? Re: questionable wc claim

mdm

I work at health care facility. I have a supervisor questioning the validity of a claim. Here is the brief overview of situation:
It snowed here this week and one of the employees slipped and fell at work. The ee was trying to enter the clinic and found the door locked. The ee instead of waiting 2 minutes for the supervisor to unlock the door, went to another door and slipped on the way. There were no witnesses. The ee entered the clinic and saw their supervisor and asked for an Incident/Accident Report claiming her back and neck hurt. The ee then went to another clinic to see a doctor about the pain. The doctor this ee saw is one who was previously employed by us and did not leave on the best of terms. This makes the supervisor suspicious about the circumstances and the doctor's note aying she cannot perform any work until next week. The ee called me and asked if they could come in and pick up paperwork unrelated to this situation. The ee was walking fine and was very upbeat. The supervisor thinks the doctor is trying to stick it to us.
What needs to be done on the company end? I have already filed my paperwork with our WC compnay and the RIDOL. Any advice?

Don D

My advice: Tell the supervisor to go back to the production floor and take care of those issues. Tell him you'll handle the comp claim. And the carrier will handle the claim and its investigation once you file the claim. In this state, what you describe would no doubt be paid as a comp incident. You simply cannot disprove an injury based on what some supervisor thinks might not have occured or some irrelevant theory about some doctor who left on other than good terms. You're farting in a whirlwind trying to disprove the claim. Move on and let it take its course.

mdm

I thought so, but the supervisor is bugging me about it. I'm not one for causing problems. This supervisor tends to think everyone is out to scam the system.

Thank you for your response.

lnelson

The employer is responsible for the care of the ee during the first 30 days from incident and unless the ee has provided the company prior to incident a personal physician or chiropractor designation. You as the ER can refer the ee to your normal W/C facility for care. But still file all W/C paperwork as normal.

If you do not follow this route continue as stated by Don D.

System

Sounds VERY suspicious!! Hire a good Investigative team for surveillance on her!

SusanW

Does your state allow you to designate a panel of providers for treating work-related injuries? If so (since it appears you do not have one) you should establish a panel ASAP....and obviously not include a former ee! It won't help for this case, but can certainly help in the future. For now, tell the supervisor you (not he/her) are handling the claim, let your carrier know of your observations on the ee, and let them handle any investigation.

Bill ONeill

This reply is issued after reading the earlier replies.
Let the Insurance Company take the lead. Inform them of your suspicions.
Did this fall occur on your property ? Was the walkway shoveled ? (the answers might be irrelevant).
If the person returns after 1 week, I would pay the claim w/o prejudice and be done with it. Your comment that the person was walking fine and was upbeat is worth Zero.