Workman's Compensation (sorry LONG)

[lovemylife]

My DH was injured at work on Dec 13. He was walking at the new construction site for his place of employment. There were deep ruts where the trucks had gone through and was covered with ice and snow. Now he did not see the ice or know that there was a rut. He slipped and dislocated his left knee. His knee cap was completely to the side of the knee. He was transported to the hospital via ambulance. His employer was notified immediately and was at the hospital when I arrived. Workman's comp was obviously called into deal with all of the bills and his time off of work. He has been off for 1 month. WC has paid all medical bills so far but we have only received 1 check and that was a guesstimated check for $473 for a 2 week period. They did not know how much to pay him because his HR didn't fill out their paperwork that was needed. Needless to say, this is a nightmare. His HR, management and payroll do NOT communicate. Payroll did not know how to pay him because his boss put in for sick time. So they paid him out of his vacation bank. Thankfully he has a lot of hours in there. So we talked to WC and they said that they had sent out 2 more checks for sums nearing $3000. We have received nothing, his payroll has received nothing. His HR will not return phone calls to my DH. Now, his payroll lady is going crazy as to what to do with his pay, still paying out of vacation time. We said that they can have the WC checks and just divide by hourly wage and put that amount back into vacation bank. She does not have a clue as to what to do. We have been paid out of my DH vacation, but WC has paid 80% of his wage. We obviously cannot be accepting both pay, right? What do we do, when these checks finally come in.

Also, his knee is really not good and his physical therapist said it may never be right. For his job, he has to walk a lot, climb ladders (lots of them), bend down to get readings, do a lot of physical work. Now he went back yesterday for the first time. Dr.gave him light duty and bosses finally let him back (because somebody quit). He really did not do anything and his knee was swollen and extremely sore. Now his dr also said that he will not let him be released as whole until he totally is, which we appreciate, but for his job, his bosses will only let light duty go for a period of 3 weeks. What recourse do we have for his work? WC? Payroll? Also, does anybody know how to handle it if his knee does not ever heal correctly. Both dr and PT said it will never be right again. The knee cap is very loose and still moves with hardly any motion.

Some people he works with said he should sue the construction company for the situation and others said sue the employer for unsafe conditions. I do not know about any of that. I am just worried about his knee and how to handle the situations stated above. He is 3 years away from being able to be vested to collect his pension at 55. He really needs to make those 3 years but his employers are not happy right now and very eager to get rid of pension employees. He is thinking that this will be their reason. He has nothing else against him, just he cannot and may not be able to do the job at his previous abilities.

Sorry for this being so long. TIA

 

[lifesavacation]

My DH was injured at work on Dec 13. He was walking at the new construction site for his place of employment. There were deep ruts where the trucks had gone through and was covered with ice and snow. Now he did not see the ice or know that there was a rut. He slipped and dislocated his left knee. His knee cap was completely to the side of the knee. He was transported to the hospital via ambulance. His employer was notified immediately and was at the hospital when I arrived. Workman's comp was obviously called into deal with all of the bills and his time off of work. He has been off for 1 month. WC has paid all medical bills so far but we have only received 1 check and that was a guesstimated check for $473 for a 2 week period. They did not know how much to pay him because his HR didn't fill out their paperwork that was needed. Needless to say, this is a nightmare. His HR, management and payroll do NOT communicate. Payroll did not know how to pay him because his boss put in for sick time. So they paid him out of his vacation bank. Thankfully he has a lot of hours in there. So we talked to WC and they said that they had sent out 2 more checks for sums nearing $3000. We have received nothing, his payroll has received nothing. His HR will not return phone calls to my DH. Now, his payroll lady is going crazy as to what to do with his pay, still paying out of vacation time. We said that they can have the WC checks and just divide by hourly wage and put that amount back into vacation bank. She does not have a clue as to what to do. We have been paid out of my DH vacation, but WC has paid 80% of his wage. We obviously cannot be accepting both pay, right? What do we do, when these checks finally come in.

Also, his knee is really not good and his physical therapist said it may never be right. For his job, he has to walk a lot, climb ladders (lots of them), bend down to get readings, do a lot of physical work. Now he went back yesterday for the first time. Dr.gave him light duty and bosses finally let him back (because somebody quit). He really did not do anything and his knee was swollen and extremely sore. Now his dr also said that he will not let him be released as whole until he totally is, which we appreciate, but for his job, his bosses will only let light duty go for a period of 3 weeks. What recourse do we have for his work? WC? Payroll? Also, does anybody know how to handle it if his knee does not ever heal correctly. Both dr and PT said it will never be right again. The knee cap is very loose and still moves with hardly any motion.

Some people he works with said he should sue the construction company for the situation and others said sue the employer for unsafe conditions. I do not know about any of that. I am just worried about his knee and how to handle the situations stated above. He is 3 years away from being able to be vested to collect his pension at 55. He really needs to make those 3 years but his employers are not happy right now and very eager to get rid of pension employees. He is thinking that this will be their reason. He has nothing else against him, just he cannot and may not be able to do the job at his previous abilities.

Sorry for this being so long. TIA

I don't have any experience with WC, but I know it is illegal for the company to terminate an employee who files a claim.

 

[Klayfish]

From the medical perspective, I'd say it's too early to say if his knee is ever going to be right again. May not get to 100% of pre-accident condition, but maybe it will. Bad injuries like that typically do have some residuals, but how much is very varied on so many things.

As for the WC side of it, that should be handled by a WC insurance carrier. You should be communicating with them. Ideally, the employer will provide the forms necessary, but if they're not, you may have to act as a go between. Find out exactly what the WC carrier needs, as well as what benefits are available to you. Then push the employer to comply.

I'm sure somewhere in this thread someone will say "Get a lawyer". That's always an option, for sure. But as someone who's been in the insurance industry for 20 years (not directly in WC, but have daily interaction with them and my employer sells it), remember that the lawyer will slow the process down significantly and take a huge chunk of the money. Again, if you want to get one, do, but understand the reality of what it will do.

 

[sam_gordon]

You need to find someone who can guide you on what the next steps need to be. It might be worth talking to a lawyer for an hour or two, not to file suit, but to find out what rights your DH has and what next steps you should take.

I don't think there's a case against the construction company or the employer for unsafe conditions based on what you've written here. What reasonable steps should either company have done to prevent the accident?

 

[usnuzuloose]

I would call a worker comp atty just to see what his rights are and how to proceed with getting paid. I would not sue to get info. I know it can be tough waiting things out. But I hope your husband comes out fine with the knee. Getting well is important.

 

[Happyinwonerland]

I would recommend contacting a workers comp. attorney in your area. Not because I am law suit happy, but because thry will know the laws in your state. They can guide you through what you need to know, and will handle the lettets and phone calls for you. I was a paralegal years ago for a workers comp attorney. Pnce the insurance companies recieve a letter from your representation, it is amazing how quickly your receive your checks and get what you need.

I know you say they are working with you now, but after a few months they will start giving you a lot of trouble. Let a lwayer deal with it so you can better care for your spouse.

 

[java]

Is he in the union? They usually take care of everything.

 

[Klayfish]

Pnce the insurance companies recieve a letter from your representation, it is amazing how quickly your receive your checks and get what you need.

I know you say they are working with you now, but after a few months they will start giving you a lot of trouble. Let a lwayer deal with it so you can better care for your spouse.

That is incorrect on so many levels. Don't give the OP a false impression that getting an attorney is going to cause them to suddenly get checks (not that it sounds like an issue with the insurance company anyway). Insurance companies don't jump to attention when they get an attorney representation letter, I can assure you. As I said before, attorneys will slow the process down, tremendously...and take 33-40% of the cash, for the privilege. Do they know the law? Some do, a surprising number of them don't. Plenty of people get attorneys, if that's what OP decides, that's up to them. But don't want to lead them into false impressions...it's not what attorneys on TV want you to think it is.

 

[CarolAnn856]

That is incorrect on so many levels. Don't give the OP a false impression that getting an attorney is going to cause them to suddenly get checks (not that it sounds like an issue with the insurance company anyway). Insurance companies don't jump to attention when they get an attorney representation letter, I can assure you. As I said before, attorneys will slow the process down, tremendously...and take 33-40% of the cash, for the privilege. Do they know the law? Some do, a surprising number of them don't. Plenty of people get attorneys, if that's what OP decides, that's up to them. But don't want to lead them into false impressions...it's not what attorneys on TV want you to think it is.

Who said anything about ambulance chasers who advertise on television? There are many honest, knowledgeable lawyers who can assist clients in navigating the intricacies of workmen's comp, and hourly fees can actually be pretty reasonable. Implying that this avenue is not valid is just as bad as what you are accusing others of doing.

 

[mrsstats]

I would get a workers comp attorney. There is no cost to you to use one.

 

[Cannot_Wait_4Disney]

You need to consult a competent worker's compensation attorney. Rules can be so complicated to wade through on your own and no, not all of them will take 33% of your award or are ambulance chasers.

 

[mnrose]

Your only recourse is workers' compensation in this case. You give up the right to sue for negligence, etc, in exchange for the relatively "sure thing" of worker's compensation. To make sure you are getting what you are entitled to receive, you can consult with and hire a worker's compensation attorney. There IS a cost to using them (no lawyer works for free), although the initial consultation may be free. They are likely to take their "pay" out of whatever they recover from worker's compensation on your behalf. So, your total due might be reduced. OTOH, they are likely to get you more than you might otherwise based on their expertise and familiarity with the laws.

 

[Happyinwonerland]

The attorney's fees are capped at 20% in our state. But they are typically able to get a much higher settlement that what the insurance company tries to settle for. They also help the workers choose the proper settlement, such as avoiding sigining away future medical on an injury that may have lingering consequences.

 

[mnrose]

I would get a workers comp attorney. There is no cost to you to use one.

This simply is not true. You may not pay "out of pocket," but you definitely will pay, usually as a percentage of whatever they recover on your behalf.

 

[Poohlove]

I would give the employer an opportunity to straighten the situation out. Contact a manager in human resources and explain the situation. I would also get a contact at the workers comp insurance company and work that avenue as well. Is it possible that disability could kick in once workers comp runs out?

I have only had one occasion where I had to deal with a workers comp case where an employee wasn't able to return to work right away. We had a part time employee break his ankle, he didn't have any sick/vacation time. My boss took him to the ER, his mom picked him up (he didn't drive) and I reported the incident to the insurance company. We also have a posting in the break room with all of the insurance company's contact info, it's a required posting. They sent out paperwork for us to fill out which included wage information. The insurance company also reached out to the employee and they handled everything from there. (Including the investigation when he claimed to still be too hurt to return to work but was missing doctors appointments and the investigator found him playing basketball) We do not have light duty and we did have to hire someone to take his place. We explained to the new hire that it was a temporary position but the other employee never attempted to return to work so I am not sure how that works.

 

[lovemylife]

OP here: I want to thank you all for your advice. DH says we will see what his work does and how they handle his pay. We are getting his paycheck, but from his vacation bank. That will only last so long and WC apparently did pay him, but nobody knows where the checks are because his work does not communicate well at all. If the checks do arrive, we will have to see what they do: either we keep them or they put them back into his vacation bank, but his payroll lady does not know how to do that. They also said it maybe a case where any vacation time he earns, will go to repaying what was used and he just keep the checks. She said that may be easier for her to do.
We are just worried because dislocated knees are known to be lifelong issues and did not know how to handle that if he cannot do his job. As of now, they are allowing light duty because somebody quit, but prior to this they told him he could not come back until he was completely proficient again. So he is really worried that they will try to get rid of him or tell him that unless he can do the job to the job description, he is gone. He is union, so if that does happen, he will be contacting them. They have been really bad to other employees who have been sick or injured before (not work related). They have terminated a lot of people due to issues as stated. They are really horrible to work for in terms of caring for their employees or trying to help them in different situations. Since he is a pension employee and there are only 4 of them left there, they have said repeatedly that they want them gone.
If they are nasty and do not get things taken care of,we will contact a WC attorney. Hopefully get it settled or something. Thanks again.

 

[Sadie22]

Don't discuss your case on the Internet. Talk to the experienced attorney you hire. In fact I suggest you delete what you have posted here now.

 

[marlynnp]

This may vary by state, but in my experience, from the employer side, what should have happened is this:

Worker is injured, incident is reported to workers comp insurance by the employer.
In emergency any hospital is fine, regular doctor visits may need to be to a doctor on a specified panel. Bills are submitted and paid by workers comp insurance.

If the worker cannot return to work, workers comp insurance starts to pay 80% of the salary* after one week. The worker can take PTO for the week not covered.

*The insurance company requests payroll information from the employer for the last four 90 day periods prior to the date of injury.

If the worker is allowed to return to work with restrictions it is up to the employer to decide if they can provide work within those requirements. If not, or if they cannot provide the full number of hours, workers comp insurance will continue to pay the employee either in full or in partial for the 'shortage' of hours.

 

[Klayfish]

Edit, nevermind, not worth arguing about. Each to their own re: attorneys. I see these things firsthand every day, just giving my $.02

OP, sounds like a pretty bad employer. Hope it works out.

 

[lovemylife]

This may vary by state, but in my experience, from the employer side, what should have happened is this:

Worker is injured, incident is reported to workers comp insurance by the employer.
In emergency any hospital is fine, regular doctor visits may need to be to a doctor on a specified panel. Bills are submitted and paid by workers comp insurance.

If the worker cannot return to work, workers comp insurance starts to pay 80% of the salary* after one week. The worker can take PTO for the week not covered.

*The insurance company requests payroll information from the employer for the last four 90 day periods prior to the date of injury.

If the worker is allowed to return to work with restrictions it is up to the employer to decide if they can provide work within those requirements. If not, or if they cannot provide the full number of hours, workers comp insurance will continue to pay the employee either in full or in partial for the 'shortage' of hours.

Yes, it was reported to WC because we requested it to be. They were not going to. WC was paying, supposedly, but we have only seen 1 check, sent to our house for $473. That was an initial payment because HR never gave them the info they needed. I had to send in my paperwork. DH talked to WC and she said that she sent out 2 other checks in tune to around $2000+ and nobody can find them. They apparently sent them to work, but payroll does not have them. HR will not answer calls. He told payroll to take the extra out of vacation to make up for what WC did not pay, but they did the 80+ hrs/2 wks out of his vacation. Now payroll does not know what to do with WC, if they get them.