procedures that are routinely followed by other recipients of these same benefits We are assuming that we can discuss his case with you because he has asked you to inquire about it on his behalf.It is an ordinary benefit requirement in workers’ compensation that a claimant’s drugs, prosthetic aids, transportation, housekeeping services, and other medical care be supported by prescriptions, and/or by medical reports and recommendations from authorized care providers Only reasonable and necessary medical benefits, that are causally related to a worker’s underlying job-related disabilities, are to be paid as workers’ compensation Because of the troubles Mr [redacted] has had with these standard aspects of the system, NPLIGA has provided Mr [redacted] with a nurse case manager to help him comply with these necessary procedures so that he can receive his benefits timely, efficiently, and effectively Nevertheless, he has chosen repeatedly to disregard and make no use of this personal case management service As a result, he frequently fails to comply with our reasonable requests for referrals and/or prescriptions that verify the compensability of what he wants to be paid as a benefit We are disappointed that Mr [redacted] feels so frustrated However, we do not think that NPLIGA is responsible for delaying or denying him any benefits to which he is entitled.Sincerely,Tom K***Claims ManagerWestern Guaranty Fund Services

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me.
Sincerely,
[redacted]

February 8,
2018RE:  Complaint of [redacted]  (Work Comp Claim)Dear Mr.
[redacted],I am writing
on behalf of the Nebraska Property and Liability Insurance Guaranty Association
(NPLIGA), which is a member organization of Western Guaranty Fund Services
(WGFS), an assigned...

servicing facility for the statutory guaranty associations
of seven states, including the Nebraska association.  We are responding to your letter to WGFS of
January 30, 2018.WGFS has
claim handling duties for NPLIGA’s workers’ compensation claimants, such as Mr.
[redacted], who were injured during the time that [redacted] provided
excess insurance coverage for a self-insured employer for whom Mr. [redacted]
was working when he suffered severe and permanently disabling injuries on the
job.  This insurer has been judicially
declared insolvent and dissolved from doing any more insurance business.  NPLIGA is a non-profit association that,
under Nebraska law, is assigned the duty of providing workers’ compensation
benefits for workers that otherwise would have been insured by [redacted].  From our
perspective, Mr. [redacted] seems to have had a hard time understanding the
workers’ compensation system under which he receives his benefits, and he is
frequently impatient and uncooperative with procedures that are routinely
followed by other recipients of these same benefits.  We are assuming that we can discuss his case
with you because he has asked you to inquire about it on his behalf.It is an
ordinary benefit requirement in workers’ compensation that a claimant’s drugs,
prosthetic aids, transportation, housekeeping services, and other medical care
be supported by prescriptions, and/or by medical reports and recommendations
from authorized care providers.  Only
reasonable and necessary medical benefits, that are causally related to a
worker’s underlying job-related disabilities, are to be paid as workers’
compensation.   Because of
the troubles Mr. [redacted] has had with these standard aspects of the system, NPLIGA
has provided Mr. [redacted] with a nurse case manager to help him comply with
these necessary procedures so that he can receive his benefits timely,
efficiently, and effectively.  Nevertheless,
he has chosen repeatedly to disregard and make no use of this personal case
management service.  As a result, he
frequently fails to comply with our reasonable requests for referrals and/or
prescriptions that verify the compensability of what he wants to be paid as a
benefit.   We are
disappointed that Mr. [redacted] feels so frustrated.  However, we do not think that NPLIGA is
responsible for delaying or denying him any benefits to which he is entitled.Sincerely,Tom K[redacted]Claims
ManagerWestern
Guaranty Fund Services