Workers' Compensation Discussion Forums

The employee reported a "scratch". He did not seek medical attention for 10 days by which time he had a staph infection. His bills are close to $30,000 and my client is self-insured. Are there decisions addressing this issue favorable to an employer.
Thanks!

Janet
Minneapolis, MN

"scratch" covers alot of ground. I am sure there are, and equally sure there are decisions for the employee. I personally know of one involving a spider bite and 30K was a drop in the bucket.

Details are to skecthy... I noticed you posted your phone number.

interpretation of caselaw on a particular aspect of a workers compensation claim requires the expertise of an experienced work comp atty in your state.
generally workers compensation is a "no fault" system and unless there are other extenuating circumstances it's unlikely the medical costs can be mitigated or shifted.
General employment law allows an employer to require a medical release or fitness for duty of employees it has health concerns about.
But even an ER visit is no guarentee of adverse consequences.

Didnt you ask yourself how Janet Minneapolis, MN knows the bill was $30K?

He reported the "scratch" the only question here is was it an OSHA reportable "scratch". I have never seen a $30,000 bandaid.

what are you trying to say?
this board is for employers and professionals.
If you can't be helpful best move on.

I noted that the wound developed into a staph infection that invaded his entire body.

Each state has thier own time limit for filing a claim.

From what I have read. Which is limited. I don't think that you are going to find anything favorable for your client.

It is not like he refused treatment. From a workers stand point. I have scratched, cut and burned myself while working. I never even thought about filing a claim and most people would not.

Thank you.
J

That is a very interesting case. Obviously if it was just an innocent scratch--who is going to seek immediate medical attention or report it in the first place?

Then 10 days later turning into a staph infection--which is very serious & can be fatal.

I think it is a valid WC claim.

It will be interesting to see how your WC handles this. Please keep us informed.

Just back to post this,

I "had" made a reference to HIPAA in this thread. BOY WAS I EVER WRONG!

Privacy Rule permits disclosures of health information for workers’ compensation purposes in a number of different ways.

How the Rule Works

Disclosures Without Individual Authorization. The Privacy Rule permits covered entities to disclose protected health information to workers’ compensation insurers, State administrators, employers, and other persons or entities involved in workers’ compensation systems, without the individual’s authorization:

As authorized by and to the extent necessary to comply with laws relating to workers’ compensation or similar programs established by law that provide benefits for work-related injuries or illness without regard to fault. This includes programs established by the Black Lung Benefits Act, the Federal Employees’ Compensation Act, the Longshore and Harbor Workers’ Compensation Act, and the Energy Employees’ Occupational Illness Compensation Program Act. See 45 CFR 164.512(l).
To the extent the disclosure is required by State or other law. The disclosure must comply with and be limited to what the law requires. See 45 CFR 164.512(a).
For purposes of obtaining payment for any health care provided to the injured or ill worker. See 45 CFR 164.502(a)(1)(ii) and the definition of “payment” at 45 CFR 164.501.
Disclosures With Individual Authorization. In addition, covered entities may disclose protected health information to workers’ compensation insurers and others involved in workers’ compensation systems where the individual has provided his or her authorization for the release of the information to the entity. The authorization must contain the elements and otherwise meet the requirements specified at 45 CFR 164.508. http://www.hhs.gov/ocr...

The above will help you understand the relationship between HIPAA and WC. There actually is very little. HIPAA pertains to ''healthcare providers'', doctors, hospitals, and the like. NOT WC adjusters. While ER/IC and CA's are in need of medical information to determine the compensability of a claim, they are still bound to treat that information with the same protections of privacy as any other personal documents

When trying to apply any law to a given circumstance, it's important to appy all of the law...and not simply the paragraph, or sentence that may appear to directly apply. It would also be good to keep in mind that once a 'law' is enacted, the agency charged with enforcing that law is also charged with implementing the ''rules'' of application/enforcement, and those ''ccr's'' generally carry the weight of 'law'. On top of those too, there can be case law, and even though those apply to that one case/claim, there are also ''en banc'' decisions (in many jurisdictions) that are citable in court, and effectively change the law.

However you choose to view this situation... HIPAA does not apply to Workers Compensation. WC has generally been specifically exempted.

This led to a self-insures discussion, which it was concluded the employers can look your HPI at anytime and suffer little if any recourse.

Obama needs to make family coverage "out of house"