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Reporting or not reporting? California

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  • Reporting or not reporting? California

    An employee work for a 7 people company lifted something heavy yesterday. Did not feel there was an injury and did not report it. Felt strange afterwards when he went home and speculated that he have hernia. Came back to the work the next day and told his boss. His boss while filing the necessary worker's comp paper work have doubts and wonder if this indeed occured at work. After a longer discussion, both parties decided to stop continuing with the paper work. The employee agreed to seek medical help on his own insurance, and the employer also agree if after further investigation, he will file workers comp claims but not until specific proof this was work related injury. The conversation was documented and there were no hard feelings as a result of the meeting. the question is: this may not be a conventional method to resolve the situation, but is there law breaking or violation of CA regulations?

    Glasspiano

  • #2
    While it certainly wouldn't have been the way I would have handled it, it isn't a straight forward case of wrongdoing on behalf of the employer. Did the employee in questuion actually have a hernia? That is an awfully unusual diagnosis to assume.

    Hernias tend to be treated differently than most other injuries in WC. Before I start quoting the regs here, are we even dealing with a hernia? Is there even an injury being alleged as a result of the heavy lifting?
    I post with the full knowledge and support of my employer, though the opinions rendered are my own and not necessarily representative of their position. In other words, I'm a free agent.

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    • #3
      When in doubt, report the claim and then figure out if it was work related or not.
      Senior Professional in Human Resources and Certified Staffing Professional with over 30 years experience. Any advice provided is based upon experience and education, but does not constitute legal advice.

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      • #4
        I have to agree wiyh ElleMD here, this sounds completely unusuall. Are we actually talking about an employee or yourself? just curious as to your interest in this situation. Why does this employee think he/she has a hernia? Like said before, hernia's are a less common diagnosis, and one that most do not come to the conclusion of unless they have already had one, or they already knew about it. What makes them suspect hernia? If this employee was sure it was caused by work, then why did he/she agree to not pursue workers comp and instead pay out of pocket costs via private insurance? Is it possible that it was not caused at work? Has this person saw a Dr. yet? If so, was it the company's designated WC Dr.? If the employee is unsure whether it was caused by work, or other, then they need to tell their boss this, and then if they want they can talk to the boss about seeing the company Dr. to evalute if there is an injury, and if it was caused by work. Which at that point the company has every right to bring forth an investigation to find out the cause of this injury. If there is a chance this injury is not work related, and it is known and not disclosed prior to this, they can then claim worker's comp fraud, and this employee can be fined for $50,000 and/or 5 years imprisonment via california's WC laws.

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