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fainted at work & hurt (work does not cover ambulance ride) California

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  • fainted at work & hurt (work does not cover ambulance ride) California

    This is for a very good friend of mine:

    he fainted at work, hit his head on a machine and went into a seasure. his co workers called an ambulance. He had all the blood work, and MRI while he was at the hospital. the insurance he has through work covered everything but the ambulance ride.
    This was last week. He got a letter for the bill for the ambulance ride (5700) and he called corporate. They said it doesn't' matter what happened because he fainted.

    he gets a physical every year (I don't know why) and he has had no history of seasures.

    He says he has horrible back pain most of the day and the doctors said he is only allowed to take non aspirin Tylenol. He still goes to work. His work refuses to acknowledge his workman's comp claim because he fainted on the job and they do not cover fainting.

    What should he do?

    Thanks
    Last edited by puzomatc; 04-30-2007, 10:01 PM. Reason: no history of fainting

  • #2
    For workers comp to be responsible for this, there needs to be medical verification that it happened BECAUSE OF something connected with his work. The fact that it happened AT work does not automatically make it workers comp. However, the employer does not make that decision; the workers comp carrier does.

    As far as his group insurance is concerned, if ambulance rides are not covered, they're not covered. The law doesn't require them to make an exception and pay for something that's excluded because of where it happened or because he has no history of fainting.
    The above answer, whatever it is, assumes that no legally binding and enforceable contract or CBA says otherwise. If it does, then the terms of the contract or CBA apply.

    Comment


    • #3
      For something to be covered under WC it must be arising out of and in the course of work. If the fainting wasn't caused by anything work related, then the fact that it happened while he was physically at work, doesn't make it a WC claim.
      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.

      Comment


      • #4
        I disagree. While the cause of the seizure is not industrial, the effects such as hitting the head are. Work comp needs to pay for the ambulance and any bills associated with the seizure. Your friend should file a claim and be reimbursed for his out-of-pocket medical costs.

        Comment


        • #5
          This post is from back in May. There's a good chance that the situation has already resolved itself. In any case, I doubt that the OP is still checking back looking for additional comments.
          The above answer, whatever it is, assumes that no legally binding and enforceable contract or CBA says otherwise. If it does, then the terms of the contract or CBA apply.

          Comment


          • #6
            [QUOTE=cbg;890885]For workers comp to be responsible for this, there needs to be medical verification that it happened BECAUSE OF something connected with his work. The fact that it happened AT work does not automatically make it workers comp. However, the employer does not make that decision; the workers comp carrier does.

            that says it best. i disagree too, but the law is the law.

            my friend just sucked up and paid the bill.

            Comment


            • #7
              He should get an attorney right away then see what is and is not covered .

              Comment


              • #8
                Originally posted by Interceptor View Post
                He should get an attorney right away then see what is and is not covered .
                he filed it with his work and workman's comp.
                they denied it, the ambulance ride was only 5700 bucks. as much as it sucks, he paid it (thank god they financed it). I tried to talk him out of it, but he does what he wants. hes fine now, but he has had back problems since. he needs to go to a chiropractor, but his hmo won't recommend him, so it won't pay for it.

                the drama continues, and the matter is closed

                thanks for the info
                Last edited by puzomatc; 08-06-2007, 07:28 PM.

                Comment


                • #9
                  California workers comp laws can be very complex. For example just because he was denied does not mean that ends the matter.

                  Ins companies often deny claims . Nothing you can really do without an attorney.

                  Consult an experienced workers comp attorney. preferably one who is a certified specialist.

                  Comment

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