workman's compensation faq?

by admin on July 6, 2010

A co-worker of mine recently aggravated her back while at work. She had mentioned to me that her back hurt before but getting off the forklift at work really aggravated it. Since she wasn’t sure where the initial event took place, she just filled this under her regular insurance rather than filling a claim with WC. She honestly thought it was a non-work related injury. Well, her insurance company sent her a letter asking if this occurred during work which apparently started a fire storm. Our company is now making her file a WC claim. The injury happened about 2 weeks prior to the WC claim beings filed

The question being is that if WC comes back denying her claim due to either the unsureness of where the injury occurred or the latency of the filling, could her private insurance also come back and deny her coverage for the treatments she has already received and going forward? That’s my biggest concern in that my company forcing her to file a WC claim might put her into a situation where all the medical expenses becomes her own liability.

Thanks in advance for the responses.

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mbrcatz July 6, 2010 at 2:13 pm

Well, they could – but they likely won’t. All you need is the denial letter from the WC carrier, and then they’re "on the hook" for the benefits.

The company HAS to have her file the WC claim – she told her doctor – or someone – that it happened at work. Legally, her employer HAS to notify the DOL and workers comp carrier, or they can get fined.

Flower July 6, 2010 at 2:13 pm

If her Workmans Comp claim is valid, they would pay back her private insurance for the treatment she has had so far. If they deny the Workmans Comp claim, she would continue as she is now using her own private insurance.

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