Q: I took a fall while on the job. The fall hurt my head and required neck surgery. While recovering at the hospital, my knee started to hurt and also eventually required some surgery. After I got home, I spent days of aggravation with the worker’s comp carrier because they were refusing to cover any knee-related medical expenses. In desperation, I phoned my boss for help. I don’t know what he did but 2 hours later the WC folks called and everything was fine. What did my boss do and was it something I could have done myself?
A: Not likely.
What your boss probably did was call the worker’s comp (WC) carrier to explain that he (the employer) believed that you had in fact hurt your knee as you fell. The WC adjuster then probably asked him to amend the initial accident report to include not just a head injury but a knee injury as well. So, you’re probably wondering “Well, I tried to explain the same thing but they wouldn’t listen, how come they listened to him and not me?” Good question.
Keep in mind that the worker’s comp insurance carrier works for the employer and wants to keep costs down. Also keep in mind that worker’s comp fraud is a fact of life and something they’re always guarding against. You might not believe the number of times they’ve heard employees attempt to tie an unrelated prior medical problem to a current injury. So don’t take it personally that the WC adjuster didn’t buy the story from you but did from your boss. They’re just doing their job. So don’t alienate them, in fact be as friendly as possible, you want that person to be on your side.
Lastly, another factor that comes into play –in my opinion- is that insurance companies sometimes try to get the “other” company to pay first. So, for instance, if after the WC insurance first denied your claim, you would have tried submitting it to your regular health insurance, they also would deny it if they suspected it was work related. This is how claims get ping-ponged.
But thankfully, it sounds like you won’t have that problem.
©Copyright Eva Del Rio
