Stupid W/C Claims

HRQ

[font size="1" color="#FF0000"]LAST EDITED ON 06-12-07 AT 02:18PM (CST)[/font][br][br]ritaanz got stuck with the gazelle's stupid hand injury.

Here's my stupid W/C story;

I was advised today that our insurance company is accepting a claim for a cut finger. The employee was opening the lid on a can of pineapple. Her own can brought in from home, for her own snack. She happened to be on the clock in her classroom, trying to fit in a quick snack. (Not allowed, by the way)

We counseled the employee for her violation and told her that the claim will likely be denied and she will probably get a bill from the clinic. She has no health insurance and expects to pay out of pocket.

I advised the insurance company that the employee fully expects the claim to be denied, and the reason why.

Today the insurance company called the employee's supervisor (not me, for some reason) and advised them they are accepting the claim, unless the employee writes a statement indicating she does not WANT it to be filed as W/C. So, the supervisor is going to ask the employee to do this.

It's like they WANT to jack up our e-mod, as if if isn't already bad enough. I realize this stuff is regulated, but it's making me crazy.

Aaarrrggghhhh.

Edit: I meant to post this in the W/C section. Sorry.

Dutch2

Here in Missouri we finally had a change in WC laws for the benefit of the employer. In the past anytime an ee fell at work, you could depend on it being a WC claim. Earlier this year we had an ee walking down a clean, dry, flat tiled hallway and tripped over her own two feet. She actually broke her shoulder as a result of the fall. We didn't think twice about this being a WC claim. However, when the claim arrived at our WC provider it was turned down as WC because if was no the fault of the ER that she tripped and fell. Sorry that the EE fell; but finally one in favor or the ER.

Paul in Cannon Beach

I just about had a WC story that might have topped yours, Q.

Earlier in the month I was doing a NEO for 50 seasonal summer staff.

Some of them have already been with us for awhile and had seen the MSDS/Bloodborne Pathogens safety videos. So, when it came time for the new ees to watch the video, I had those that had already seen the video leave the room.

I gave them a digital video camera and told them they got to film their own safety video that the rest of the employees would watch after they had seen the MSDS videos.

These employees are all 18-24 so they had a fun time creating an elaborate safety video. In one scene a female ee walks through an area that has been recently mopped but no warning sign is present.

She does a very convincing fall. I was worried that she would do such a good fall that she would actually hurt herself.

THat would have been an interesting claim.

How was the employee injured? Filming a safety video.

ray a

Dutch, was the ee then able to make a claim against their health insurance? I've had ee's claims rejected by W/C because it was deemed not the employers responsibility then when they file with our health insurance provider it is rejected again because they believe it is work related. Catch 22.

Dutch2

No problem with moving this over to our Group Health Plan as we are self insured. However, the ee will now be responsible for her share of the co-pays and deductibles.
However, since all of the original services and subsequent bills were sent in as a WC claim it is going to take months to get them all converted over to our Group Health Plan.

E Wart

I don't know the exact wording of it, but NC's worker's comp has to have an "accident" or something related to the injury. Then they make a decision as to whether or not it was work related. We had an employee who comes in at night to check machines. When checking he moved something and felt a "tendon tear". W/C wanted to deny it since they said there was no "accident related to it", just normal wear and tear. We finally talked with into it. (Very good, long term, honest, employee. Then you have TX who will pay anything. We had employee sitting in lunch room during break/lunch leaning back in his chair. Fellow employee walked in and shook the chair to scare him, (it didn't fall and he was in the chair all the time) and he claims all types of neck injury, including 2 surgeries. W/C paid it and all his lost time!!(I hate TX worse than CA.)
E Wart

Irie

My story: Last week a young lady left here complaining of a headache and dizziness. She went to the med center and was diagnosed with a UTI, headache, dizziness, and menstrual cramps. Now she's trying to get our WC to pay for it.

Knowing Ohio's BWC they will probably allow the claim.

ritaanz

I would contact the insurance company and find out who is in charge of that department and ask to speak to them. The clerk that decided that this was a work related injury needs training.

ACU Frank

Paul, I once had an employee who cracked a vertebrae in his neck when he was struck by an overhead safety beam that he dislodged with the forks of his lift truck. That was an awkward incident report... "Cause of injury: Struck by safety beam"

Paul in Cannon Beach

Nice Frank. I also recently dropped the MSDS video on an employees toe while trying to open a door to the training room where the ee was to watch the safety video.

The ee was wearing sandals and the VHS tape landed on her toe hard enough to cause some pain.

No claim was filed of course because it was so minor but I did think that it would have been funny to write "Injured by Safety Video" on the WC form.

HRQ

Got a letter yesterday from our w/c insurance company, indicating the employee's claim was denied. Woohoo!

Gosh, all I have to do with any future BIG claims (thank God this was a little one anyway) is get the injured employee to write a statement indicating the injury isn't job related and they don't want it filed as such. Wonder if that'll be difficult.