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employee living at worksite New Jersey

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  • employee living at worksite New Jersey

    I am relatively certain of the answer to this, but I'm posting to confirm that I am not delusional (since some at my company disagree with me).

    An employee is considered a "live-in." This means that he/she has an apartment attached to the work site, so they are available for crises on a 24 hour basis. The employee is paid for regular shifts, 40 hours a week, and for overtime when they are needed outside of those 40 hours. The employee gets free rent and utilities. He/she is reponsible for the cleanliness and safety of his/her own apartment.

    If the employee is injured in his own apartment, when he is not "on the clock" (such as slipping and falling in the shower) is this a work related injury that our WC needs to pay for? I say no, but perhaps I need antipsychotic medication?

    If the person already reported it to HR as a WC injury, and WC paid for a medical visit (it was over $100 so I think there was an x-ray), is it too late to do anything? No days were lost. Well, no days were lost so far, but now that it's been recorded as a WC report, I am worried that he could later report soreness and get a few days off.

    Please validate me, or correct me if I am wrong.

  • #2
    This would not be WC. Paying one medical bill in your state does not obligate the employer/insurer to accept the claim. In other words, just paying a bill does not mean you can't deny the claim or contest it if need be.

    You did the right thing in reporting it to the carrier as I always let the carrier make the determination on what is and is not covered. I would make sure they are aware that he was not performing work that the time and was taking care of personal business so to speak. They may not have the details at this point to deny the claim otherwise. For all they know he may have been fixing the shower.
    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.


    • #3
      Thanks, glad I am not delusional.

      HR only reported to the carrier that employee "slipped on wet bathroom floor" and didn't include that it was his own residence.
      I e-mailed the risk mgmt person at the carrier today.
      This particular HR person seems to have life-long mission that says "I'm out to be the savior of poor employees everywhere." I guess she saw this as furthering her agenda.

      Good to know we can fight it if more costs are incured.
      Sheesh, he could have just gone to his own doctor; we have excellent benefits here, so no need to jump to using WC.


      • #4
        As well intentioned as your Hr person may be, what she did is fraud and in many states would get her into significant trouble. Lying about how an accident occured to help someone obtain benefits is fraud, plain and simple. You can advocate for employees without lying or telling half truths. I'd come clean with the IC now.
        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.


        • #5
          TSC if you don't mind sharing exactly what was he doing when he slipped? Was he indeed on personal time not company time? Was he taking a shower in between jobs where he got extremely dirty or sweaty and needed to clean up to do the next task? Was he fixing his own shower or taking a shower? There really seems to be something missing here. I expect it to be something about 1/2 the way between what you have stated and what the HR person stated. Could that be?


          • #6
            He was taking a shower in the morning before the shift was to start (I think the shift was 12noon-8pm or 11-7, and this incident was like 10am).

            When my dept (quality & compliance) followed up to investigate, the injured person reported that he was showering, and water dripped from his hair onto the floor and he slipped on it and fell.

            His only claim to it being work-related was that he was getting ready for work when it happened. He decided on his own to report to HR and go see the WC physician rather than his own doc.

            Also, no one gets "extremely dirty or sweaty" at our workplace. They are in comfortable apartments and group homes providing counseling and teaching disabled people to cook, do laundry, and balance checkbooks, etc. They aren't even supposed to try to fix showers or any household things. The live-in employee has an apartment provided by the company, and the company does all repairs and maintenance.

            We discourage any physical labor (staff aren't even supposed to move furniture; they need to put in a work order for the maintenance staff to do it).

            We strongly emphasize separating work life from personal life, even for our live-in staff. When they are off the clock, they cannot be disturbed, unless they are on-call for emergencies (this is on a schedule and is followed strictly so as not to make them feel abused). If they are called in for an emergency, they go onto the clock, and they are covered by WC.

            We have had other staff slip and fall in a bathroom, and we were fine with it being covered by WC. In these cases, it was a bathroom in the group home, and the employee was helping residents clean the tub, etc, and slipped on water spilled during house cleaning. I'm completely ok with THAT being under WC, even when the employee didn't follow safety policies.

            But in your own apt, on your own time? No.

            Our carrier (and therefore my company) paid almost $200 so far for a medical exam. And I'm banging my head into the wall (which, of course, I would never report as work-related).


            • #7
              Fully understand and definately agree, for all that it's worth, this is not a WC related injury. The HR person that authorized the doc visit and the employee may need a review of what WC fraud is. Perhaps then they will understand that it is not a plesant place to be. Both of them are guilty of trying to defraud the WC IC and should be called to task for it. If only by a firm reality check in having the WC fraud statments pointed out and what the possible outcome could be for future abuse of the WC system. There are far too many injured workers denied benefits for legitimate injuries, not necessarily at you location by in general, to allow such abuses that are blatant and intentional fraudulent acts by the two of them. Things like this is part of what makes it so hard on legitimate claims to be addressed and done so in a timely manner.


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