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My employer denied my workers comp claim

Nurses   (2,076 Views 11 Comments)
by mclovin mclovin (Member) Member

mclovin has 3 years experience and specializes in ER.

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I just received a bill from the hospital I was working at as a registry nurse for what I believe was a workers comp case (i got a needle stick on the job). I called the hospital and they said that my employer denied the claim three separate times. I'm in California and all employers are legally entitled to providing their employees with workers compensation. The incident happened Sept 2013, I didn't fill out any forms, but I did immediately inform my employer, and the hospital obviously knew I was being triaged as a workers comp case (how could they not). In any case, am I at fault for not filling out any forms? Is my employer at fault for not informing me regarding the workers comp process? Or even denying my claim? Any insight/input is appreciated.

Thanks!

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roser13 has 17 years experience as a ASN, RN and specializes in Med/Surg, Ortho, ASC.

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We are always told that if no forms are filled out, you have no case. No paper trail. We are encouraged to always do the paperwork even if we're 99.9% sure that we have not suffered an injury.

Just curious: for a needle stick, why didn't you fill them out? And are you just now filing or has it taken this long for the claim process to wind down?

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mclovin has 3 years experience and specializes in ER.

44 Posts; 2,014 Profile Views

I had a previous needle stick with another employer (hospital employer) and I wasn't aware of any worker's comp paperwork that needed to be filled out. Everything was taken care of at that time. This time around with the registry I found out through billing, which has went through my employer and was denied, then it was sent to me. It doesn't sound right, especially when the billing department already knew to bill my employer instead of me. Also wouldn't my employer legally be entitled to having me initiate the workers comp process?

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roser13 has 17 years experience as a ASN, RN and specializes in Med/Surg, Ortho, ASC.

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"Also wouldn't my employer legally be entitled to having me initiate the workers comp process?"

 

Sorry - I don't understand the question. Could you re-state?

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bagladyrn is a RN and specializes in OB.

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I believe the word the poster is looking for is "obligated" rather than "entitled". Makes more sense that way.

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mclovin has 3 years experience and specializes in ER.

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Obligated, sure.

The thing I'm worried about is I was never informed by my employer to fill out any form for workers comp. So they may have the right to deny any claim. But shouldn't they be at fault for not having me fill out the correct paperwork?

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CrunchRN has 25 years experience as a ADN, RN and specializes in Clinical Research, Outpt Women's Health.

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If you didn't do the forms you are out of luck usually. It is the employees responsibility and obviously the registry doesn't care and the hospital doesn't consider you their emp.

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roser13 has 17 years experience as a ASN, RN and specializes in Med/Surg, Ortho, ASC.

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Thanks, bagladyrn! I looked at that word every which way and just didn't have a guess.

OP, I'm sorry for your situation. I'm wondering if being employed by the registry had anything to do with the ball being dropped.

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mclovin has 3 years experience and specializes in ER.

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Update: I called my employer and the person in charge is unavailable until tomorrow, but I did follow up with the department of workers comp, and a rep instructed that I call the hospital and request a letter of denial from my employer. I did so and the hospital finance department lady stated they do not have a written letter of denial from my employer (she sounded defensive). She went on to say "It was a verbal denial," then she said "We tried contacting them, but we were unsuccessful." After that I informed them it was illegal to bill me directly without this letter (according to labor code 3751:

3751. (a) No employer shall exact or receive from any employee any

contribution, or make or take any deduction from the earnings of anyemployee, either directly or indirectly, to cover the whole or anypart of the cost of compensation under this division. Violation ofthis subdivision is a misdemeanor. (b) If an employee has filed a claim form pursuant to Section5401, a provider of medical services shall not, with actual knowledgethat a claim is pending, collect money directly from the employeefor services to cure or relieve the effects of the injury for whichthe claim form was filed, unless the medical provider has receivedwritten notice that liability for the injury has been rejected by theemployer and the medical provider has provided a copy of this noticeto the employee. Any medical provider who violates this subdivisionshall be liable for three times the amount unlawfully collected, plusreasonable attorney's fees and costs.)Hopefully, once I speak with my employer all this will be taken care of.

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Esme12 is a ASN, BSN, RN and specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

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I am sorry you are going through this.....however as per the Terms of Service we cannot offer legal advice

[h=3]Legal Advice:[/h] ALLNURSES.COM, INC. or it's members do not offer legal advice. Any requests for such will be removed. If you have a legal problem, please seek legal counsel.

The laws vary greatly state to state, facility to facility, it would be best to contact a lawyer.

You might also check with OSHA.

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Ruby Vee has 40 years experience as a BSN and specializes in CCU, SICU, CVSICU, Precepting & Teaching.

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I had a previous needle stick with another employer (hospital employer) and I wasn't aware of any worker's comp paperwork that needed to be filled out. Everything was taken care of at that time. This time around with the registry I found out through billing, which has went through my employer and was denied, then it was sent to me. It doesn't sound right, especially when the billing department already knew to bill my employer instead of me. Also wouldn't my employer legally be entitled to having me initiate the workers comp process?

The fact that no paperwork was required with another employer does not excuse you from finding out at the time of the needlestick what paperwork was required with THIS employer. Some facilities give you up to a year to complete the paperwork. Perhaps you'll be lucky and that will be the case with this employer.

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