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using ur own ins for w/c Pennsylvania

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  • using ur own ins for w/c Pennsylvania

    The third time is a charm...
    Last edited by rear-ended; 02-25-2010, 05:38 PM.

  • #2
    Why would you use your own insurance if this is a Work Comp injury?
    I don't respond to Private Messages unless the moderator specifically refers you to me for that purpose. Thank you.

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    • #3
      Check with the IC before you let your Dr bill for treatment to a work related injury or PI/MVA or however your injury occurred.

      I don't believe your HR person is in a position to tell you one way or the other what amounts to 'fraud'... Fraud against an insurance company happens when you KNOW the treatment you are receiving is the liability of another party, yet you do not divulge that information to the provider or the carrier, because you are attempting to get benefits you know you are not legally entitled to.

      It's not unusual for another person to tell you lots of things they ''think'', but don't really have all that much knowledge of. WC is one of those areas very few people know much about until they suffer an industrial injury, and/or file a claim for WC benefits.

      As a rule... your personal health coverage does not cover industrial/work related injuries... because you are not liable. And when you have health coverage, whether you pay the premiums or your employER... you are the one paying the bills.
      W.C is paying only 34% to the surgeon and also me while I am off. So do any of you smart people know anything about this matter????
      As I recall this has been addressed, more than once maybe.
      They are paying a reduced benefit because you received money in your 3rd party claim for FMC/future medical care... and YOU have to prove you have paid that fully before the carrier will begin to pay 100% benefits again.
      They could have taked the money and paid full benefits... but what if you died before it was exhausted? They would have to pay back the money to your estate... IC's don't like that scenario. So, they are taking the credit instead.

      Besides the 'fraud' issue here... You were paid up front for FMC, so your personal carrier could claim you are double dipping by letting them pay for the full amount of your surgery/Dr etc. That could very well be fraud.

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      • #4
        I would ask her, but I hate asking her questions, I have asked her enough over the last couple years.
        LOL... SHE is the person handling your claim... and should know the comp rules in your state... yet you are hesitant to ask a question about your coverage...(?)

        Sorry, I didn't notice how many posts you have here... or on other WC message boards...where the info is generic at best, and may or may not be entirely relevant to your situation...but hey... it's definately worth what you pay for it.

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        • #5
          If you were to use your private insurance for a w/c claim it is possible that BOTH parties can deny payment.

          Your private insurance will probably deny payment due to it being a W/C claim. If they were to pay the claim and then find out that it was incorrectly paid they can come to you for repayment.

          Depending on the particulars of this case if you go to a different vendor during your first 90 days you can be denied from the W/C carrier.

          Most Companies in PA are not self insured. Does your particular company have an insurance company that is handling your claim and/or a third party administrator that handles workers' comp? If so, I would recommend talking directly to them as they are the experts in W/C.

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          • #6
            Why would you not run it through WC? Seriosuly. Stop trying to make your situation more complicated and just do what you know it right/allowed. It is a WC injury, and your WC carrier has accepted compensiblity. Why, why, why try to run it through another insurer and risk it being kicked out or worse, considered fraud? Whether it is fraud or not is borderline, but knowing it was accepted by the WC carrier and knowingly trying to get it covered by another insurer does kind of push it much closer to the fraud line.
            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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