Where Does One Start?

[Loving Brother]

My brother recently required a hernia operation that cost him quite a bit, given his income level. His outside insurance company says they will do nothing because he claimed it happened at work. His work says they won't pay anything, and are now saying they would be very unhappy if he wanted to file a worker's comp claim because they would be assessed a penalty by corporate of $600 because they didn't file it within 48 hrs. Nice guy that he is, he doesn't want to see his branch 'dinged' but by the same token, it seems he should have some coverage on all of these bills.

Where does one start in this labyrinth of rules and regulations....a lawyer?

[stiffnecked]

He needs to file the Work Comp claim ASAP. Let the lawyers figure it out after that.

[hurt at work]

its not his fault they didnt do there job so to bad for them maybe they will learn something.if this is wc then get it filed ...............it might not hurt to talk to a lawyer,he should not be paying for anything if this is a work related injury.good luck hurt.

[capricorn]

I agree.

[jayne]

hernias are tricky.....talk to a certified WC lawyer now......it isnt fair for him to pay the bill and the next one if something goes wrong....normally if WC denys your other insurance should pick up

[hurt at work]

yes your own insurance will pick it up IF you are denied by wc so keep that letter that wc sends you if they deny your claim.if the wont pay for what you had done the hire a wc lawyer.it will get tricky if ur insurance picks up the bills as wc will owe your insurance that money back if you win the wc in court.im fighting this same issue right now.the employer can not force you to not file a claim for any reason..........by law they have to turn it in to wc to be looked at.hope this helps and good luck this sounds kinda shady on the employers part.hurt.

[bagpussinamerica]

You don't say whether or not he informed his employer of the accident when it happened. That will count as well. I assume someone at work must have been there to tell, or perhaps saw the accident. Of course I know some people work on their own, but it will mean alot of he actually reported it to his employer at the time.

[kate]

Loving Brother Wrote:... Nice guy that he is, he doesn't want to see his branch 'dinged' but by the same token, it seems he should have some coverage on all of these bills.

Where does one start in this labyrinth of rules and regulations....a lawyer?

You know the old saying "Nice guys finish last..."

He needs to report this as WC if it happened at work. Most states have very specific time periods in which a claim can be filed. Not knowing your state, I can't tell you what that time period is. But the longer he waits, the worse it will be.

[1171]

the way to avoid the $600 penalty was to file the claim timely not to get the employee to drop the claim.
some states require that a claim be filed by the employer whenever they have any knowledge of a work related injury -whether the employee wants to or not.
As an adult it's his choice and he's reponsible for the consquences of his decisions.
And, in my opinion, like the the employer you should let him make the decision.

[borninabarn]

Loving Brother,
I feel that the Employer should have been notified right away of the injury if it happened at work.The longer you take to report it no matter what! The weaker your case becomes of not having it reported by the injured.Good Luck!Born