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Workers Comp Questions

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I'm sort of familiar with workers comp since I have been an HR contact for it previously. My understanding is that if the initial injury requires immediate treatment you are allowed to go the closest facility.  Then any followup treatment usually has to be with an approved provider.

DD had a burn at her college workplace that gave her blisters on on her hand.  She went to the campus clinic when the blisters started appearing, within an hour of the injury.  The company  Her boss is giving her problems saying she should have gone to another facility.  (She also didn't have a car.)  She hadn't even filed a report at that time.  

I know blistering is not life threatening, but still wouldn't you think that should receive immediate attention for a burn?  

Edited after DD clarifying it was her boss, not the company.

 

Edited by goldberry

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I have no idea about workers compensation other than my husband would have to log a report with HR, copy his supervisor on it and state that it was a workplace accident during the doctor’s visit. 

From the insurance perspective, we attended a new members session at Kaiser Permanente and the presenter kind of explain that the closest facility is for cases that are critical like heart attacks, severe allergic reactions, drowning. Or in the case when there is no Kaiser facility within a certain radius. I think your daughter’s burn would be considered second degree.

I’m not sure if her workplace or insurance is giving her problems. Insurance companies are open to lengthy negotiations while I have no idea if it is her workplace that is kicking the fuss.

My husband’s employer pays for Uber and Lyft, and HR would have helped called Uber (which is more common locally) for any of the employees if the injured employee are unable to.

Edited by Arcadia
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I would expect an injured worker, with a non-life threatening injury, would contact the employer and ask what to do before seeing the doctor. If she tried to contact the manager and couldn't (he/she didn't answer phone or return call in a reasonable amount of time etc), then yes, I would go to the closest, most generic public facility.  ie Hospital urgent care vs private practice/facility (not all will accept every form of billing/payment).  BUT.....I also know that they may not cover every facility and that it would be a risk to do so. 

Edited by Tap
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On 1/10/2019 at 8:33 PM, goldberry said:

I'm sort of familiar with workers comp since I have been an HR contact for it previously. My understanding is that if the initial injury requires immediate treatment you are allowed to go the closest facility.  Then any followup treatment usually has to be with an approved provider.

DD had a burn at her college workplace that gave her blisters on on her hand.  She went to the campus clinic when the blisters started appearing, within an hour of the injury.  The company is giving her problems saying she should have gone to another facility.  (She also didn't have a car.)  She hadn't even filed a report at that time.  

I know blistering is not life threatening, but still wouldn't you think that should receive immediate attention for a burn?  

 

 

It can vary by state, but in general a burn that is blistering would be considered emergency care and she would be able to seek treatment at the nearest emergency/urgent care facility.  They usually can require follow up care through their provider. 

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A second degree burn that is not over a large area of hands/face/genitals/feet is not urgent and many people just do home first aid to treat it. 

The employer procedure should have been followed but was not.  At this point, no one should be harassing anyone.  The insurance company people can work it out among themselves.   If necessary, the judge on the workman's comp case will make a decision on who pays what and what followup doctor needs to be seen.  Don't pay a dime to anyone until the judge is done, and do follow the instructions for workman's comp. Employee should Involve the employer HR if necessary, as well as immediate manager if things stall.  Keep every document and keep notes on conversations..one party may turn something over to collections and you may see that two or three years down the road.

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Workers Comp procedures vary greatly by state.  In my state, a doctor's office while often first ask "Did this occur at work" if there is any type of injury that a person is being seen for to make sure that it might not fall under worker's comp.  If it is a work-related injury they want to make sure it is handled according to procedures

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On 1/11/2019 at 10:04 AM, TrixieB said:

Your signature references a child at a Colorado university.  If that is the child in question, here is information from Colorado workers compensation:

https://www.colorado.gov/pacific/cdle/node/37306

 

The technical wording is "life or limb threatening" which the injury was not.  However in practice, workers comp has not had a problem with someone who had a nasty cut for example going to the nearest urgent care even though it was not limb threatening. In my practical experience, an external injury (like a cut or burn) treated within the first few hours or so usually causes no issues.

Honestly I'm not sure if DD told the clinic it happened at work?  They have her on file there and they may not have asked.  Also DD gets very scattered under stress. It was just her and a coworker there, and when the blisters started coworker said "you should go to the clinic".  It was also very painful obviously and she wanted to get something to put on it.   The boss was not contacted until after the fact.

It's not a disaster, the bill was $109.  But we have a lot of medical bills right now, and every bit is adding up. They billed regular insurance and of course regular insurance rejected it on the basis of it happening at work.  Her boss said they probably aren't going to pay it since it wasn't an approved provider.  DD is going to go ahead and give the clinic the workers comp info and see what happens.  

Adding:  It did blister a large portion of her hand.  It was a hot water spill.

Edited initial post after convo with DD that it is her boss saying they likely won't pay.

Edited by goldberry
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Is the boss really up on this ?  Your dd needs to obtain a copy of both pieces of paperwork the employer filed, as well as the list of ALL the acceptable medical providers.  She needs to make sure the filing actually happened.

After that, do yourself a favor and call your insurer and ask for a subrogation specialist, then discuss the facts.  The bill should have gone to workman's comp, as that box should have been checked at the time the insurance info was given/verified.  The insurer has a subrogration dept that works out these types of  things, they may be able to help you out.  

If you get sent to collections, don't pay a cent, and repeat that you need the bill to be sent to workmans comp as requested.  Keep documented, you will need this info if w.c. case goes to hearing.

Have the patient take a photo next time she unwraps her hand so the workmans comp hearing judge can see it was a large portion of hand and needed immediate first aid, if the dispute can't be settled over the phone. 

This is all a big pain.  If you pay the bill, will you actually be oop anything? in other words, does this count toward a family or individual deductible that you will go over anyway?

 

Edited by HeighHo
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The boss did file it, we received a workers comp claim form in the mail.  We can pay the bill if necessary, but it will not count toward deductibles or anything because it has been rejected.  $109 is not crazy, but like I said, we just happen to have a lot of other medical bills which we legitimately owe, so I'm hoping at least this one we may not owe!  We will have the clinic refile it with workers comp and see what happens.

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Since it was work related and the provider knows that, it will likely be settled at the hearing if you can't persuade the provider to bill correctly. Your dd will need the injury description from the treating doctor to show the judge that it was an emergency. Hopefully that will be enough to persuade and the workmans comp insurer will then pay up.

Do get the names of the preferred acceptable providers.

Edited by HeighHo

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My workman's comp claim was complicated because I was out of state when the injury happened.  My understanding is that the state where I was injured and sought treatment (NY), and the state where I live and work (MD) had different rules because WC is different state to state.  

I sought treatment at the hospital that the police officer who helped me recommended.  I didn't ask WC or HR for a place to go.  But I was in an unfamiliar city and unable to put weight on my leg, so it wouldn't have been reasonable for me to travel home to see someone chosen by my employer.  Once I was stabilized and traveled  home, I was allowed to choose any orthopedist who was covered by my regular insurance, and WC paid for it. Similarly, I asked to see the PT who is across the street from my house and was approved.  

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