Denied Claim

[bob28607]

Let me start by saying that I have an old back injury from 2006. In January 2012, I was injured while helping my employer move 2 stone benches. We got them from his mother's house in Virginia on Saturday, and brought them back to his house in NC and unloaded them on Sunday. I was paid for both days in my regular paycheck. My back started hurting mildly on Saturday while loading them up into his truck, and even worse on Sunday, after unloading them at his house. These benches are about 4-5 feet long, and about 5-6 inches thick. It was just he and I lifting them the first day, and his stepson helped us on the second day. Anyways, his worker's comp insurance company is saying that it occurred outside of the course and scope of employment. They offered a settlement to keep it from going to trial, which equals about 2 months of TTD, and the cost of the physical therapy that was recommended by the doctor. It's rather measly, considering that I had only been working for the guy for about 2 months, and that was part time because it was during the winter months. (We do property maintenance) Anyways, what should I do? I feel like I'm getting a raw deal here. Should I take the little money now, or risk going to court and not getting anything? I mean, I can't lose what I don't already have...

[1171]

whether you can win at a comp hearing depends on the facts.
did both you and your employer have a mutual understanding that you were working as an employee rather then as a friend or as a favor?
did you both agree beforehand that you would be paid your regular pay?
was it both your understandings that you were acting as an employee?
will your employer's statements support your employment and comp coverage position?

whether you should accept the settlement depends on how much you think you would get if they accepted the claim.
is the amount offered less then the time you were disabled and the amount you paid for treatment?

[bob28607]

According to the carrier's attorney, my employer thought I would be covered for the work that I was performing on those days. It was typical for me to drive to his house in the morning, and that's where we would meet to start the day. He also had paid me before for doing work around his house doing things like weeding, cleaning gutters, putting up Christmas decorations, and helping him clean his basement. I'm not one to complain about what work I'm doing, as long as it's work, and I'm getting paid. It was strange to help him do Christmas decorations, but it was work. My TTD checks equal about 115 a week, and they offered 4200. Workers comp paid me for about 2 months, and then denied the claim.

[1171]

if the employer thought you were covered and you were acting as his employee at the time of the injury, then the carrier is on the hook as you are covered under state workers compenstion laws as an employee.
their own policyholder's testimony will support your claim at a comp hearing.
you may not have been functioning within the occupation they thought you were but that is not your problem and does not entitle them to reject benefits for your injury.
covered employment is not determined by the carrier's billing or underwriting unit but by the provisions of the state's work comp code.
it's up to the carrier to price the risk correctly on their end and not to deny coverage for legal employment on your end.

[kwhite48]

Very important.

Did employer know about your previous injury? If they're smart they'll say that the old injury was a re-injury. Or that you had never told them about it before working for them.
I had an injury in 08 and at first "forgot" about it. But have since told them, because I was paranoid as hell about if they found out etc.

Here's another story. A person for the post office 17 yrs. Had seizures. they ask did you have before? Yeah about 20 years ago. wow, you never told us that on your application. Fired, no unemployment, no coverage, no nothing accept a George W Bush kick in the pants. Which comes with the tshirt if you live in texas.

(07-07-2012 07:04 PM)bob28607 Wrote:  Let me start by saying that I have an old back injury from 2006. In January 2012, I was injured while helping my employer move 2 stone benches. We got them from his mother's house in Virginia on Saturday, and brought them back to his house in NC and unloaded them on Sunday. I was paid for both days in my regular paycheck. My back started hurting mildly on Saturday while loading them up into his truck, and even worse on Sunday, after unloading them at his house. These benches are about 4-5 feet long, and about 5-6 inches thick. It was just he and I lifting them the first day, and his stepson helped us on the second day. Anyways, his worker's comp insurance company is saying that it occurred outside of the course and scope of employment. They offered a settlement to keep it from going to trial, which equals about 2 months of TTD, and the cost of the physical therapy that was recommended by the doctor. It's rather measly, considering that I had only been working for the guy for about 2 months, and that was part time because it was during the winter months. (We do property maintenance) Anyways, what should I do? I feel like I'm getting a raw deal here. Should I take the little money now, or risk going to court and not getting anything? I mean, I can't lose what I don't already have...

[1171]

not smart.
a re-injury is still an injury and covered by their workers comp.

falsifying an application can be grounds for termination--always has.
and certain jobs especially those that might endanger public safety would require a seizure condition be disclosed.

I wouldn't want to fly with such a pilot or have my kids ride a school bus with such a driver.

that's not bad behavior by an employer to protect me and others from
someone who's taking an unnecessary risk with the lives of others.

maybe your story need more details ....
there is always another side to a story.

[bob28607]

I never filled out an application. The only application process was doing a day's work for the guy, and he chose the best out of three. I told him later on during the course of my employment that I had a previous back injury/workers comp claim, but that I was alright now. But, he also stated that he had a previous back injury too, and he was doing the same work.

[jayc123]

sounds like its time for an attorney. are you still working for him or are you able to work?

[bob28607]

I'm out of work. I'm in the process of sending emails back and forth to their attorney.

[bob28607]

If I sign the settlement agreement, does that only release him as an employer? Can I still sue his homeowners insurance since workers comp says it "was out of the course and scope of my employment"?