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workmans comp or not? - California

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  • workmans comp or not? - California

    So this individual dropped someone off, in their own vehicle, because the other individual did not have a ride. On the way back, the individual with the vehicle got into an accident. No injuries, just a totaled vehicle. The next morning, the supervisor tells the individual that they needed to fill out the workmans comp form and go to a hospital. The individual willingly went, HOWEVER, the individual also reiterated and asked numerous times whether or not they would get billed for the hospital visit. The manager reassured numerous times that they wouldnt get billed. There is actual written documentation with this information stating that they wouldnt get billed. The individual also stated that if they were going to get billed, they preferred to go to an alternate hospital that is covered under their personal insurance. They were denied that request. A couple months come by, and the individual gets a bill from the hospital. Now the company refuses to pay for it. They have actually opened up a workmans comp case a few times and closed it because it was not a legitimate case.

    Is this a valid workmans comp case? Should the company be held accountable for "promising" that the individual would not have to pay for the hospital fees? How would this be fought if it can be fought? Thanks again for any info!!

  • #2
    I don't see how this could possibly be a WC claim unless part of your job is to act as chauffer. If you have in writing that the company will pay for the exam, then you need to take that document to a lawyer to see if it constitutes a true contract. Otherwise, it would be between you and the company. I suppose you could try small claims court.
    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
      Originally posted by ElleMD View Post
      I don't see how this could possibly be a WC claim unless part of your job is to act as chauffer. If you have in writing that the company will pay for the exam, then you need to take that document to a lawyer to see if it constitutes a true contract. Otherwise, it would be between you and the company. I suppose you could try small claims court.
      So it is completely legal for a company to have an employee file a workmans comp claim, and then charge that employee for any hospital fees that come out of it? Even if they stated they would pay for it? And even after that employee gave an alternate hospital where they knew they wouldnt get charged, however went under the trust of the company to the hospital they told them to go to?

      EDIT:
      Adding the following:

      Also, you are right, their job description does not require them to be a chauffeur. They were not arguing that part. In fact, they didn't want anything back aside from the company paying the hospital bill. I don't see how they can be held accountable for a bill when the company reiterated that they wouldnt get a bill at all and that the company would cover it.
      Last edited by ltg7; 11-06-2006, 10:02 AM.

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      • #4
        unless the written agreement to pay the bill constitutes a contract to pay, yes, it would be legal. Otherwise, the employer would be on the hook for all kinds of medical bills if the employee claimed it was work related. Given that there are some very stiff penalties for employers not reporting a claim, most err on the side of caution and treat it as a claim until they hear otherwise from the carrier.
        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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        • #5
          Originally posted by ElleMD View Post
          unless the written agreement to pay the bill constitutes a contract to pay, yes, it would be legal. Otherwise, the employer would be on the hook for all kinds of medical bills if the employee claimed it was work related. Given that there are some very stiff penalties for employers not reporting a claim, most err on the side of caution and treat it as a claim until they hear otherwise from the carrier.
          Yea I get what your saying. It just bothers me that this person is in the situation. I was actually in the car with them that morning after. I took them to their site and then the hospital with the their direct supervisor along with the other individual (I think the other person was a day supervisor or soemthing to that extent). I recall reiterating NUMEROUS times to make sure they wouldn't get billed for this because it would be about a 2k bill, which they cannot afford to pay at the moment. And they asked numerous times. From what I recall, the direct supervisor even contacted their HR team and the HR team told them that it was ok and that the individual would not have to pay the bill if they went to that hospital for a check. So that's where I am guessing is that gray area...unfortunately...

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          • #6
            A check up shouldn't be 2K, but aside from that, what is legally required and what is a best practice are two very different things. Should they pay it? Probably. Are they legally responsible for a medical bill that is not related to a WC claim? No.

            He can try submitting it to the carrier to see if they will cover it. Your state does permit the carrier to cover up to 10K in bills before denying a claim. It doesn't mean they must cover it, but they might. It can't hurt.
            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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            • #7
              The carrier being the insurance that does cover?

              EDIT:
              Adding the following:

              The company wanted to make sure they were checked by a hospital to assure nothing was wrong. Actually I went through a post I had about this when it happened. The hospital/doctor told her to take 3 days off because it was a WC claim originally. After the WC claim got denied, she was left out of 3 days worth of pay along with a hospital visit of around 2k. So she completely came out losing on this one which bothers me a bit because at the very least, she would have not had to worry about the hospital visit if they would have just listened to her and gone to the hospital where she is covered.
              Last edited by ltg7; 11-06-2006, 02:14 PM.

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              • #8
                By carrier I meant the WC carrier/insurer.
                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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                • #9
                  Ah ok. Sorry for the delayed edit on my previous post by the way.

                  Thank you for all of the info you have provided so far. I greatly appreciate the time you are taking to post about this.

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