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Texas Employee W/C Procrastination of Physician Visit and Work

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  • Texas Employee W/C Procrastination of Physician Visit and Work

    An employee at our Texas facility just had a w/c claim filed. He did not go to affiliate medical facility however, did go to the emergency dept. He was given by the emergency dept a note informing him to be out from work for three days. This was on May 12th. He has not yet visited our w/c facility to ensure the appropriate status report so that the employer will know if he is back to work for regular, modified or restricted duty. He has not yet returned the several phone calls made by his supervisor to give the status of when he intends to rtw or any communication.

    I know that due to the w/c filed, we cannot discriminate and terminate him. If this was a different circumstance not including injury, after 3 days no cal no show, he would have abandoned his job. Are we to just continue to try to contact him in hoping he gets back to us for status or what do you advise?

  • #2
    I would make an appointment for him and send him a certified letter informing him of the appointment and that he must make arrangements to keep it.

    When you call, are you getting voice mail and leaving a message and he isn't calling you back? Or just no answer?
    I don't respond to Private Messages unless the moderator specifically refers you to me for that purpose. Thank you.


    • #3
      Agree with Patty. But unless you are legally self insured, you should be letting the CA/claims adjuster of your carrier handle this until the employEE/Injured Worker is released by his Dr to return to work. The immediate supervisor actually has nothing to do with this once the claim is filed. A CA would also be permitted to visit the IW residence for a "look see". The employer/supervisor would not.

      The IW is required to provide the Dr determination of 'disability' and any time loss, as well as any restrictions there may be to a modified or light duty job restriction.

      Employee must use a Dr in your network unless the injury requires emergency treatment. After that a Dr should be selected from your/carrier list of providers.

      Info and FAQ's for employERs here

      Based only on the scenario you present here... if all employEE's are treated in the same manner where they do not report for their regularly scheduled job duties... it could/would be job abandonment, regardless of the injury/claim. In any event, the IW is required to keep the CA appraised of the situation.
      If May 12,13,14 are "TD" days, and the 15th a regularly scheduled day off, the EE wouldn't be required to present for work until the next scheduled shift.


      • #4
        Good point, CAIW, thanks.
        I don't respond to Private Messages unless the moderator specifically refers you to me for that purpose. Thank you.


        • #5
          Thank you Patty.
          lisa22, Considering this claim has not actually reached a point of wage loss or significant medical treatment needs, as the employer/HR rep, you might want to determine if this employee is FMLA eligible.
          If you notify, in writing, (again, certified/return requested) your intention to run the WC leave concurrently with the FMLA that would be your option and probably in the best interests of the employer.

          The EE's job and ER provided benefits would be protected up to 12 weeks/annum, but after the FMLA is exhausted you would be under no further obligation to offer any protection. ER is generally free to treat the injured worker as any other employee when making business decisions or applying your company policies.

          This is a good site addressing employer questions on ADA/EEOC/WC overlaps and your rights/responsibilities.


          • #6
            You can't retaliate, but you can hold the worker to the current reporting policies both under WC and FMLA, as long as you hold other employees to those current policies also. Failure to do so can lead to negative consequences of losing protections under each.

            I am unclear as to whether you have actually filed the claim with your WC carrier. I would talk with both your carrier and broker about how to handle the "out of network" part of this. Do you have the employee's original acknowledgement that he/she had to go "in network" for the injury to be covered (unless it was life threatening and a true emergency)?


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