You got hurt at work. You were doing your job, probably injured your shoulder, back, knee or a disc and now are faced with how to submit the medical bills. In the past you’ve watched co-workers who have made on-the-job injury claims and not liked how they were treated, what management said about them and that in the end they lost their jobs. “No way are we going down that road!”, you think. You do not want to suffer the same fate and so you’ve made the decision to not file a work. comp. claim.
But you still need medical care and maybe even surgery on a shoulder (rotator cuff) or a disc (either on a cervical or lumbar disc). To avoid the supervisor’s wrath, you first went to your own family physician who after an x-ray and/or CT scan referred you to an orthopedic surgeon who concluded surgery will be necessary.
Hmmm…. You’d not really thought this far ahead and now are wondering, “What do I do next?” and so you delay the decision for surgery.
You start working with the surgeon to avoid surgery, or at least that was your plan, but it now appears you can’t avoid surgery.
So now what do you do? How do you proceed and who do you turn for advice?
For starters at the first visit with both the family doctor and the orthopedic surgeon you made one of two choices: Either you were honest about how the injury occurred and told them it happened at work OR you weren’t and vaguely gave him the impression it was non-work related. Maybe you even checked off the “NO” box for whether this injury was work-related.
Depending on which way you chose to go your choices now are somewhat limited.
First of all your health insurer, Blue Cross Blue Shield, may be refusing to pay the surgery bills because they are now claiming the need for medical care should be paid by the workers’ compensation insurance program and not your private health insurance. That’s confusing to you because you thought you got to choose how to file the claim.
Well, you don’t and here is why.
Unfortunately for you that is really not your choice or your employer’s choice; it is a matter of the terms of two written insurance contracts long ago entered into.
Workers’ compensation insurance agreed to pay for all medical care associated with work injuries and BCBS agreed to cover medical care for non-work related injuries. Choosing to split these two types of events that cause the need for medical care allowed each to collect a premium commensurate with the risks of those injury events happening.
So what you want to do has little to do with who has been getting paid a premium to cover those medical needs. In your case, this work injury medical treatment was agreed to be paid for out of the premiums collected by the workers’ compensation insurance carrier, not BCBS. So the money set aside to cover the medical care necessary for surgery is sitting in the “float” of the workers’ compensation insurance company’s coffers.
You see you don’t get to re-write the insurance contracts just because you think the workers’ compensation program is a hassle or you fear being fired for filing a workers’ compensation claim. Those contracts were written long ago and premiums were paid to secure the coverage. You now don’t get to do whatever you want just because you don’t like the program. Now what?
So either you play by the rules or else you will find yourself personally liable to pay for the surgeon’s or hospital fees charged to do the surgery.
We handle workers’ compensation claims for injured workers and have been for over thirty-five years. If you are a person with this sort of a problem and need help call the Lombardi Law Firm, answer a few questions and then you will be given an appointment to speak directly with a lawyer who handles this sort of a claim. Your situation is not all that unusual. We hear this all the time and can usually eliminate the damage you are causing by acting as your own lawyer. So call, call now.
Attorney Lombardi queued up three videos that will help you understand workers' compensation claims for Iowa's injured work force. Here is how to find and watch the right videos. Follow this link and then once on the video page scroll down to the workers' compensation category. Then watch Workers' Compensation 101, Just the Basics; Work Comp: Never Report a Work Injury as Non-Work Related and finally, Always Report Work Injuries as Work Injuries.
Other Work Comp Blogs Worth Their Weight in Gold
- Can your employer fire you after filing a workers’ compensation claim?
- Do you have to give the insurance company's adjuster a recorded statement?
- Can you settle your workers’ compensation injury claim by yourself?
- The five things to focus on in a cumulative trauma case.
- How not to let the company doctor kill your workers’ compensation claim