Announcement

Collapse
No announcement yet.

My boss waited 6 weeks to return WC paperwork California

Collapse
This topic is closed.
X
X
  • Filter
  • Time
  • Show
Clear All
new posts

  • My boss waited 6 weeks to return WC paperwork California

    I had another thread on this site with this question but I can't find it to research.

    I had an injury Friday July 1, where I suffered an injury on the job in a hardware store. My boss was not in the office when it happened, so I notified him via email from home, and on Monday morning requested the paperwork. He did not give it to me until that Wednesday though I asked every day, and gave me something he downloaded from some college site. I searched and found the correct form on the net, and filled it out and gave it to him with two pages of attached instructions. He would not return it to me until 6 weeks later, when I demanded it because my nose was still hurting. (I asked over and over, and documented each time I asked. I didn't demand right away because I was afraid of losing my job and my access to WC.)

    When I demanded it, he asked why I still needed it, as my nose was no longer swollen!

    I took it to Kaiser Occupational Health, they xrayed my nose and it is broken.

    They turned in my paperwork to the WC carrier, who contacted my boss. He was very angry I had turned it in! He retaliated by reducing my break time from 15 min to 10 min.

    I would very much like to stay with Kaiser, none of the ENT drs. in the network are very close (the one they assigned me to is 50 miles round trip), or have gotten very good reviews about their care (the one closer I found on the MPN listings).

    Since I turned the form in to my boss on July 6, and it was 6 weeks until he returned it to me, do I have any rights to go with my regular medical organization?

    I looked at the CA labor law site covering WC issues, but they don't mention anything like this.

    Thank you for your assistance.

  • #2
    It doesn't really matter that your boss didn't return a copy to you...as long as he files a claim with his IC. However, you did that though seeking medical care, and the provider bills the carrier. You have a valid claim filed. YOU should have kept a copy of the form you gave your ER.

    Because you feel your boss has discriminated/harrassed you by cutting your regular break time, you could add that to your claim, section 132(a) of the labor code.http://www.leginfo.ca.gov/cgi-bin/di...file=110-139.6

    Because your boss did not inform you in how to seek medical care, you are free to treat with any provider who agrees to treat industrial injuries. Twenty five miles round trip to a Dr is not unreasonable...thirty five one way may be. You are entitled to mileage reimbursement for medically necessary trips. Including Dr, Rx etc.

    I'm somewhat confused on your question, you said you would like to stay with Kaiser, found a Dr close to your home in the MPN, yet want to treat with your "regular medical org".... You can change PTP/Primary Treating Physician at any time (pretty much) by notifying the CA/Claims Adjuster of the new Dr who agrees to treat you.

    There is a lot of information in the Fact Sheets for Injured Workers here http://www.dir.ca.gov/dwc/iwguides.html

    I had another thread on this site with this question but I can't find it to research.
    Just click on your ''name'', and your profile will come up. Then click on "all posts started".

    Comment


    • #3
      I did keep a copy of the DWC1 I signed and gave to my boss. I was told by Kaiser Occupational Health that I needed his signature on it and the name of the carrier so they would know who to bill. He did not return it to me for six weeks, and he did not submit it to his carrier. Kaiser did.

      Thank you for your guidance.

      Comment


      • #4
        It would of course be your burden of proof where your ER has delayed in cooperating with the intent of denying you benefits..namely medical care at the time you reported the injury. It is illegal....and could be fraud. At the very least, it could cost him..out of his pocket, up to an additonal 10K for what he has done. A WCAB judge would make that determination.

        I was told by Kaiser Occupational Health that I needed his signature on it and the name of the carrier so they would know who to bill.
        All kinds of people will tell you something that will alleviate their responsibility... Kaiser does not need his signature...as you have found.
        When there is industrial/occupational injury, the IW can file the claim, with the ER or the carrier...a hospital, or a Dr who treats you. Having the ER/IC info up front simply makes it easier for the person you dealt with.

        Thank you for the additional info... I am still not sure what your question is?
        You can also contact an Information and Assistance offer at the WCAB, or consult with any WC attorney. www.caaa.org for names in your zip code.

        Comment


        • #5
          I'm sorry, I guess I didnt' make myself very clear.

          Basically, I am wondering under what circumstances I can use Kaiser (my health insurance company) for an ENT instead of the WC carriers MPN.

          When the carrier asked my boss why he didn't submit the paperwork, he said that he had no idea what to do, because in the years his family has owned the business they have never had an injury. I know this is not true because I have seen many injuries in the almost 4 years I have been there. I told him once about an employee that had piece of metal shaving in his eye (from cutting keys) and should see a WC doctor and my boss just hung up on me. I know the young man never got the paperwork though my boss was notified. I believe he withheld my paperwork for six weeks because he did not want his premiums to go up. When I finally demanded mine, he noted my nose was no longer swollen so why did I still need it?

          But yes, it would be my word against his, in spite of my dated emails to him and my notes, etc.

          Comment


          • #6
            Basically, I am wondering under what circumstances I can use Kaiser (my health insurance company) for an ENT instead of the WC carriers MPN.
            Since you were not provided the instructions on how to seek treatment at the time of hire, or injury and filing the claim, you can select any Dr willing to act as PTP.

            You cannot bill your own GHP, they will deny coverage for work injury.
            But yes, it would be my word against his, in spite of my dated emails to him and my notes, etc.
            You don't need to worry about your word against his...everything in WC is based on what you describe happened, and the medical evidence provided by your Dr.

            Comment


            • #7
              Originally posted by CAIW View Post

              You cannot bill your own GHP, they will deny coverage for work injury.
              GHP -- General Health Provider? I am confused. Kaiser is my health insurance for many years. They have an Occupational Health department. How would I bill them?

              Comment


              • #8
                GHP/Group Health Plan, or private pay IC... you can't switch back and forth between you/your IC paying and the ER WC carrier paying for medical care.

                And, Kaiser KNOWS better than to do that... even if you are treating with the Occ health dept.

                Comment


                • #9
                  ok, I understand. As of yet, I have not seen a doctor because the WC carrier forgot to tell me that I had to call a doctor, that a dr. they approved would not call me for an appt. So I have been researching doctors in the MPN, and thought I would ask about Kaiser, since their best drs. are in SF and I'm on the other side of the bay.

                  Comment


                  • #10
                    The CA/Claims Adj is going to try to make you choose a PTP in the MPN... because you don't know how to challenge this.

                    As I said, because your ER did not tell you where to see a Dr, or select a PTP in the MPN.. they lose the right to control what Dr you see. You do not have to choose a Dr/PTP in the MPN.

                    You should be consulting with an attorney on this one...

                    Comment


                    • #11
                      Thank you! That is excellent information.

                      Comment


                      • #12
                        ok, when I tell the worker comp case worker that because my boss did not do those things, I should be able to go to any Dr. that will take my case, she ignored that and told me to go to the MPN and pick a doctor if I wanted to keep my case open.

                        Do I have to get a lawyer? Or is there a section of the labor law of CA that I can direct her to? I have searched the Industrial Relations Worker Comp site but I don't see that info.

                        Thanks.

                        Comment


                        • #13
                          Another question, it seems you have to qualify to be able to predesignate a doctor. My employer does not offer any employee benefits at all, except for Workers Comp. Does this mean I can't use Kaiser even though he did not give me the info as stated above?

                          Comment


                          • #14
                            ok, when I tell the worker comp case worker that because my boss did not do those things, I should be able to go to any Dr. that will take my case, she ignored that and told me to go to the MPN and pick a doctor if I wanted to keep my case open.

                            As I said, "The CA/Claims Adj is going to try to make you choose a PTP in the MPN... because you don't know how to challenge this.
                            Call and I&A officer at the WCAB. Or, talk to an attorney. www.caaa.org for names in your zip code.
                            Another question, it seems you have to qualify to be able to predesignate a doctor. My employer does not offer any employee benefits at all, except for Workers Comp. Does this mean I can't use Kaiser even though he did not give me the info as stated above?
                            You are not pre designating... it's too late for that.

                            Why did you go to Kaiser/occupational health in the first place?

                            You are going to be compelled to select a Dr/PTP in the MPN unless you know how to challenge this... and a message board is not a substitute for legal advice from an attorney. WC is not a "DIY" project unless you know what you're doing, from the get go.

                            Comment


                            • #15
                              I went to Kaiser Occupational Health because my boss did not tell me where I could go. I am a long time Kaiser member, and that was the only place I knew to go.

                              Comment

                              Working...
                              X