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Who pays for care
#1
California Claim.

Injured workers has a 71 % disability to her neck. P and S moves on with life. Keeps medical open .10 year old claim.

 While hanging Christmas lights on her house she falls off a ladder and lands on her head .. now needs more neck surgery 

Who pays for care ? Comp or Private Insurance? Or both ? 

Thanks
 
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#2
Unless she was employed to hang the lights this was not a work injury. there is no employer to cover the new injury.
Workers comp is for on the job injuries.
You must be confusing an injury with a body part. An injury is an event/accident. A body part can be injured many separate times each with different coverages and liabilities.
The employer has the coverage not the worker. The employer is protected from a worker's claim. Comp is not health insurance. The neck is not covered by comp; only the results of the prior on the job incident. The new medical problems are not due to the original event with the prior employer.
That's why patient history and causation are so critical To work comp claim investigation.
The employer only pays for claims due to accidents during their job. not to prior conditions or problems that occur afterwards. Always look at the cause not the body part; cause determines whether it's comp or not.
Signature/Reminder :
........Each state has their own comp system; POST YOUR STATE to get accurate information.........
 
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#3
(07-10-2017, 11:42 AM)1171 Wrote: Unless she was employed to hang the lights this was not a work injury. there is no employer to cover the new injury.
Workers comp is for on the job injuries.
You must be confusing an injury with a body part. An injury is an event/accident. A body part can be injured many separate times each with different coverages and liabilities.
The employer has the coverage not the worker. The employer is protected from a worker's claim. Comp is not health insurance. The neck is not covered by comp; only the results of the prior on the job incident. The new medical problems are not due to the original event with the prior employer.
That's why patient history and causation are so critical To work comp claim investigation.
The employer only pays for claims due to accidents during their job. not to prior conditions or problems that occur afterwards. Always look at the cause not the body part; cause determines whether it's comp or not.


Thank you ..good answer.
 
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#4
its a common confusion: the definition of injury and that comp is the employers insurance/protection & not the workers.
In every day life, the one that buys the insurance (auto, health, home owners, etc. gets the $$.
In comp the worker gets the benefits so the employer doesn't get sued in civil court.
Signature/Reminder :
........Each state has their own comp system; POST YOUR STATE to get accurate information.........
 
Reply
#5
(07-10-2017, 04:46 PM)1171 Wrote: its a common confusion: the definition of injury and that comp is the employers insurance/protection & not the workers.
In every day life, the one that buys the insurance (auto, health, home owners, etc. gets the $$.
In comp the worker gets the benefits so the employer doesn't get sued in civil court.

Right ..so it is possible to have a work related injury covered under private insurance in the event of a new non industrial accident ..then private insurance takes over? I wonder if this would be subrogated ?
 
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#6
When the cause/liability issue is in dispute private health is often the primary payer. They have Lien rights for their costs with the comp court.
Signature/Reminder :
........Each state has their own comp system; POST YOUR STATE to get accurate information.........
 
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