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Claim paid, but not through w/c carrier Arkansas

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  • Claim paid, but not through w/c carrier Arkansas

    My boss (CEO) was out of town at a work function and was injured. He used our group medical to pay for most of the claim. When he received the balance billing due, he told me to pay it since it was a workers comp injury in actuality. He basically didn't want to go through all the paperwork of w/c. I paid the remainder, but our CFO is not happy about it.

    There's no question that it would have been a legitimate w/c claim ... my question is this -- other than the auditors shaking their fingers at us, is there a legal reason why this should have been handled in proper channels? I want to be prepared if this should happen in the future. Thanks.

  • #2
    Proper channels are called proper channels for a reason. There is a process for everything. Including WC. If he wasn't at work when injured, how is it WC? I don't understand, and I bet the CFO and auditors won't either.
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    • #3
      What are the circumstance of the injury? Just because he was out of work at a work function, does not mean that the injury is automatically covered by workers comp.
      I find that the harder I work, the more luck I seem to have.
      Thomas Jefferson


      • #4
        There's no question that it would have been a legitimate w/c claim ...
        Whether or not this is a work injury would be determined by the treating physician medical evidence...not opinion of the CEO, CFO or you.

        If the CEO/IW did not want to file a claim because of difficulties, or in an attempt to keep the WC premiums from escalating... doesn't matter, but could be fraud against your WC carrier.

        Need more info here...on the injury itself as well as if your company is legally self insured.

        Sounds like this CEO is being a tad bit shifty...


        • #5
          We market the city in which we live. One of our campaigns involves the use of a hot air balloon that features our city logo and web address. While at a balloon rally (he is part of the team that operates the balloon), prepping the balloon for the competition, another team member let a part of the equipment fly loose and it whacked him in the face, knocking him down and nearly out. Blacked his eyes, and cut his face in several places. They went to the ER, but luckily nothing was broken. He then returned to the rally and continued in the competition.

          Trust me, the CEO is not shifty. He might have made a bad decision here, but I've worked for him for 15 years and highly respect him.


          • #6
            Get the medical reports, a statement from the CEO, and file a claim with your comp carrier.
            They will review, and make the determination of liability.
            If necessary, the GHP/Group Health Plan will be reimbursed, as well as your ER for their contribution of copay/deductibles.

            It was definately a bad decision.
            Contact your corp atty, or the comp atty for additional info.


            • #7
              Ditto. Sounds like a WC. It needs to be reported to the carrier. For one, there is a better than average chance the medical carrier will reject the claim down the line as it was the result of an injury that should be covered by another policy. Happens constantly.

              This shouldn't be a hassle. It is a straightforward claim as you described it and shouldn't cause any problems with the WC carrier.

              Not what you asked but the other reason the CEO needs to report it is that whole example setting bit. If he demonstrates he is beyond the rules and there is no need to follow the proper channels, good luck getting the rank and file to comply. Those at the rally see that the "proper" thing to do is to just run it through the medical carrier and get the company to pay any difference. I hope I don't have to tell you how that has the potential to implode. Unringing that bell is a royal pain.
              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.


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