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Can this really go under Worker's Comp? New Jersey

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  • Can this really go under Worker's Comp? New Jersey

    Hi everyone! I have not been here in a long time, but you have all been so helpful in the past for this non-HR person.

    We have an employee who was going to medical appointments as follow-up to a WC injury. He got into a motor vehicle accident on his way to one of these appointments (PT) and had another injury. He now has representation and is now claiming that the treatment for this injury has to be covered by WC. He was not working or "on the clock" when this MVA happened. He was in his own vehicle, on his own time. I think his assertion is that the trip was "work related" because he was going to WC medical treatment.

    To complicate matters, he was almost finished PT and was going to be considered able to return to work just before this happened (convenient).

    Has anyone encountered this? Does his assertion have any merit? Could we be on the hook for this as well?

    thanks!

  • #2
    Ugh! Welcome back! I remember your screen name.....

    That said, your state is not mine and WC is so very state specific. I would definitely pass on all the documentation/facts to your carrier. I would personally agree with you, but it can surprise me what will be approved. Was he at fault? If not, it is possible that the WC insurance will try to subrogate the costs back to the other driver's car insurance (lost wages and medical costs). Don't know if they will credit your loss run if they do. But it is something to ask!!

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    • #3
      There is only one state where WC appointments are considered work time and therefore an accident on the way *might* be covered. That state is not your state. And yes, I have had this happen to an employee. It was denied. Let your carrier know and let them handle.
      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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      • #4
        Thanks. Yes, the carrier already knows. I was just blown-away at the gall of the employee for making this claim. I didn't think it would fall under WC, but I'm continually surprised when bizarre things end up being covered by our comp, so I've started just expecting the worst.

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        • #5
          I've had the exact same thing happen in two different cases. In the first the employee was on full restriction and not working. His accident was NOT accepted by the carrier. The second was working light duty and the appointment was during work hours and he was being paid at the time by the employer. His claim was accepted.

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          • #6
            Just being on the clock should not be the determining factor for any claim, but facts matter.
            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
              I've had a guy who had a heart attack behind the wheel while driving our company truck. He had no injuries other than the heart attack itself. To his credit, he did not attempt to claim worker's comp, but his health insurance (which was through his spouse) sure tried everything in the book to try to make worker's comp pay for the pacemaker, etc. Fortunately, it's kind of hard to argue with them when your worker's comp is state run.

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              • #8
                I've been trustee for a self-funded WC plan, and administrator for self-funded health insurance plans. I get it.
                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
                  Originally posted by ElleMD View Post
                  Just being on the clock should not be the determining factor for any claim, but facts matter.
                  That's how I argued with the carrier at the time as well. Their logic was A. he was on the clock; and B. he was going to the doctor under the instructions of the employer.

                  And this was the carrier that was having to pay the bill so other than protecting EMR I had no real reason to push it.

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                  • #10
                    This person was not working at full duty or light duty, but was actually out on WC leave.
                    I would understand if he were still working, on light duty, and went to a PT appointment from work.

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                    • #11
                      If the employer sent him for treatment, then it is no different than any other errand or special assignment and likely would be covered. Like I said, facts matter. There are also times fighting the claim if minor enough isn't worth the cost.
                      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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