Incident not report now wants Med Cost Riembursed

smkrause

An EE had an incident (particles getting in eye) and did not report it to the supervisor on a Thursday. The next day (normal day off) the EE went to dr. Monday the EE reorted to work and did not state that their was a problem with the eye. Tuesday the EE called in saying that the eye was bothering her and would be going to the eye doctor. The EE has been prescribed eye drops . The EE has asked for riembursement on the medical co pays and to have Tuesday as a paid day without docking the CompTime bank.

The area that the EE was working in does not require safety glasses. About 50 feet from where the EE was stationed a cutting machine was being operated which causes particles in the air. Because of the distance between the two work areas and how infrequently the machine is used, we had not considered that the "dust" would cause a problem, and has not in the five plus years that it has been in that location.

We are considering paying the co-pays and the day off, but also want to give the EE disciplinary action for failure to report an injury. Had she reported the incident right away the EE would have been made to use the eye wash station immediately and possibly prevented the problem she is now having.

Should we pay the copays or have her file a claim with W/C? Also, should I go ahead with the disciplinary action or just speak to her about the importance of notifying the Supervisor of any incident, big or small?

Thanks for your help.

Geno

"Should we pay the copays or have her file a claim with W/C? Also, should I go ahead with the disciplinary action or just speak to her about the importance of notifying the Supervisor of any incident, big or small?"


Yes, yes and yes.
Yes to the co-pay. Yes to the filing of a W/C claim. And finally yes to some type of counseling or discipline -- depending on your company’s established policies and procedures. If the worker comp laws in your state are anywhere close to the ones in Maryland, you really can't win on the first two. You do, however, have the discretion to expect compliance with your policies and procedures as they relate to accident reporting. The act of being injured does not relieve the employee of his/her obligation to report accidents in a timely manner --- nor does it protect the employee from some level of discipline for failure to do so.

GENO

Don D

My question to you would be this: How is it that the clinic filed against her group insurance if she told them she got particles in her eye at work? Typically, that would be treated by the clinic as having WC potential and the clinic would call and get it approved and find out how to bill it as comp. The comp carrier is going to probably deny it if the medical records show that she reported a cause totally unrelated to the work environment and now is trying to change her story. At least that's the way it works here.

smkrause

According to the receipt and what the EE told her Supervisor she complained of possible allergies to her regular doctor. However the eye doctor was told of the correct circumstances.

HRinFL

I agree with The Don and Geno. You should pay the co-paya and turn it in the your W/C carrier. The Don is right that the claim will probably be denied initially, depending on what the treating physician put in his or her notes. I would send her to your approved W/C clinic the next day she works to have her evaluated and get the process rolling for her claim. That may help when your carrier reviews the file.

I would also agree with Geno that this warrants some form of disciplinary action.

smkrause

Thank you so much for your advice.

Shannon

Don D

Shannon: You may have more information than we do about this; but, I don't see anything in your posts that tell me for sure it was not allergies to begin with. I'm not accusing the employee at all, but it is typical behavior, probably more often than not, that employees will search for a way to get medical treatment covered under comp so they avoid copays and out of pocket expenses. For that reason, I would let the process as it is sort itself out and not send her to your comp doctor in an effort to open a comp claim.

Even if you do that, the next doctor's notes are going to reference the last visit, if there is honesty in the process; and, comp will again deny it, in my opinion. But, since she has been successfully treated, apparently, I'd let it lie.

E Wart

First, immediately report it to you W/C Carrier, and report it as ALLEDGED. This triggers them to immediately investigate. Also, they should ask when employee reported it to employer and make sure you let them know the correct dates. Also, give the employee an accident report to compelte (in their own handwriting) and sign and date it. Make sure you ask if there were any witnesses, when was the first time she was aware of the injury, who did she tell first, and when, when did she report it to her supv/the company?
Let the insurance company make a decision as to whether or not the claim will be paid... not you. Also, they will determine if they will pay the medical bills, not you. (Get name, address and number of the treating physician so far. You may also want to call your w/c carrier and ask them if they think it would be good to send her to eye doctor for evaluation, not treatment, as soon as possible so it won't have healed.
As far as time off from work and how paid, again, you don't need to do anything. Tell her that she can address this with w/c when they call her. (If it was only one day, wouldn't be covered in GA, TN and most other states due to waiting period of a week.)
Lastly, check your handbook, handouts, training material, posters, etc to see (and make sure) that they reflect that an employee is REQUIRED to report any injury/accident as soon as possible to their supv. or whomever else is appropriate. If you have documentation that she should have known this, by all means discipline her for not notifying you immediately of the injury and especially before she needed medical treatment.
Good Luck.
E Wart

TN HR

Our policy mandates immediate termination for failing to report ANY accident, incident or near-miss. My suggestion is that you consider a heavy-handed and barbaric policy like ours x:D It works.

Gene

dbutton111

Agree 100% with E Wart. Don't pay the employee a penny for the co-pays. Once WC gets the claim they will discuss with the dr. And the dr will need to recind the claim he processed with her group insurance carrier. In turn, the doc will probably be required to refund her co-pay.

And also agree that if you have a policy in place that the employee has been informed of, then discipline to the max allowed under the policy. Not reporting situations such as this causes HUGE admin burdens not only on you but all parties involved.

Best of luck,

dchr9203

Ditto! Right on advice!