I slipped on the stairs at work today and ended up pulling muscles on the sides of my foot and chipping off part of my ankle bone. There was no negligence on the part of the school, I just stepped wrong, and down I went. My coworker drove me to the doc-in-a-box and they checked it out, x-rayed it, put me in a boot and crutches, and made a referral to an orthopaedist (for the bone chip). My co-worker and I were joking around about the reaction of my office mate (freaked out). The doc asked if I was injured at work and when I said I was at work, he told me BCBS probably wouldn’t pay my claim. He says I must file a worker’s comp claim.
Do I need to file a WC claim even if there was no negligence on the part of the school?
Worker’s Comp is usually not a fault based system. If you get injured on the job, your employer is usually liable under the WC laws, which means his insurance pays the claim…eventually. It’s a trade off–your payment is often faster and more certain than it would be through litigation, but there are caps on benefits available, and you do not have the option of filing a personal injury suit against the employer.
From the employer’s point of view, WC insurance is cheaper than defending lawsuits and risking jury awards.
Note: the above is a simplified, broad-brush nutshell description. There are various nuances that may apply to a particular case. Consult an attorney licensed in your jurisdiction for actual legal advice.
To put a little more clarity on what** Manda JO** said - BCBS will try to avoid paying for any of the medical costs they think they can prove were a work injury. So your alternative is to pay all your medical costs out of pocket. Your worker’s comp policy is no-fault, there’s no need for there to be negligence.
Filling a claim does not mean your employeer is negligent. Filing a claim is up to you. But if you do not fill out an accident form you may be violating your employeer’s rules. And you may end up paying all medical cost.
As others have said, if your normal health insurance finds out this happened at work they’ll do everything in their power (and they have more then enough power) not to cover it and just make workers comp cover it.
With that, workers comp really, really, really doesn’t like claims that aren’t filed ASAP. If you wait to long they might not accept the claim.
Some employers will try to hold off on filing the claim until they get the medical bills. This way if the bills are small enough they (the employer) can just pay them out of their own pocket and not file the claim but if it’s to much they can submit it to WC. WC doesn’t like that. They would rather pay out all claims and raise the employers rates accordingly to cover the loss.
Every time I have any kind of injury which requires medical treatment I get a form in the mail a few weeks later from my health insurance company, which I am required to fill out and send back. One thing the form asks is whether the injury occurred on the job. If I say that it is I have no doubt that they would refuse to pay for it, saying it should be covered by worker’s comp.
I’m surprised your work doesn’t have a rule requiring you to report any injury suffered while working. It’s standard for employers to require you to file a report for workers compensation in response to workplace injuries, regardless of who was at fault.
A reason (whether good or bad) to not file a claim is many companies also want a drug test done along with it. Ostensibly it’s for safety reasons but it’s really a CYA for the company and also to get ammo to fire someone if need be.
As someone “familiar with” worker’s comp claims, file it ASAP. Pretty much any medical attention you will ever need related to that injury (and you have no idea yet what future problems you may have) will probably be covered. Plus you get paid for any time missed at work for recovery or docs visits, any prescription costs, etc. The WC system is very pro-employee. As far as medical insurance goes it’s probably the best system out there (not so good for defense lawyers though). Indeed I used to joke that if you are ever going to get hurt, make sure you’re at work. I’ve seen things like heart attacks covered. File. Besides, as others have said it’s probably company policy.
I’ve known, personally, to people two have injuries outside of work claim they had them at work for this reason.
One worked at a major factory that you’ve probably heard of. He tore his rotator cuff on his own time (on a Friday afternoon), dealt with it all weekend and on Monday morning got to work, punched in, picked something in, yelped and got a ride to the hospital.
Second one, business owner, broke his knee outside of work, went to hospital and said he was at work.
Both of them did it for the same reasons you said. It’s just easier to get care through the WC system. Everything from beginning to end is covered, no questions…
Also, now that I think about it. The business owner tore his rotator cuff outside of work also, but claimed it happened at work and got a $30,000 disability settlement from WC for it.
I’ve also dealt with plenty of legit employee injuries at work. Again, very easy, as soon as they get hurt and we decide they need medical attention I fill out an injury report and send it to the WC people. From there they take over. I make sure to my employees give me any bills they get from injury, but usually after I turn the first one over to WC, I never see another one. As you said, WC will also pay for lost time as well.