Workers comp case help?

Question

i was recently at the hospital for a lacerated hand which happened during work. Having 7 stitches, the cost was around $200 and the charge was picked up by workers comp. On my return visit, a week after to have the stitches removed, the cost was $167. The problem i'm having is the employer refuses to pick up the latter tab.

Honestly, i'm thankful for worker's comp for paying for the initial visit, but shouldn't they have the obligation to pay for both fees. Especially because the stitches can't be taken out myself, i feel at loss. What can i do?

Answer 1

I don't know how GA work comp works but somebody messed up somewhere.

If you have a laceration to the hand and you got stitches your claim should remain open until your released back to work at a medically stationary (MS) or reached maximum medical improvement (MMI) or p.r.n.

You should contact your adjuster regarding this and ask them why there are 2 claims for the same injury?  I'm pretty sure that the company you work for doesn't want to be hit with 2 claims by the same person for the same injury that occurred on the same day.

Answer 2

the employer HAS TO pick it up - he has no choice - the case can not be closed - if it happened at work and you had a follow up visit for the same injury its his problem - PERIOD

the bill does not even have to come to your employer - tell the hospital to send it directly to the insurance carrier -

as a backup - give them your health insurance to file against - but your insurance company will automatically default to the workman's comp ins -

Answer 3

You need to ensure your employer reported your injury to the insurance carrier as is their obligation.  The should not just pay the bill for you and not file a claim.  You have what is considered a "recordable" injury per OSHA standards so your employer needs to report it to the insurance carrier.  Work comp premiums go higher for employers if they have a lot of injuries so some employers try to pay the medical bills without filing a claim.  If, they have reported the injury, then you need to call the insurance company to let them know you have an outstanding bill.  The hospital may not have any idea the second bill is for a work comp claim.  Each time you visit the hospital, they set up a new bill and if the registration clerk did not get the correct billing information, then you get the bill as the hospital does not know where to send it.   If your employer refuses to file a claim, then contact your states Industrial Board to see what your rights are regarding this claim.

Answer 4

What state are you in?  Each state has different statutes and processes for workers' comp programs.  Generally speaking, though, I can't imagine why the employer *wouldn't* be required to cover the costs of all forms of treatment related to the original injury.  Do you know if your company has a workers' comp insurance carrier, or are they self-insured?

Answer 5

Depending on your state will depend on the answer. However, generally speaking, I would think that if Workman's comp did pick up the earlier tab (which indicates to me, you ARE eligible for the benefit) there is NO reason why they should Not pay anything related to the incident. You should also be receiving a worker's compensation weekly pay check for loss of wages. You may want to talk to your Attorney General or the Workman's Compensation The site I am sending is a very good start. Don't let them cheat you! GOOD LUCK!

Answer 6

The employer has nothing to do with it.  They don't get to choose whether or not it's part of the workers comp claim.

Workers comp isn't pre-approved, either.  If they're not picking up the second one, expect that the first one is going to be rejected, too.  In some states, it's not enough that it happened at work, it has to be related to your job.  

You need to call your adjuster.  If you haven't heard from your adjuster, ask your employer to get their name and phone number.   It's possible that your employer let the coverage lapse, and didn't put the claim in.