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  • Wrist injury to workers compensation California

    I have a wrist injury that is aggravated by the type of work I do. I have surgery thru my regular doctor scheduled for next week. My boss is denying the time off for surgery and has told me to reschedule for next year. If this is put off, it will be several months before I can schedule the time to do this as I am a single mom and don't have the at home support. As the injury is aggravated by work, am I legally able to take this to worker's comp to get addressed and fixed?

  • #2
    You can report it as a workers comp claim. The workers comp carrier will determine if it is covered or not.
    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
      Also see http://www.laborlawtalk.com/showthread.php?t=243145
      Too often we underestimate the power of a touch, a smile, a kind word, a listening ear, an honest compliment, or the smallest act of caring, all of which have the potential to turn a life around. Leo Buscaglia

      Live in peace with animals. Animals bring love to our hearts and warmth to our souls.

      Comment


      • #4
        You should know that if you have been treating and have a surgery scheduled, the doctor likely doesn't believe (based on what you have told him/her) it is work related. When you report your claim, the IC will likely delay your claim until it can determine if this is work related. It make take 3-6 mos to get your surgery approved, IF it is determined to be work related.

        Disputes like this are generally decided by medical opinion. It does not bode well that your current doctor is treating on a non-industrial basis; it is going to have to be a hurdle you will have to overcome.

        If it was work-related, you should have filed it as such in the first place. If you are trying to get back at your boss for not authorizing the time off, this is a bad way to do it. Like mentioned in a previous thread, you have an obligation to schedule your surgery where it would provide the least impact on your employer. Of course, that obligation should not be at the expense of your health.

        Comment


        • #5
          If your treating physician feels this is a work related injury, HE is required to report the injury, and NOT bill you or your personal health coverage provider.
          It is illegal for the Dr to bill you for treatment to a industrial injury.

          You are required, by law, to report your injury as soon as you have knowledge of this being related to your job duties. Your employER has the right, again under the law, to control the medical costs of the claim through the use of MTUS/ACOEM treatment guides, UR process, and requiring you to select a Dr in their MPN/Medical Provider Network.

          Generally speaking, it's not up to you to schedule treatment for your work injury, Workers Compensation is a law, not a benefit. Your ER is the insured party, not you or your injury. WC is intended to provide you with treatment as expediciously as possible, and get you back to functional restoration, and gainful employment as soon as possible.
          I have a wrist injury that is aggravated by the type of work I do.
          So, the injury itself is not related to your job duties ?
          If that's the case... I don't believe you have a claim for WC benefits. Because, you should not be performing job duties that are outside any restrictions you may have due to your non industrial injury.

          My boss is denying the time off for surgery and has told me to reschedule for next year. If this is put off, it will be several months before I can schedule the time to do this as I am a single mom and don't have the at home support.
          As far as I know, there is not law that requires your ER to provide you with the time off... UNLESS you are eligible for FMAL leave...
          As the injury is aggravated by work, am I legally able to take this to worker's comp to get addressed and fixed?
          If you have a pre exsisting condition that is re injured, or aggreviated by your job duties...that can be a compensable consequence... but as I said above, IF you have an ''injury'' that is non industrial, and you are performing job functions that are outside any restrictions you may have... it's difficult to claim your ER as liable for the treatment to that injury.

          I'm pretty sure what you are asking about accomplishing here... I'm not sure it's a valid claim. (based on the info you are providing)

          Comment


          • #6
            I wish there was some good advice to offer you on ANY workers comp injury, the bottom line is the workers comp laws as they stand in most states are not to the benefit of the injured, but to the employer and insurance carrier.

            Time and again you can read the night mares that occur with workers comp injuries and the night mare claims process.

            In your instance as others have done knowing the process is never in your favor people have resorted to using their OWN health care providers and insurance and actually LYING saying it is NOT a work place injury or anything to do with such because they are MARKED for life after as well as the serious games they play with the victim who has been injured, even seriously injured employees have this occur.

            It truly is the most tainted system there is in my opinion. There are FEW who abuse this system, however the majority are legit and the FEW that did taint the system did not make this system fail as it has, it is the system itself to benefit the carrier and employer.

            Just my opinion.

            Best wishes to you and happy holiday's !

            Comment


            • #7
              You are correct in your opinions of the WC system. Nation wide there are difficulties.

              However, in your assumption there are 'few' who abuse the system, IMHO, you're a bit off the mark. Unfortunately, there are many more than what are actually reported, or heard of. For the most part, again IMHO, employers are much more guilty of committing fraud in the WC system than the employees/injured workers. The biggest 'fraud' ER's commit is the under reporting of their payroll. WC premiums are based on a $100 wage structure. There are hundreds of job classifications... ER's are prone to misclassifying their EE's with the goal of reducing those premiums.
              I can tell you of more than one personal experience where the ER paid minimum wage on all EE's, and handed cash on Friday/payday to compensate for the 'reduced' earnings. A much lower comp premium was the end result.

              A recent case in So Calif a ER was arrested/charged with fraud against SCIF to the tune of about $1.2 million over the course of just a few years in premium fraud. A ''temp'' agency if I recall.
              You don't hear about the providers/ER's who commit these crimes because there isn't enough money in them for the Dist Attys to prosecute but the biggest of the bunch.
              You don't see the media taking up the cause of IW's because there isn't that much interest. Oprah won't get involved.

              Dr/Chiro's were, prior to the changes of April 2004, some of the biggest comp scammers, and, Dr's who Rx/fill in their offices. The tens of 1000's of unnecessary chiro visits, PT/OT that were Rx'd was inconceivable. The IC's participated there too... CA's were demanding more than one or two courses of PT before a MRI was done to determine surgical necessity. No one is exempt from misuse of the ''convsertive'' treatment approach.

              The biggest misconceptions of WC as a whole is that of what benefits are available, and maybe more importantly what is not available to the IW. And, because the word ''insurance'' in included here, IW's think that medical benefits are included much the same as under their own coverage, or the GHP provide by the ER's. Compound that with a general ignorance of the WC system overall...and you end up with a lot of angry, disgruntled IW's all over the country.

              No one looks to the day they suffer a industrial injury/illness. Why should an EE be aware of the system and what is offered. Why would the general public pay any attention to the information offered during an election year and the potential changes to the system by the IC lobbys, or Chamber of Commerce ?
              Why do those entities spend so much money ''educating'' the public to the IW's and their ill gotten gains by manulipitating the system ?
              The general public, the voters, know next to nothing about the WC system. The media only provides a portrayal of the IW who is committing the scam/fraud against the ER's and IC's. That way they get the legislation passed in favor of the EE/IC's and ''big business''. That alone was the biggest issue Arnold ran on in his first run for office in ousting his Democratic predecessor. Giving too much in benefits, too much in PPD indemnity awards was going to kill business in Calif. That scam is now coming back to bite those in business in the ***... WC premiums are going higher and higher each year since those SB899 changes and massive reductions, yes, in benefits and premiums. The IW"s got screwed, and now the ER's are getting the same, from the very IC's who said ''trust me''.
              people have resorted to using their OWN health care providers and insurance and actually LYING saying it is NOT a work place injury or anything to do with such
              True. And, that too is fraud against an insurance company. Lying with the intent of receiving benefits you know you are not entitled to is fraud.

              The laws do need to swing back to the middle. There has to be equity for all the parties in a claim. You do that by going after the elected representatives. Those are the people who did this. Those are the people who are taking the IC lobby dollars and selling their souls for a seat in the state house. The public is charged with complacency, and a general misinterest in anything relative to workers compensation...UNTIL they need the benefits.

              Unfortunately this nation has become used to a ''cradle to grave'' mentality. Once you have a job, that employer is responsible for everything that happens to you from that first day you punch the clock. Right up to and including the day you die.

              Workers compensation is not a 'benefit', its' a law. The EE/IW is not the insured party, the ER is. IW's are simply receiving the benefits being provided. The sad thing about all this is IF there were no law, ER's would not stand up and provide those benefits voluntarily... EE's would not buy STD/LTD wage loss benefits on their own...nor would EE's buy health coverage.

              If you want change... VOTE.
              Workers compensation is just as important an issue as the economy, health care reform, the war's in the Middle East, and IMHO...more important than same sex marriage (!)

              This rant could go way past the number of key strokes this board allows... so from me/mine too...HAPPY HOLIDAYS.

              Comment


              • #8
                While I agree with part of the last answer, I am going to do a minimal oppositional response.
                - My last 4 employers were all based in CA, and pretty large. We did not ever pay wages in cash. We were audited like clockwork by worker compensation auditors. All four employers used ADP and the first thing that all auditors did was to look at the ADP YTD QTD register. Wage under reporting was an issue with any of these firms.
                - Interesting wage over reporting was an issue. In CA, the overtime premium was not considered WC wages, something that the auditors would not mention if not asked. Senior executive compensation tends to cap at a certain point, something also not mentioned if not asked. Worse, we were in 20+ states for most of these employers, meaning that we had to create custom WC reports using each states specific WC wage definition (different for most states of course). We had to figure out exactly which information each auditor needed, start with ADP gross wages, then back out all non-wage categories to determine the actual WC wage as defined by law. Fortunately, do this once, and you can keep using the same report definition. And while auditors would prefer to just use gross wages (so they can over collect WC fees), I have never meet one who would not use the right numbers if you could show that you knew what you were doing.
                - The category classification is interesting. While there are indeed hundreds of categories defined, I have never worked for an employer who used more then 5. Employers who only used 3 categories were more common. Example, manufacturing companies I worked for used Factory (7%), Administrative (1%) and Outside Sales (6%). Most employees are darn obvious which category they belong in. The questionable people are (for example) things like office clerks who have to walk through the factory. HR would argue that everyone was Administrative (cheap rate). The WC auditor would argue that everyone who every went in or near the factory or had ever heard of the factory was Factory. I had clerks who sole factory experience was walking 6 feet into the factory to get time cards from a door clock. The door clocks are a good 100 feet from anything OSHA would consider remotely dangerous, but WC auditors will argue that picking up the time cards once a week makes the clerk a Factory worker. Of course, all parties go to this dance every few years, and after some ceremonial posturing, they meet somewhere in the middle, same as always.

                Now none of these were "bad employers". They paid employees on time. They *****ed and whined but mostly tried to follow the law. There are indeed bad employers out there. If someone doesn't pay minimum wage or overtime, why would anyone expect them to not also try to cheat on WC.
                "Reality is that which, when you stop believing in it, doesn't go away".
                Philip K. **** (1928-1982)

                Comment


                • #9
                  Originally posted by CAIW View Post
                  You are correct in your opinions of the WC system. Nation wide there are difficulties.

                  However, in your assumption there are 'few' who abuse the system, IMHO, you're a bit off the mark. Unfortunately, there are many more than what are actually reported, or heard of. For the most part, again IMHO, employers are much more guilty of committing fraud in the WC system than the employees/injured workers. The biggest 'fraud' ER's commit is the under reporting of their payroll. WC premiums are based on a $100 wage structure. There are hundreds of job classifications... ER's are prone to misclassifying their EE's with the goal of reducing those premiums.
                  I can tell you of more than one personal experience where the ER paid minimum wage on all EE's, and handed cash on Friday/payday to compensate for the 'reduced' earnings. A much lower comp premium was the end result.

                  A recent case in So Calif a ER was arrested/charged with fraud against SCIF to the tune of about $1.2 million over the course of just a few years in premium fraud. A ''temp'' agency if I recall.
                  You don't hear about the providers/ER's who commit these crimes because there isn't enough money in them for the Dist Attys to prosecute but the biggest of the bunch.
                  You don't see the media taking up the cause of IW's because there isn't that much interest. Oprah won't get involved.

                  Dr/Chiro's were, prior to the changes of April 2004, some of the biggest comp scammers, and, Dr's who Rx/fill in their offices. The tens of 1000's of unnecessary chiro visits, PT/OT that were Rx'd was inconceivable. The IC's participated there too... CA's were demanding more than one or two courses of PT before a MRI was done to determine surgical necessity. No one is exempt from misuse of the ''convsertive'' treatment approach.

                  The biggest misconceptions of WC as a whole is that of what benefits are available, and maybe more importantly what is not available to the IW. And, because the word ''insurance'' in included here, IW's think that medical benefits are included much the same as under their own coverage, or the GHP provide by the ER's. Compound that with a general ignorance of the WC system overall...and you end up with a lot of angry, disgruntled IW's all over the country.

                  No one looks to the day they suffer a industrial injury/illness. Why should an EE be aware of the system and what is offered. Why would the general public pay any attention to the information offered during an election year and the potential changes to the system by the IC lobbys, or Chamber of Commerce ?
                  Why do those entities spend so much money ''educating'' the public to the IW's and their ill gotten gains by manulipitating the system ?
                  The general public, the voters, know next to nothing about the WC system. The media only provides a portrayal of the IW who is committing the scam/fraud against the ER's and IC's. That way they get the legislation passed in favor of the EE/IC's and ''big business''. That alone was the biggest issue Arnold ran on in his first run for office in ousting his Democratic predecessor. Giving too much in benefits, too much in PPD indemnity awards was going to kill business in Calif. That scam is now coming back to bite those in business in the ***... WC premiums are going higher and higher each year since those SB899 changes and massive reductions, yes, in benefits and premiums. The IW"s got screwed, and now the ER's are getting the same, from the very IC's who said ''trust me''.
                  True. And, that too is fraud against an insurance company. Lying with the intent of receiving benefits you know you are not entitled to is fraud.

                  The laws do need to swing back to the middle. There has to be equity for all the parties in a claim. You do that by going after the elected representatives. Those are the people who did this. Those are the people who are taking the IC lobby dollars and selling their souls for a seat in the state house. The public is charged with complacency, and a general misinterest in anything relative to workers compensation...UNTIL they need the benefits.

                  Unfortunately this nation has become used to a ''cradle to grave'' mentality. Once you have a job, that employer is responsible for everything that happens to you from that first day you punch the clock. Right up to and including the day you die.

                  Workers compensation is not a 'benefit', its' a law. The EE/IW is not the insured party, the ER is. IW's are simply receiving the benefits being provided. The sad thing about all this is IF there were no law, ER's would not stand up and provide those benefits voluntarily... EE's would not buy STD/LTD wage loss benefits on their own...nor would EE's buy health coverage.

                  If you want change... VOTE.
                  Workers compensation is just as important an issue as the economy, health care reform, the war's in the Middle East, and IMHO...more important than same sex marriage (!)

                  This rant could go way past the number of key strokes this board allows... so from me/mine too...HAPPY HOLIDAYS.
                  Appreciate your opinions and I agree.


                  You did point out that injured workers who use their own health insurance and lie about their injury is fraud. I SEE where that it fraud, but its SAD when an injured worker must do so.

                  That employee pays from their earnings at work for health insurance and should be ABLE to use it for such in ANY circumstance. As we SEE how the Workers comp madness unfolds these people are aware and want no PART of that CORRUPT system, a system that will bring them down at a time they least need it, being injured down and out. So they try and protect themselves in some way and try to use their own health insurance that THEY PAID for.

                  As you also said its NOT the employee who is INSURED it is the EMPLOYER, you could not have said that better! That is a real eye opener.

                  You are right we do need to vote, we do need to speak up, sadly though the system has been corrupt so long and so many hands in the pot it seems futile, we need OBAMA to step in on this, certainly THIS is more important then trying to make changes for same sex marriage, how how true.

                  Their are Doctors involved in this corruption too though and on the other side of the scale then what you mentioned. There are doctors out there who ignore and deny serious injury even when the diagnostic tests prove serious injury and let nerve damage and devastation ensue, deny patients need surgery ( WHAT could be in it for them to proceed in this manner) Its in contrasts to one scenario you pointed out where Doctors are ordering and doing TOO much, just want to touch on those that will do and say nothing to help the patient when clearly diagnostic tests contradict their opinion. the problem comes in because once these workers are in the hands of THOSE Doctors, the injured only have at times a one change in physician and even their one time change ends up with the same type Doctor who is working for the insured ( employer) and will say all they can to deny any injury.

                  It happens more then anyone can imagine and it is fraud and mal practice in my opinion. Thank you again for your comments, they were right on!

                  Comment


                  • #10
                    ...we need OBAMA to step in on this, ...
                    No..we do not need Obama, or any other administration to step in on WC. Insurance, and WC particularly are STATE issues. Getting the Federal Gov't involved would be next to the worst thing to happen.
                    The worst being to have the system, such as it is, be terminated completely.

                    That being said however, where do you think IW"s would be with out the benefits provided by WC ?
                    I'd like to hear your/anyones take on that....
                    That employee pays from their earnings at work for health insurance and should be ABLE to use it for such in ANY circumstance
                    Not always.... ER's provide GHP/Group Health Plans. There may be a basic coverage, and if the EE's opt for additional, or family coverage, then of cousre they should pay their share of the cost.
                    Why is it the responsibility of the employer to provide health coverage?
                    Actually I'll answer that for you... because if the ER paid the EE for the GHP cost, the EE would NOT use that money to buy health insurance, but rather buy a bigger 'hog'. You cann't trust anybody to step up to the plate and take care of their own responsibility. That's one of the reasons congress is mandating everyone to buy health ins. just like liability for auto ins. That's the cradle to grave mentality...let the ER/someone else pay for coverage.
                    Its in contrasts to one scenario you pointed out where Doctors are ordering and doing TOO much, just want to touch on those that will do and say nothing to help the patient when clearly diagnostic tests contradict their opinion. the problem comes in because once these workers are in the hands of THOSE Doctors, the injured only have at times a one change in physician and even their one time change ends up with the same type Doctor who is working for the insured ( employer) and will say all they can to deny any injury.
                    It's not about what is diagnosed...you're still thinking of WC medical in the same manner as your personal coverage. It's not.
                    The isssue is whether or not what those test show are related to the job injury, and treatment is reasonable on a industrial basis. There may very well be a need for surgery... but IS the ER/IC liable ? No one denies there may be medical problems. In many states there are occupational/industrial medical treatment guides. Not all treatment in WC is avaliable as it might be under your own coverage. When you are paying the bills, you can have whatever treatment you want. You ask someone else to pay... there are going to be limitations.

                    WC is a trade off...in exchage for immediate treatment and wage loss benefits while you treat/recover, and a pre determined settlement/award for permenant impairment due to the injury, IW's give up the right to sue the ER in civil/tort actions.

                    Without WC, there would be no treatment, remember your GHP isn't going to pay. No wage loss benefits...unless you/EE buys the coverage, and remember you can't trust the EE's to do that. And getting to court, to prove the ER is at fault, and liable for all those costs could take years. Only to find another EE/IW got in front of you and though their settlement/award by a jury... the ER went broke and there is no money to pay you. (that's the answer to my question above) The reason there is a comp system in the first place is because you cannot trust a employer to step up to the plate and voluntarily pay those bills, or buy insurance to cover their ***.

                    Once again, much like your own auto, home, health coverage... someone, or some law has to demand it... because people can be trusted to do it on their own.

                    Comment


                    • #11
                      Originally posted by CAIW View Post
                      No..we do not need Obama, or any other administration to step in on WC. Insurance, and WC particularly are STATE issues. Getting the Federal Gov't involved would be next to the worst thing to happen.
                      The worst being to have the system, such as it is, be terminated completely.

                      That being said however, where do you think IW"s would be with out the benefits provided by WC ?
                      I'd like to hear your/anyones take on that....
                      Not always.... ER's provide GHP/Group Health Plans. There may be a basic coverage, and if the EE's opt for additional, or family coverage, then of cousre they should pay their share of the cost.
                      Why is it the responsibility of the employer to provide health coverage?
                      Actually I'll answer that for you... because if the ER paid the EE for the GHP cost, the EE would NOT use that money to buy health insurance, but rather buy a bigger 'hog'. You cann't trust anybody to step up to the plate and take care of their own responsibility. That's one of the reasons congress is mandating everyone to buy health ins. just like liability for auto ins. That's the cradle to grave mentality...let the ER/someone else pay for coverage.
                      It's not about what is diagnosed...you're still thinking of WC medical in the same manner as your personal coverage. It's not.
                      The isssue is whether or not what those test show are related to the job injury, and treatment is reasonable on a industrial basis. There may very well be a need for surgery... but IS the ER/IC liable ? No one denies there may be medical problems. In many states there are occupational/industrial medical treatment guides. Not all treatment in WC is avaliable as it might be under your own coverage. When you are paying the bills, you can have whatever treatment you want. You ask someone else to pay... there are going to be limitations.

                      WC is a trade off...in exchage for immediate treatment and wage loss benefits while you treat/recover, and a pre determined settlement/award for permenant impairment due to the injury, IW's give up the right to sue the ER in civil/tort actions.

                      Without WC, there would be no treatment, remember your GHP isn't going to pay. No wage loss benefits...unless you/EE buys the coverage, and remember you can't trust the EE's to do that. And getting to court, to prove the ER is at fault, and liable for all those costs could take years. Only to find another EE/IW got in front of you and though their settlement/award by a jury... the ER went broke and there is no money to pay you. (that's the answer to my question above) The reason there is a comp system in the first place is because you cannot trust a employer to step up to the plate and voluntarily pay those bills, or buy insurance to cover their ***.

                      Once again, much like your own auto, home, health coverage... someone, or some law has to demand it... because people can be trusted to do it on their own.
                      Where is the ANSWER: it appears no one has a solution, so it needs chipped away at piece by piece I suppose.

                      Self insured entities have made health care insurance a business, and a profitable one. When health care reform is being talked of to reform it, self insured entities ( ie) huge hospital Co's who are non profit started screaming that they would go UNDER IF their employees opted to take the STATE plan instead of what they currently elected under their employers self insured plan. IF it were not profitable to them, they would not have cared, IF there were no money in it for them, they would have gladly handed over the responsibility to the employee to look out for their OWN interest in seeking health care benefits, but this is NOT the case and so the self insured entities are screaming ( no one screams STOP if there is NOT a profit being made).


                      When you speak of employers being responsible to provide HCB and WHY should they, it sounds like you think there is nothing in it for them and I can not agree with that.

                      Also you make is seem as though those who opt and elect benefits under an employer plan get this for FREE. This is NOT the case either, it is costly, it comes from the paychecks that are earned from the employee, granted unless you are under a plan as an individual where you took out a policy with out group coverage it is much more costly and MOST can't afford that, so to have a health care plan provided at a group rate is great for the employee, but in turn it is GREAT for the large self insured employer. It has become an insurance business for them and a profitable one with all the same RED TAPE and ROAD BLOCKS other insurance companies who are in the business to make a profit.


                      As far as the Workers comp go and what would happen if there was none? Who knows, but perhaps EACH individual would be covered under some other policy that you could purchase as well, SUCH AS AUTO insurance with PIP included. You get hurt at work, you use the PIP to pay wage loss, if there is negligence involved, take it to court. You claim that with out Workers comp insurance this stuff would be tied up in court for years.... ( IT ALREADY IS !) And it it never to the benefit of the injured because of the corrupt laws set in place to protect EVERYONE BUT the injured worker.

                      Yes I believe ALL should have the option to to self insure for ALL work injuries or any other injury with a PIP type benefit to pay wage loss and medical care and IF negligence comes into play then grant the right to SUE the company for such injury and going further OSHA should be revamped to do the JOB they were set out to do and make it a LAW to have every protection in place, such as ergonomics and more and when OSHA does not do THAT job properly sue them too.


                      Workers Comp is failing miserably as it IS and I see no END in sight.

                      I feel that it is against humans constitutional rights to ALLOW ANY ENTITY TO DICTATE ones health care when there is SO MUCH fraud and corruption involved. A human being should have the RIGHT to seek medical care from ANY provider they so choose and have the RIGHT to purchase a personal protection plan, similar to AUTO insurance, and again fears that these things would be tied up in court? I do not agree as the Workers Comp system is tied up in court for years anyway debating every loop hole the corrupt system has in place anyway.

                      Worst yet employees who are seriously injured may never be able to work again, have their lives and those of their families destroyed with out one ounce of recourse in their favor...this is a trade off?

                      I think their should be a mandatory course for each employee in any job to teach them the truth about workers comp injuries and have the option to purchase their OWN protection and see what option they so choose.


                      This could go on and on and I have not even touched on the heart of it.

                      Comment


                      • #12
                        I think their should be a mandatory course for each employee in any job to teach them the truth about workers comp injuries and have the option to purchase their OWN protection and see what option they so choose.
                        It is mandatory in Calif that EE's be told what to do if there is injury, were to file, where to seek treatment, it's all there. And ER's suffer the consequences when they don't do the info seminars.
                        They lose the opportunity to require treatment in the MPN.

                        As to your other suggesting of EE's buying their own coverage... THEY CAN... the problem is THEY DON"T. Ever hear of STD/LTD insurance... thats' what it's for.

                        And don't kid yourself, there is no self insured employer making money off providing health care, or work comp benefits. It is not a money making proposition. Money saving possibly, but certainly no profit.
                        I feel that it is against humans constitutional rights to ALLOW ANY ENTITY TO DICTATE ones health care when there is SO MUCH fraud and corruption involved. A human being should have the RIGHT to seek medical care from ANY provider they so choose and have the RIGHT to purchase a personal protection plan, similar to AUTO insurance, and again fears that these things would be tied up in court? I do not agree as the Workers Comp system is tied up in court for years anyway debating every loop hole the corrupt system has in place anyway.
                        And you are free to seek treatment from ANY physician you like... that option is always there... just pay the premiums for that coverage. When you want low cost, or 'free' health coverage from your ER...you take what is offered.
                        When you pay out of pocket, you can have anything you like.
                        WC isn't failing anyone... benefits are being provided as the law demands.

                        It would be much more difficult to just pay the medical costs for whatever the Dr/IW want, then go back and see what was ''medically necessary'', on a industrial basis. WC simply does not, and cannot work that way. You never get everything you want... (unless once again, you are paying the bills.)

                        Medical treatment in this country is not a right or entitlement, it's a fee for service just like having your house cleaned or car engine worked on. Medicine is a business just like any other that provides a service. We have come to expect it because it's not a "DIY" project.

                        Those people who see this as a corrupt system... are those who have had their demands for benefits denied because the injury has been found to be non-industrial. When you ask someone else to pay the bills, you are going to experience resistance.

                        But, this thread isn't about health care reform or GHP's or buying your own health care coverage...it's about WC in California...and that remains a law not a benefit. You won't change that until you change the state legislature.

                        Comment


                        • #13
                          Originally posted by CAIW View Post
                          It is mandatory in Calif that EE's be told what to do if there is injury, were to file, where to seek treatment, it's all there. And ER's suffer the consequences when they don't do the info seminars.
                          They lose the opportunity to require treatment in the MPN.

                          As to your other suggesting of EE's buying their own coverage... THEY CAN... the problem is THEY DON"T. Ever hear of STD/LTD insurance... thats' what it's for.


                          Of course I have heard of it, but STD/LTD is NOT for a workers comp injury, most STD/LTD have work injuries EXCLUDED, if there is a dispute that it is a work place injury there is a BATTLE as to WHO is responsible for paying the wage loss protected by either the STD or workers comp benefit, and AGAIN the injured are who suffer from the battle that ensues. And YES employees DO take out these policies ( how many who knows, but they DO and you can best believe it will become a battle.

                          And don't kid yourself, there is no self insured employer making money off providing health care, or work comp benefits. It is not a money making proposition. Money saving possibly, but certainly no profit.

                          No I would never kid myself, I KNOW there is money being made off the health care premiums large self insured Hospitals offer their employees and the policy premiums that are deducted from their paychecks, these self insured HOSPITALS turn themselves into an insurance company and there is profit, trust me, or why else would these self insured entities speak out and protest,claim they will go under IF the health care reform act goes through and their employees no longer get their coverage from them, please, it is more then obvious. IN FACT any entity that starts protesting has a $$$ backed reason for doing so, please I would never kid myself or anyone else.

                          And you are free to seek treatment from ANY physician you like... that option is always there... just pay the premiums for that coverage. When you want low cost, or 'free' health coverage from your ER...you take what is offered.
                          When you pay out of pocket, you can have anything you like.
                          WC isn't failing anyone... benefits are being provided as the law demands.


                          [b] WRONG WC law dictates WHO WHAT AND WHEN you SEE a Doctor , you can NOT use the private health insurance you pay for EVER if it is a work place injury and even if its in question there are laws on WHAT Doctor to seek treatment from, meaning you MUST only use their choice, some states have more choices, some have a ONE time change through the LIFE of the injury and even THAT one time change of Doctor is the insureds CHOICE, not the injured, not the injured who pays for health care insurance, because YOU CAN NOT USE IT once there is a dispute whether an injury or illness may be work related.[b]

                          It would be much more difficult to just pay the medical costs for whatever the Dr/IW want, then go back and see what was ''medically necessary'', on a industrial basis. WC simply does not, and cannot work that way. You never get everything you want... (unless once again, you are paying the bills.)


                          So an injured worker who pays health care premiums does not pay a sum of money to have that medical coverage? Of course they DO, the PROBLEM is if its a work place injury or even in question you can not use your own health insurance. So even though you do PAY the bills WC dictates you and this is what should be against humans constitutional rights, its absurd!

                          Medical treatment in this country is not a right or entitlement, it's a fee for service just like having your house cleaned or car engine worked on. Medicine is a business just like any other that provides a service. We have come to expect it because it's not a "DIY" project.

                          Those people who see this as a corrupt system... are those who have had their demands for benefits denied because the injury has been found to be non-industrial. When you ask someone else to pay the bills, you are going to experience resistance.

                          That is NOT TRUE, there are MANY who have been injured and LIED about where their injury occurred because they do not WANT to use the workers comp system,but their OWN health insurance that THEY pay the premiums for because the system is so corrupt and they KNOW it. So this is in total contrast to what you are stating. Have you been there and done it to see just how it works, please research and SEE what is really going on, it is just as I have said.

                          But, this thread isn't about health care reform or GHP's or buying your own health care coverage...it's about WC in California...and that remains a law not a benefit. You won't change that until you change the state legislature.

                          Nothing will change this world of corruption, but GOOD people with no motive just trying to HELP OTHERS, but the motive of the corporations has another agenda and its always backed by $ and power, once the money is no longer of issue it is the POWER seeking that corrupts. The people who want to speak out for the people with no motive other then to HELP are those unheard, for the the OTHERS, with the different agenda there is nothing in it for them.....the greedy that are seeking $ or power, whichever the case may be, very sad indeed...thank you for sharing your thoughts.
                          Last edited by LETC; 12-26-2009, 09:46 AM.

                          Comment


                          • #14
                            It is always difficult to discuss any issue with someone who takes a few words or a sentence here and there and misconstures it for the sake of arguement... which is appearantly your process in attempting to get your point across with out taking into consideration what I have said.

                            You can and some EE do, purchase STD/LTD policies that DO cover work related injuries... and there is a premium to be paid.
                            You can purchase any kind of insurance you like. But most don't.

                            Nothing will change this world of corruption, but GOOD people with no motive just trying to HELP OTHERS, but the motive of the corporations has another agenda and its always backed by $ and power,
                            Ya know, that thought process is not worth even taking into consideration. That is NOT going to happen, ever. Everything you do, yes, you, do every day is relative to money. There is nothing that is not relative to money in some form or another. That is what every system is based on... how can you place any value of anything without taking into consideration the value of a dollar. And I'm not talking about charity work.
                            You would never think of going to work for a week out wages out of the sheer consideration of your ER's financial situation. It's not going to happen. To think that WC is ever going to be thought of on a humanitarin basis is delusional.

                            If you want think of WC as being 'corrupt' in the true sense of the word, ''utterly broken'', then I can possibly agree with you. I do not agree that there is 'corruption'' in the meaning you are declaring here.

                            I'm sorry you are not understanding the seperation of WC and your personal health care...or how the issue of liability is the issue as to why IW's cannot use their own coverage. I can't explain that any clearer than I have, so I'll leave it at that.
                            Nothing will change this world of corruption, but GOOD people with no motive just trying to HELP OTHERS, but the motive of the corporations has another agenda and its always backed by $ and power, once the money is no longer of issue it is the POWER seeking that corrupts. The people who want to speak out for the people with no motive other then to HELP are those unheard, for the the OTHERS, with the different agenda there is nothing in it for them.....the greedy that are seeking $ or power, whichever the case may be, very sad indeed...thank you for sharing your thoughts.
                            Im sorry, you wouldn't do away with your 'corruption' in a fully socialistic society. Unbelieveable...what possible 'power' is there in health insurance, or the WC system... power, indeed.
                            Now that you've taken this off in a whole different thought process, similar to a ''tree hugger'' or save the whales.. I'm done. Sorry.

                            Comment


                            • #15
                              I did hear you out, you didn't hear me out. I am a tree hugger and more and I would do just about anything, WITHOUT money being involved for the good of human kind.

                              What you accused me of, you are guilty of as well, but note I did hear you out and you refuse to believe what I have stated and what I have stated is true, research some injured workers plights, you will it too, maybe you would get upset, maybe not; it depends on what is the motivating factor and you hit the nail on the head about the $ and the power, well lets just say each has their own sense of power and how they want to distribute it.

                              None the less, I appreciate the opportunity to share my thoughts. Thanks again.

                              Comment

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