Workers Comp Claim (WCC)

Ladies, have any of you ever filed a WCC?

Not one where I lost enough time to matter. But I used to work for an insurance company years ago and handled WC cases. I know a little about what goes on now with the job I have, but the laws may differ in different states.

My states WCC site is out of service presently. This past Tuesday/Wednesday I was moving files and bottom line I(w/out going into the politices of it) no cart was available. I stopped moving files early Wednesday afternoon and my left foot began hurting. Thursday morning I could hardly walk and luckily the attorneys I work for were in a hearing, thus little up/down. The file room is located about 100 feet away and my attorneys have Large files involving much discovery! Anywho, Wednesday night while in class my left foot was throbbing and Friday morning it hurt. The employee manual says to report w/in 24 hours, yet I did not report until Friday morning via email to HR. HR filed my WCC w/out explaining the process and the insurance company provided a list of providers. I immediately made an appointment for 2:45. I arrived at Doctors Care and waited over 1.5 hours to be seen -- Doctors Care was awaiting authorization from my employer who relayed that it was a WCC (something I had already done) as the receptionist was unfamiliar with the process. Thus, due to the receptionist's lack of training and that I followed guidelines, I had to wait until 4:21 to see a doctor. X-rays were taken and it was determined that the foot was strained, no fracture, given a velcro boot, and instructions for 20 minutes on/off frozen peas/ice, and 3X daily 3 Advil. I was given a "Return to Work Form" and to return on Monday, 4/2/07. I had planned for vacation on that date and was driving to Georgia for the weekend for niece's birthday, yet have cancelled as I fell that all that activity (skating party, shopping, walking, etc.) involved with nieces would not benefit my foot. It simply would not be enjoyable.

Well, the insurance agency (Harleysville) stated that they authorized and would pay for the first visit, but needed a diagnoses/treatment sent from the doctor. The doctor's nurse refused! I asked her 2X to please fax the information (as I was instructed by my HR and insurance company) and also asked her to talk with either HR and/or Harleysville. She refused, threw up her hands, and was very rude and verbally abusive. So, after speaking several times w/ Harleysville and HR until 6:30 PM, we determined that this was very unusual. Now, I feel caught between b/c I'm following direct orders, my foot continues to hurt, and not certain if I will be allowed to see the doctor on Monday. I did a license look up for this Nurse, and none is listed.

I just feel awful b/c I was following procedures, and yet I'm certain HR thinks I'm a biotch b/c a few weeks ago I complained about someone taking my reserved parking space, about a receptionist, and about a co-worker I've problems w/ for over a year wherein she is constantly on smoke break and refused to take her phone calls while shopping online.

According to my state's law, no one can be fired for filing a WCC claim, yet if it is denied, I imagine one could. This is such a stressful job (yes, I'm looking), but working for a law firm (which is my field) stress comes with the territory. Although I work at a law firm, I really don't know much about WCC.

I'm having trouble getting to the gist of your issue.

*You injured yourself at work and filed the injury claim late.
*The doctor's office refused to provide documentation of the injury and the diagnosis.
*As of yet you have not filed a claim and don't know whether or not you have the right to.

I have some scattered thoughts.
1) Indeed, Workers Comp is completely a state-by-state adjudicated fund. If you need information on your state's law and the website is down, you'll have to find paper copy of the law. You work for a law office--I would guess this to be a great resource.

2) Usually you have to be off work due to the work injury for a certain period of time before you can file for Workers Comp. Some companies require you to use up all your sick leave and vacation days off before a claim can be filed. By the time you've used all those up, your foot may be healed.

3) These are dangerous waters. I would consider filing a Workers Comp claim to be a last ditch effort of desperation. Even though by law you cannot be fired for filing the claim itself, there is no guarantee that if you leave your job because of the injury the job will still be available when you're ready to return. They do not have to hold your job for you.

Any such claim will be reviewed by the state Workers Comp board/committee/whatever. They can either deny or grant the claim. If they deny you can file an appeal. You'll have to hire a lawyer for that. This process can literally take years. You'd need reams of documentation proving that you are no longer capapble of performing your job due to this work injury. You will have to prove without a doubt that this injury was not pre-existing nor incurred off the job.

And, perhaps you've never really noticed it before, but a lot of job applications have questions regarding previous Workers Comp claims made. If you check the "yes" box you'll need to fill out the next box with an explanation of the injury and the length of time you were off work due to the injury. Many companies will throw any application in the trash if the applicant has ever filed for a Workers Comp claim. And if you have suffered an injury they might not hire you due to the health insurance premiums/liability that they would be responsible for.

If I were you I would consider filing a claim only in the most extreme and debilitating case. Be careful.

I did not file a WCC, my HR department did when I informed them of the accident. The HR manual says to report it w/in 24 hours, yet I was about 36 hours. I am informed that the state law says 7-days. I did not want to file a WCC, simply an accident report so that remedial action would be taken so that this would not happen again. I've hurt myself working in the file room b/4, due to the close quarters, bumping and bruising my elbows, knees, and hips. I never reported. They simply don't want to spend the money to have filing shelves to accomodate the large load of files. Also, some have actually leaned on us and we're reported to office services.

Thus, a WCC is filed. The doctor's office is refusing and the insurance company is not happy b/c they have signed an agreement to do so, yet now refuse. The doctors office says other claimants are not this astringent.

No, I've never really noticed that job applicantions have questions regarding WCC. Thus, now I'm very wary.

I am cleared to return to work. I am following the exact protocol and annotating each and every conversation.

I'm on the Safety Committee at work and each month there is a W/C report. All accidents at work are supposed to be reported. A form must be filled out no matter how trivial it seems. (Of course, I too am forever bumping into things in the mail room, etc. and couldn't possibly fill out a form every time I bump or bang something.) HR is supposed to report them to the insurance company. Lost time cases are the ones they worry about, but our insurance costs are based on the total amount and frequency of accidents.

Mrs. is right about being careful what you put on an application.

Oh Gawd, I'm so screwed!

I'm serious, I'm really afraid.

You didn't lose a lot of time from work and it wasn't a serious injury. It was broken or anything so it seems pretty cut and dry. Not like a back injury, which they are always leery of since it's hard to prove and so often re-occurs. Does your company have a lot of WC accidents/claims? They're lawyers. They should know the law. If they fire you, they'd be in trouble. I doubt they'd be that stupid. The thing is with WC, you go to their doctors and their doctors want to get you back to work asap. Reports are often filed after the fact. I wouldn't worry too much about the time frame.

I went for my re-evaluation today and it is interesting that the Physician Assistant I'm assigned to is directly related to the attorney I work for. I'm to continue on lite duty and report for another re-eval on 4/9/07. Gosh, next time I'll simply suffer the pain as the paperwork is beyond idiotic and feel like I'm being questioned by a Nazi!

It seems to me that there would be some kind of conflict of interest via the attorney and the PA. You would think that the company would evaluate the situation (file room?) that creates such injuries! I'm so sorry for you struggle(s) at work, mustang.