On the job injury

Sandy Hart

An employee(who was hired 2 weeks ago) calls his supervisor and says he tweaked his back "last night". The supervisor lets him know he needs a Doctors note saying he is able to return to work with no restrictions before he can go back out in the field. The employee was on a day shift the day of this event. A doctors note gets faxed over saying the employee needs to be off for 3 full days and modified duty for 7 days thereafter. The company has no modified work. H.R. calls the employee to let him know there is no modified work and he has the right to file for State Disability. The employee informs H.R. he tweaked his back on the job during the day. What would you do?

LindaS

File the report with your W/C carrier and let them determine the compensability. As for the modified work, if you don't have anything, keep him off work. If you have something, bring him back to modified duty.

pork1

Sandy: I would turn the details over to the W/C Insurance carrier. Let them do the necessary paper Drill.

we are self Insured and our 3rd Party Administrator would need to be informed with the information so that they can manage the case. The carrier will keep your companyin compliance with the legal proceedings.

Simply reading your thread if he told someone in authority on the date of the injury, it would be a W/C case!

PORK

WT

In this case, I would be immediately suspicious that the employee was hurt off duty and changed his story to get paid time off. This leads to a number of questions. Do you require an accident report anytime an employee gets hurt at work. If not, you should. Require it on the day of the injury and be strict on enforcement. This practice really helps prevent off work injuries from changing into on the job injuries if employees need a period of time off work.

What did the employee tell the doctor? He should have explained to the doctor whether he was hurt at work or at home. The doctor's paperwork will reveal this. Did he fill out an insurance claim and if so, what did he write? Most of them ask if any accident was work related.

Call the carrier and explain the situation. Let them chase out the case.

System

Technically, you've probably incurred a workers comp claim. Even requiring "immediate notice" does little good in most states. You were notified of an injury (although we all know it was most likely not work related), and with a back injury claim, there is no way to prove a negative (he didn't incur it at work). In Alabama, claimants have up to 2 YEARS to file a claim. Now how ridiculous is that. My bet is you will have little to no luck denying the claim.

Dasher

Don't even try to deny the claim! File the necessary reports and let the "claim" go forward. Additionally, I would certainly find some light duty assignments (almost anything) for this employee. It is much better to get them back to work and in your face rather than at home looking at the legal ads on the tv.

Balloonman1

First off, this is a questionable claim, do to the employee's inconsistent statements. Call the doctors office and ask that all notes be faxed over to you. The page the patient fills out as well as teh Q&A the doc did. Call your WC adjuster,(send in the claim paperwork) tell him to contact him and get a recorded statement asap. Make them aware of inconsistencies, saying it happened at night, employee is day shift etc and if there are any discrepancies within the clinics/doctors paperwork make it knows. If your gut tells you this is bogus tell the adjuster you want the claim denied........

Balloonman

E Wart

Contact your w/c carrier immediately and let them advise and handle. Get employee to w/c doctor for evaluation/treatment depending upon what the w/c carrier says.
Also, get a statement of exactly what happened from the employee, find out if any witnesses and interveiw them if so. Talk with supv. and find out what the employee said when he originally called in. Do you tell your employees to notify you immediately when injury/accident occurs? If not, you need to make sure this is covered with all employees. If the employee didn't tell the supv. how it happened, did supv. ask if he hurt at work or at home? (I find that employers are so "scared of brining this up" and you will find out if you ask this immediately, employees will be honest because they aren't expecting it and that will "kill the problem" at the very beginning and you will know how to handle it.
Good luck and work with your w/c carrier. They are the best at this.

E Wart

JM in ATL

What was the "diagnosis" from the WC doctor?

Anytime we have an employee with a back injury we immediately assign a case nurse or case manager. This way the injury is being closely observed at all times and that treatment is valid and necessary.

I think WC back injuries are the biggest crock (90% of the time anyway) so I recommend staying on this guy like white on rice.

I also recommend that you schedule an IME if he completes any physical therapy and the problem is not "fixed".

I am such a skeptic when it comes to WC injuries.

System

Surveillance is another handy little tool that often catches the "injured" employee engaging in activities that fly in the face of their so-called pain an agony they claim they experience on a regular basis. Although, the last time I requested surveillance for a back injury, we had undeniable footage that showed him giving his girlfriend piggy-back rides, riding a four-wheeler, and carrying packs of roofing shingles. I was thrilled and anticipated my moment where I could present the tape as evidence of fraud. Then I found out I had a minor problem - this yo-yo has an identical twin brother. Bye-bye fraud case... never even used the tape.

JM in ATL

OH THAT SUCKS!!!

LMAO!!!