Misunderstandings Need to Be Address ASAP
Work comp misunderstandings are not a puzzle to be solved by the curious – they can be deadly if not properly addressed as quickly as possible. A complaint site to which people can report problems with insurance companies had the following anecdote:
“A NY employee was injured while out of state and received local treatment. The facilities were never paid, although bills were submitted. The worker called the carrier and was told that medical reports were never submitted. The employer had verified the injury and had no problem with the claim.”
The editor of the complaint site suggested that the worker file a complaint with the Workers Comp Board (WCB) in NY.
Employers hear similar stories all the time. What should have been done? (Filing a complaint with the WCB is possible, but few life expectancies are long enough to make the choice viable.)
Get the Facts
First, the story has many loose ends. How does the worker know what an out of state medical office submitted? Was it just a bill? Was there a medical report which clearly indicated a relationship to work activity? What does it mean to say that the employer had no problem with the claim? Did the worker see the employer’s First Report of Injury (C-2)?
Make the Call, Be Proactive
The correct plan is for the employer to call the medical facility and discuss it first. Then, with a HIPAA from the worker, ask for a copy of the file. Inform the facility that the employer will try to resolve this matter. In the meantime, advise that the medical bill should be submitted to the group health plan. They will be reimbursed by the carrier when the matter is resolved. (The NY WCL has provisions for group health plans paying when such snags occur.)
Why should he employer make the call? Because the problem will only drag on if they don’t. A recent study of smaller comp claims shows that when small claims encounter snags the worker will eventually get a lawyer (90 days into the claim) and the small claim grows into a mid-size claim, or larger.
The problem may not be solved immediately, or at all, but a worker seeing that the employer is doing something to help will almost always eliminate the need for a lawyer on a small claim.
Next, the employer should call the carrier to find out if no medical reports were received, or if reports were sent which lacked sufficient information. Or, perhaps, the reports describe something which cannot be considered work-related. None of these would warrant filing a complaint against the carrier with the WCB.
Employers should remember – it’s their claim too.
Author: Attorney Theodore Ronca is a practicing lawyer from Aquebogue, NY. He is a frequent writer and speaker, and has represented employers in the areas of workers’ compensation, Social Security disability, employee disability plans and subrogation for over 30 years. Attorney Ronca can be reached at 631-722-2100.
Editor Michael B. Stack, CPA, Director of Operations, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher. www.reduceyourworkerscomp.com. Contact: [email protected].
WORKERS COMP MANAGEMENT MANUAL: www.WCManual.com
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
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