Workers' Compensation
nohr4u1yr
218 Posts
It's another one of "those" days!
I had an employee come to me this morning regarding her back. In August of 2003 she slipped in our break room and pulled her back muscle. She was given a clean bill of health on 10/10/03.
She states that her back has been bothering her. And wants us to re-open the claim.
Am I correct that she just needs to go her her own doctor and that this does not fall under Worker's Compenation?
Thank you for your assistance in this matter.
I had an employee come to me this morning regarding her back. In August of 2003 she slipped in our break room and pulled her back muscle. She was given a clean bill of health on 10/10/03.
She states that her back has been bothering her. And wants us to re-open the claim.
Am I correct that she just needs to go her her own doctor and that this does not fall under Worker's Compenation?
Thank you for your assistance in this matter.
Comments
If you ask the employee when she re-injured her back, she's apt to think of an incident. I would ask if she's seen her doctor in reference to her complaint and I would leave it there. I would not encourage FML or reopen an earlier claim.
I will inform her to see her primary doctor.
As always - very helpful!
I ask:
1. Briefly describe the condition.
2. What symptoms are you experiencing?
3. When was the first time you noticed a problem?
4. How often do you experience the problem? (approx. # times per week)
5. During what time of day does the problem most often occur?
6. Why do you believe this condition is caused by your employment? Be specific.
7. Any other information you think would be helpful.
After they complete this I review each question with them and get as much info RIGHT THEN as possible. I think I am pretty liberal in terms of siding with the employee, and if I can't justify in my mind why we should request work comp, then I simply tell the employee that this does not appear to be work related and they will have to see their own physician. Sometimes this takes care of their interest in work comp, and sometimes they contact a lawyer and pursue it anyway. We deal with that when it comes. But this is a process that helps me.
Gene
Relating a physical condition to work or anything else is, after all, a medical conclusion.
For example: an employee came to me and said "my belly button hurts, I need to go see a doctor." When I realized this employee was serious I asked him to fill out an accident report and as he was doing so he stated that he could not answer some of the questions because there was no specific incident. So I created this form to help me understand what the problem was. As it turns out, he did not see any doctor (to my knowledge) and when I asked a few days later how he was doing he said fine and had no more problems. (I personally think someone told him he could get a few days off and when I questioned him he backed off.)
Another case: an employee had dust in his eye over 2 years ago. A simple eye appt flushed it out with no additional medical care needed. Last week he tells me he just had some strange separation of layers and he is going in for eye surgery. He wants us to see if this is related to the incident 2 years ago. I had him fill out the form, and that gives me the justification to go to the work comp company and say 'please check this out and determine if we are liable.'
How do other people determine when to send employees for work comp, and when to send them away and try to discourage work comp? I want to be fair to the employee, but I also have an obligation to my employer not to be unfairly generous.
If the clinic called here, which they typically will, we would NOT tell them it is authorized as comp. We do not do that unless we send them there subsequent to a definite on job incident. We would also feel free to tell the clinic the name and phone number of our comp carrier, at which point the clerk at the clinic and the adjuster or claims agent at our comp firm would debate the issue and it would be approved or not.
Consider this example: We had an employee slip and fall (supposedly) last year. We sent her to our clinic and she was treated, the fall was written up and we took our comp and OSHA licks. About two months ago she comes to HR to report that her knee is bothering her and she wants to go to the clinic under the comp policy because she thinks it might be related to that fall. I refused that and told her it was entirely up to her if she wanted to seek treatment, that I would not authorize it as comp. Had I called and authorized comp, we would have paid the bill for the knee replacement she had three weeks ago. As it turned out, she went on her own and the doctor wrote it up as arthritis and not job related. So, health insurance paid the bill and she paid her deductible. She now has an attorney who has filed a petition to controvert with the state comp commission. Still, it's between those players and our comp carrier. That's what we pay THEM for.
We are not in the comp business. It sounds to me as if you ARE.
If I were you, I would call my comp carrier and get them involved in the decision.
2. What symptoms are you experiencing?
3. When was the first time you noticed a problem?
4. How often do you experience the problem? (approx. # times per week)
5. During what time of day does the problem most often occur?
6. Why do you believe this condition is caused by your employment? Be specific.
7. Any other information you think would be helpful.
I understand your motive. We've all been in that quandary. Think of the reason and employee comes to HR with a medical complaint. Normally an employee who is sick or experience pain just go to a doctor? Are work related injuries reported to department heads or to the person who supervises the employee? My first question would be 'did you notify your supervisor?' I would avoid #'s 1,2,4,5,6, and 7. Maybe I would ask #3. I'd definitely call the supervisor and find out if the employee has made a complaint.