A friend of mine was going to work the other day and slipped and fell on her back seriously injuring herself. The side walk at her employer was an ice sheet. My question, would this be a workers comp claim or handled by her private insurance? The company maintains since she was not punched in or doing company duties it is not a comp problem. I am not a legal expert but it seems to me the injury happened “at work” so it should be covered. I don’t know, any advice or suggestions?
I just dealt with this last week when I slipped on some stairs at work. I went to the doctor and filed it against my BCBS, as you would any normal appointment. Somewhere in the doctor’s notes, he mentioned it happened at work so BCBS denied my claim. They said because it happened on work “property” that I had to file a worker’s comp claim. If WC denies it for some reason (they shouldn’t) then BCBS will pay.
But be forewarned…there is a assload of paperwork!
Hope your friend is okay!
Depends on the laws of your state. In my state, you must be injured performing your work duties. Just being on company property is not enough. This stems from a case of a woman that slipped in a rest room during a break period. Her worker’s comp claim was denied and she sued all the way to the state supreme court. The ruling was her employer could be held liable for her injuries but because she was not performing her work duties, worker’s comp would not pay.
I had a relative in NJ who was injured similarly, but it was in the company’s parking lot, not on the sidewalk. ‘Workman’s Comp to the rescue’, was the decision.
Not sure if there’s any difference, but was an exempt employee, no punching of a clock or anything like that.
IANAL and I don’t know what the laws say on the subject.
This exact same thing happened to me a couple of years ago. It was a workman’s comp claim and the company gave me no flack about that at all.
If the company does not want a claim against WC then there is the company’s liability insurance.She got hurt on their slipery sidewalk.
They are required to post the labor laws in the office somewhere. Have her take a look at them.
Cheap-ass companies like this piss me off, btw. It’s not right - she never would have slipped and fell on that sidewalk if she wasn’t coming to work, and if you look at my company’s grounds, you’ll see they are VERY diligent about putting ice down on all the company property because of this. It’s not like she’s asking for a million dollars. She’s simply asking for what is due to her. This is not the time of The Jungle.
When I worked in H/R for a situation like this we would always file for Workman’s Comp if the employee was punched in or salaried. If Workman’s Comp didn’t pay, we’d go through a private insurance.
Yes.
At a previous job, my secretary was getting out of her van in the office parking lot. She parked under a bunch of pine trees and it had been raining. Anyone who has ever tried to walk on a pile of wet pine needles knows they are slicker than duck shit. She crashed and fell and smashed her ankle to bits. My company paid the Workman’s Comp claim for that and the next five surgeries that she had, all related to that one fall. She ended up with a bunch of hardware in her foot and it was removed and replaced a couple of times and then finally, she had her ankle fused. I left the company at that point, but she had another surgery scheduled for something for a couple months after I left.
Eventually, she got fired for using my replacement’s company Amex card to buy a big screen TV. She told the CFO upon being fired, “But I was going to pay it back when my tax refund came in!!!”
:: face palm ::
Even if worker’s comp doesn’t cover it, the employer’s general liability insurance might. However, general liability insurance is going to require that you show fault, unlike worker’s comp.
At my husband’s work, where he’s in charge of such things, their company has always been responsible if anyone fell. We’re in Texas.
A worker at my last job sued the company because it wasn’t a workers comp claim, as she was not working. She was walking into the building. Their property liability carrier had to pay. i don’t know what she has to do in your state other than call a lawyer now.
I lease office space in a larger building but if I were in the position to, I’d put ice down every morning just because I like to challenge my employees. 
Disclaimer: I take work comp claims from every state (except self-insured monopolistic states) but do not adjudicate them.
This absolutely needs to be filed as a claim, whether the company likes it or not. It’s not up to them not to file and say it isn’t “their fault.” Work comp insurance is NOT about determining fault, it’s about liability for medical bills and can ONLY be determined by an adjuster. Additionally, WC is state law, not federal. Laws vary depending where she lives and works, and also there may be specific policy in/exclusions that affect adjudication of the incident. Only an experienced insurance adjuster with her company’s carrier would be able to tell you whether this is an included or excluded incident. Ingress and egress, or the “coming and going” law, is a grey area in many states. The employer is freaking NOT qualified to determine this. I work with this stuff every single day, and I’m not qualified to determine this. They have to talk to an adjuster.
If her hr department refuses to file the claim, she needs to press them harder. If they still refuse, then the medical provider or her insurance company (or both) need to call the company and ask them for their work comp carrier, phone#, and policy# (and then your friend can file her own claim).
If the company STILL refuses to file a claim or give your friend their policy information, she will unfortunately need to get a lawyer. Lawyers have powers that employees do not. A lawyer can get the policy number of the company if they refuse to release it to the employee. I definitely think PI lawyers can be slimy, but this is one instance where it may be necessary to hire one. If the company continues to refuse to file a claim, they will get charged a non-compliant penalty by the state (this is something powerful, and it’s worth bringing up when your friend is talking to HR or her boss).
I see this happen all the time, an employee will suffer an injury and the employer will refuse and refuse and refuse to file a claim because they think it will just go away (and an employee without health insurance can’t afford to take care of the injury on their own, so they just try to self-treat at home). Then the injury worsens over time, employee goes to the emergency room and gets a lawyer, and the insurance company ends up stuck with MANY THOUSANDS in legal defense fees, PLUS paying tons, maybe even up to surgery, to repair what would have been a much simpler fix if it had been addressed in a timely manner. If they had just filed the goddamn claim in the first place they’d only be shelling out a few hundred bucks for the employee to get seen at a clinic, some PT, and some pain meds.
And when insurance pays big bucks, they pass that on to the company in future (skyrocketed) premiums. So long story short, she needs to get them to file the claim. It may be covered depending on her state; it may be not. If it is not covered by work comp, then her health insurance will pick up the tab. But they can only do that with an official denial on file.
Interesting. I fell in the parking lot this week and tweaked my back. My boss sent me down to talk to the folks in HR and they said I couldn’t file a workmans comp claim because I was coming into work…according to them, that means I wasn’t actually at work yet.
-XT
And then there are lawyers who practice both WC and PI, which might actually be a good thing in this situation. (And not all of them are slimy - I used to work for some who were top-notch.)
And for sure, don’t rely on what HR tells you; even if they have the best of intentions, about which we have no idea, they may not have a clue what they’re talking about.
Very much this. In a smaller organization that’s never had a work comp claim before, they may not know that they are required to file a claim even for an ee that’s not yet on the clock. Or they may be evil enough to pretend they don’t know in the hopes of saving a few company bucks.
For anyone reading the thread who may not know, here’s a few links about “ingress and egress” work comp law:
http://www.google.com/search?hl=en&source=hp&q=work+comp+ingress+and+egress&aq=f&aqi=&aql=&oq=
The first result that popped up (http://www.gaworkerscomp.com/wna1298.htm) is regarding Georgia law:
"If an employee is injured on an employer’s property within a reasonable time of ingress or egress, it is generally accepted that such an injury would arise out of and in the course of the employee’s employment and would, therefore, be compensable. While a “reasonable time” for ingress and egress has not been statutorily defined, case law has provided us with the knowledge that an employee taking 30 minutes from leaving their automobile in a company parking lot and beginning work was not an unreasonable time.
“When an employee is injured in, or going to or from, a parking lot which is owned or operated and maintained by the employer, the accident is generally compensable. However, when an injury occurs in a public parking lot which is not owned or controlled by the employer, the injury is not compensable.”
And one from Indiana (http://www.ufcw227.org/documents/IndianaWCsummary.pdf):
“…[accidents] in parking lots owned by the employer are generally considered to be covered, even if the accident occurs before the employee clocks in or after the employee clocks out… the time required to enter and exit the employment premises is generally covered. Injuries occurring in employee parking lots are generally within the course of employment.”
Again, this information is not universal, it WILL depend on your state and to whom the parking lot belongs. But it definitely indicates that a claim MUST be filed. You, I, even an experienced agent may not be able to make the final decision. It HAS to be an adjuster, or potentially an attorney.
I get calls all the time asking “should we file a claim for this?” Well, if you’re asking that question then YES you should bloody well file it. I’m not an adjuster. I won’t be held responsible if you get dinged to the tune of five grand because you didn’t fucking file. That’s your problem.
Do not depend on HRs advice. Most companies I have worked for do not hire professionals in HR. They normaly come from a different department and are moving to get better hours. They start with no training and are trained by people who are trained by people that fit the “they say” group.
It has been funny going to union meetings sometimes. The business agent is still laughing about his run in with HR. The number of stories about someone in HR desciding that they are going to have a new policy and it is now company policy so you have to go by it. Only to find out that the new policy violates the contract or manytimes the law.
So just because HR said it doen not make it so.