Complete Labor Law Poster for $24.95
from www.LaborLawCenter.com, includes
State, Federal, & OSHA posting requirements

Announcement

Collapse
No announcement yet.

Workman's comp being denied Pennsylvania

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

  • Workman's comp being denied Pennsylvania

    -Pennsylvania

    Wednesday night at work a group of kids were in our store and attempted to steal a few cans of computer duster a co-worker spotted them and the kids ran out while dropping the cans they had on them causing 2 of the 5 cans to drop to the floor and explode.

    After blocking off the aisle I went to clean up the mess that was made. Being totally unaware of what I was really cleaning up I went in unprepared, I seriously thought canned air was just that...air. As soon as I stuck the sponge in and tried to apply pellet chips I realized it wasn't just air, the sponge froze almost immediately and my arm and parts of my hand that were exposed were covered in a thin white layer of ice. I immediately got up and taped off the aisle completely and ran to the washroom to clean my hand and arm off. After a couple minutes of running it under the water I felt I was fine my fingers were red and parts of my arm as well. I wrote out an accident report and phoned it into another office to report as I was the only manager on at that time.

    The following morning about 8 hours later I checked with the other manager on duty and told him about the report he asked if further medical assistance was needed and I declined saying I was fine. However, later into thursday I noticed something was very wrong my entire right arm & hand were numb tingling like your foot does when it falls asleep. I went to the ER shortly after and was told that it was frostbite. They treated me and kept me overnight due to being exposed to the chemicals. I missed work on thursday night and went in for work on friday, I spoke to the manager on duty first and told them I needed to file a WC claim but they stated that because I told 2 different managers that I was "fine" and failed to seek immediate medical assistance that I "waived" my right to utilizing WC.

    I can't afford to miss that day I missed while being in the hospital and have no more sick days left to use, nor can I afford the hospital visit/stay and I have yet to pick up one of the medications simply cause I cannot afford it. I said I was fine at the time because I didn't know I was frostbitten nor was I aware of what I was even dealing with.

    Do they have the right to deny filing with the WC insurance because I stated to two people I was fine when the effects didn't really kick in until hours later? I'm still feeling the effects of it.

    Thank you to anyone who answers and I apologize for the length.

  • #2
    No, you did not waive your rights.

    How do I get the benefits?


    Prompt reporting is the key. Report any injury or work-related illness to your employer or supervisor immediately. You must tell your employer that you were injured in the course of employment and inform your employer of the date and place of injury. Failure to notify the employer can result in the delay or denial of benefits. Once you have lost a day, shift or turn of work, your employer is required to report your injury to the Bureau of Workers’ Compensation (bureau) by filing a First Report of Injury.

    The employer may choose to either accept or deny the claim. If your claim is denied, you have the right to file a Claim petition with the bureau for a hearing before a WC judge.
    You did report the accident promptly by completing the report. You do not have to seek "immediate" medical treatment.

    This link also includes a phone number to call and you should contact the Commission immediately and ask what your next steps are.
    http://www.dli.state.pa.us/landi/cwp...?a=138&Q=58929
    I don't respond to Private Messages unless the moderator specifically refers you to me for that purpose. Thank you.

    Comment


    • #3
      Patty has given you excellent advise here... I would add at this time however, since your ER/employER, is attempting to deny this claim, you may very well need an attorney...because...
      Do I need an attorney?

      You may represent yourself in WC proceedings, but a non-attorney cannot represent you. However, you should be aware that WC litigation is complex, and your employer or your employer’s insurance carrier will be represented by an experienced attorney. If you hire an attorney, you should discuss fee and cost arrangements. The fee agreement must be approved by a WC judge or the Workers’ Compensation Appeal Board. Your local Bar Association or the Pennsylvania Bar Association can help you find an attorney: (800) 692-7375.
      Unfortunately there is a waiting period for TTD benefits in PA. You must be unable to perform your job duties for 7 days...
      You must be disabled more than seven calendar days (including weekends) before WC payments for disability are payable. Benefits for time lost from work are payable on the eighth day after injury. Once you have been off work 14 days, you receive retroactive payment for the first seven days.
      As you are experiencing difficulty here...there are rules for resolution....
      What if there is a problem?

      If you think you haven’t received benefits due you, contact your employer or your employer’s insurance carrier. The insurance carrier is allowed 21 days from your notice to the employer of your disability to decide to accept or deny your claim or to make payments of temporary compensation for up to 90 days.

      Cooperative communication with your insurance carrier is recommended. If the problem is not resolved, it may be necessary for you to file a petition with the bureau. Forms can either be obtained through the Claims Information Helpline (800-482-2383) or filed online (www.dli.state.pa.us, Keyword: workers comp). The bureau is responsible for resolving disputes by assigning petitions to WC judges who decide each case after holding hearings on the issues.
      Your supervisors are totally in the wrong here. It is a medical decision whether you are unable to perform your job duties, not the ER. It is the ER duty to file the claim with their IC...and they will make the decision to accept/deny your claim for benefits under the ER's plan.

      When you see 'ER/IC', meaning 'employer/insurance company'... once the "ER' files the claim with their 'IC', the IC becomes the ER for the duration of your claim. The ER has very little say in the provision of your benefits.

      ER's are always trying to pull these stunts because they think there are limiting the increase in premiums for their coverage. What they are doing is discriminating/harrassing the IW, which is illegal.

      Unfortunately WC moves very slow. The benefits are limited, and treatment is not the same as you would expect under your personal health coverage.

      Go to the link Patty provided... read through the FAQ's, and come back with your questions. It will be easier to help you then...and, please contact a few attorneys who handle WC. You don't have to sign right away, and there is no fee for the consultation. IF there is a fee it would come at the end of your claim...and must be awarded through a judge. So don't worry about comming up with money now.

      I don't know that PA offers any type of state disability benefits, but if they do, you should apply for those now, and UI...as it would protect your date of entitlement to what ever benefits you may be eligible for.

      Good luck to you...

      Comment


      • #4
        Originally posted by CAIW View Post
        Unfortunately there is a waiting period for TTD benefits in PA. You must be unable to perform your job duties for 7 days...
        I don't mean to ask a dumb question but are you saying that if I am able to work then I don't qualify for WC or is that for something different?

        I've missed only a day and a half thus far due to it. I think I am able to continue working my regular schedule the Dr. didn't give me any restrictions except to not lift anything containing chemicals while the skin on my arm heals.

        Thanks to the both who helped it's greatly appreciated.

        Comment


        • #5
          If you don't miss 7 days of work, you are not eligible for wage replacement benefits.

          However, you still need to pursue this for reimbursement/payment of your medical costs for this injury.
          I don't respond to Private Messages unless the moderator specifically refers you to me for that purpose. Thank you.

          Comment


          • #6
            I'm a bit bummed that they won't reimburse the missed days but will definitely keep on it for the medical portion as I cannot afford the bill.

            One more question, sorry, but the WC will reimburse for continuous treatment right? Because the Dr. at the hospital said when he released me that it wasn't done and over with that I would have to be seen again and he said most likely by someone my employer suggests.

            Can I also take this up with the corporate office instead? Our store is such a mess right now due to lay offs and our main store manager has changed so much lately that perhaps going to corporate would be easier on all involved.

            Comment


            • #7
              Originally posted by FlyinHawk View Post
              I'm a bit bummed that they won't reimburse the missed days but will definitely keep on it for the medical portion as I cannot afford the bill.

              One more question, sorry, but the WC will reimburse for continuous treatment right? Because the Dr. at the hospital said when he released me that it wasn't done and over with that I would have to be seen again and he said most likely by someone my employer suggests.

              Can I also take this up with the corporate office instead? Our store is such a mess right now due to lay offs and our main store manager has changed so much lately that perhaps going to corporate would be easier on all involved.
              Yes, continuing treatment would also be covered. It's probably not a bad idea to go to corporate. Your manager is just wrong.
              I don't respond to Private Messages unless the moderator specifically refers you to me for that purpose. Thank you.

              Comment


              • #8
                You really need to read through the FAQ's for IW at the link Patty provided.
                It would be good, and important for you to know and understand how the WC system works, and what benefits you are entitled to under the law.

                FAQ's are here...http://www.dli.state.pa.us/landi/cwp...Q=58929#doctor. These will be a big help in answering your questions.

                There are circumstances where the ER/IC is permitted to provide a list of doctors to select from...
                Medical Care

                Employers are responsible for advising workers of their rights and duties under Section 306(f.1)(1)(i) of the Act (medical benefits). The written notice of these rights and duties is to be provided to the employee at the time of injury or as soon after the injury as is practicable.

                In the event of a work-related illness or injury, you are entitled, if covered under the Act, to the payment of related reasonable surgical and medical services rendered by a physician or other health care provider.

                Medicine, supplies, hospital treatment and services, orthopedic appliances, and prostheses are also covered for as long as they are needed. (To assure payment of medical services, see Choice of Doctor.) Even if you have lost no time from work, health care costs for a work-related injury or illness are payable at the fee schedule rate. However, an employee may not be charged the difference between the health care provider’s charge and the amount paid by the employer or its insurance carrier. In other words, there can be no "balance billing" to you.

                Choice of Doctor

                You are free to choose your own doctor unless the employer accepts your claim and has posted a list of six or more physicians or health care providers in your workplace, then you are required to visit one of them for initial treatment. You are to continue treatment with that provider or another on the list for a period of 90 days following the first visit. You may see any provider on the list; your employer may not require or direct you to any specific provider on the list.

                Comment


                • #9
                  Yes, please follow up with corp. Most of my managers deal with w/c 1-2 times per year and they are not well versed in the handling of the claims. On the other hand, when they call here, we can immediately give them the right answers.

                  However, I wouldn't seek representation at this point. I understand that CAIW is trying to protect you in the long run, but at this point, we are looking at a medical only claim with some relatively minor treatment and no real probability of TD. Additionally, you did report it ASAP and we all know those cans contain frostbite warnings. Your mechanism and description of injury all seems reasonable. To me, this is a no-brainer, I would accept compensibility and wish you well in your recovery.

                  Now if you filed a psyche claim on top of the frostbite??? That I would deny.

                  Comment


                  • #10
                    Just curious as to if the employer had the required toxic materials statements on file as required by OSHA (I can't remember what they're called). This is not my area of expertise though.
                    I don't respond to Private Messages unless the moderator specifically refers you to me for that purpose. Thank you.

                    Comment


                    • #11
                      Just curious as to if the employer had the required toxic materials statements on file as required by OSHA
                      MSDS--Material safety data sheets.

                      Good question. We have an 800-page MSDS book and have only had to use it once! Meanwhile, we have those books in over 400 locations!

                      This year, we will be converting to a PDF-file which should elimiate the huge book.

                      Comment


                      • #12
                        Thats why all our managers/supervisors are not allowed to discuss any WC issues or procedures (besides getting medical attention when needed). Like you mentioned earlier, they just do not have all the knowledge of dealing with it on a day to day basis.
                        Please call corporate, and make sure they get a copy of the accident report as well. You would be surprised how many "managers" do not report things in order to remain the "safest" division/department.
                        Good luck.

                        Comment


                        • #13
                          Material Safety Data Sheet might be required under SARA

                          Originally posted by FlyinHawk View Post
                          -Pennsylvania

                          Wednesday night at work a group of kids were in our store and attempted to steal a few cans of computer duster a co-worker spotted them and the kids ran out while dropping the cans they had on them causing 2 of the 5 cans to drop to the floor and explode.

                          After blocking off the aisle I went to clean up the mess that was made. Being totally unaware of what I was really cleaning up I went in unprepared, I seriously thought canned air was just that...air. As soon as I stuck the sponge in and tried to apply pellet chips I realized it wasn't just air, the sponge froze almost immediately and my arm and parts of my hand that were exposed were covered in a thin white layer of ice. I immediately got up and taped off the aisle completely and ran to the washroom to clean my hand and arm off. After a couple minutes of running it under the water I felt I was fine my fingers were red and parts of my arm as well. I wrote out an accident report and phoned it into another office to report as I was the only manager on at that time.

                          The following morning about 8 hours later I checked with the other manager on duty and told him about the report he asked if further medical assistance was needed and I declined saying I was fine. However, later into thursday I noticed something was very wrong my entire right arm & hand were numb tingling like your foot does when it falls asleep. I went to the ER shortly after and was told that it was frostbite. They treated me and kept me overnight due to being exposed to the chemicals. I missed work on thursday night and went in for work on friday, I spoke to the manager on duty first and told them I needed to file a WC claim but they stated that because I told 2 different managers that I was "fine" and failed to seek immediate medical assistance that I "waived" my right to utilizing WC.

                          I can't afford to miss that day I missed while being in the hospital and have no more sick days left to use, nor can I afford the hospital visit/stay and I have yet to pick up one of the medications simply cause I cannot afford it. I said I was fine at the time because I didn't know I was frostbitten nor was I aware of what I was even dealing with.

                          Do they have the right to deny filing with the WC insurance because I stated to two people I was fine when the effects didn't really kick in until hours later? I'm still feeling the effects of it.
                          Your employer should have been required to conduct safety meeting and training of various hazards in your workplace. Material safety data sheets might be required to be available for review by all employees under SARA and for emergencies. You should have received a Material Data Safety Sheet for the computer dust cleaner and other chemicals sold by the store that disclosed the name of the active ingredient. The material safety data sheet (MSDS) would have told you whether the material was flammable, corrosive, an oxidizer, and/or hazardous. Also, the material safety data sheet would have told you what type of protective protection was required such as safety glasses, gloves, face shield, and/or respirator. In addition, the MSDS would have told you the steps to take if you was exposed and what reactions to expect from the dust cleaner.

                          Your employer should review their safety program and training. A good manager might not be so hard with you about the time you missed from work. If you have further complications, the goodwill might be in the best interest of the company. The managers who asked you were you fine were not fimilar with the MSDS for the dust cleaner either. You should have been sent directly to the hospital been exposed to the material. In fact, you might have been stop from cleaning up the mess if someone was familiar with the MSDS. Your company probably would have been facing a lawsuit if the right customer had been exposed.
                          Last edited by DrumMajorChange; 04-06-2009, 05:19 PM.
                          I am not an attorney. My personal opinions are not legal advice.

                          "The only thing we have to fear is fear itself." --- Franklin Roosevelt

                          The ultimate measure of a man is not where he stands in moments of comfort and convenience, but where he stands at times of challenge and controversy. --- Martin Luther King Jr.

                          A trap was set once upon a time; however, the designer fell in himself!!

                          Comment


                          • #14
                            , I wouldn't seek representation at this point....
                            ...we all know those cans contain frostbite warnings
                            I'm afraid I have to take exception with your opinion at this point HR...this EE took the steps to clean up a mess left by kids robbing the store...and in the process sustained a severe injury to the upper extremities...to assume we have ''we are looking at a medical only claim with some relatively minor treatment'' isn't fair to this IW.
                            [QUOTE]
                            later into thursday I noticed something was very wrong my entire right arm & hand were numb tingling like your foot does when it falls asleep. I went to the ER shortly after and was told that it was frostbite. They treated me and kept me overnight due to being exposed to the chemicals.[/QUOTE]
                            While 'frostbite' may appear to be minimal on the surface, there are many people, Marines come to mind, that have lost digits due to frostbite, and are currently receiving disability benefits from the Federal Govn't.

                            On top of chemical exposure, I imagine if I were the HR/Dist mgr, I'd be somewhat more concerned with that chemical exposure being added to the claim, as well as the possibility of a 'psych' claim...It's nice however to have a defense point of view.

                            This year, we will be converting to a PDF-file which should elimiate the huge book.
                            I can't see that PDF-file releiving any ER of the OSHA or State mandate of workplace posters...

                            I'm wondering now IF this ER had the required Workers Compensation posters in place...at the least the supervisors would have reference to the process.

                            FlyinHawk, once the claim is filed by the ER with their IC... there is no need for additional conversation with this corporate office, but for the relaying of information regarding any restrictions you may have, and your eventual return to work.

                            Comment


                            • #15
                              Thank you for all the responses. I faxed over all the paperwork and medical papers along with photos for corporate like they asked and said I will get a call in the next day or so. They were a lot more prepared to handle the situation than the manager we currently have.

                              If they try to deny it I will just stop in at midpenn legal and get help from there to further it along.

                              They don't train any of us managers nor employees about safety with the chemicals in the store I guess they figure common sense would cover it. And I admit my stupidity on cleaning it up without really seeing what I was dealing with. I have placed a sign near the cleaning supplies to read the labels before you clean something up.

                              I'm not looking to hurt my company at all just really want the medical bills paid. The Dr. did state that my prognosis is good as most the areas have already started to blister and the fluid is clear. But surgery may be needed later down the line for one of the spots to remove the dead skin as it's already turned purple.

                              I've also printed out the FAQ from PA's website and have also placed a copy in the employee break room. If the managers don't care to know what they're doing the employees need to.

                              Thanks again for all the help with this, it's appreciated.

                              Comment

                              The LaborLawTalk.com forum is intended for informational use only and should not be relied upon and is not a substitute for legal advice. The information contained on LaborLawTalk.com are opinions and suggestions of members and is not a representation of the opinions of LaborLawTalk.com. LaborLawTalk.com does not warrant or vouch for the accuracy, completeness or usefulness of any postings or the qualifications of any person responding. Please consult a legal expert or seek the services of an attorney in your area for more accuracy on your specific situation.
                              Working...
                              X