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Workers Comp Claim For Mom

Workers Compensation Law Discussion

Workers Comp Claim For Mom

Postby Cyndeyrn » Fri Dec 09, 2016 10:57 am


My mother slipped and fell on ice yesterday at work, while on break.  She has a severe break in her wrist.  She went to the ER, and is scheduled for follow up with the orthopedic surgeon in 2 days, with surgery to follow this week.

She was taken my ambulance to the hospital that the company uses for Workers Comp claims, but has not received or filled out any paperwork for workers comp.  Can she continue care with the orthopedic surgeon she saw at the ER, or does she need a referral to a specific Dr?  How do we proceed with the claim?  The company seems a bit confused themselves.

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Joined: Mon Jan 06, 2014 10:17 am

Workers Comp Claim For Mom

Postby Richmond » Sat Dec 10, 2016 1:23 am

Cheri, not sure in which state your mother's accident occurred, but if it involves ice, it didn't happen in Florida(which is where I am).  Your mother's claim should be covered under your state's workers compensation laws.  If she works for a hospital, which is usually a fairly large employer, they should be well versed in how to process a workers compensation claim.

Generally, workers comp will provide two main benefits - medical care and a wage benefit while your mother is unable to work.  The amount of the wage benefit varies from state to state but it is usually about 2/3 of her average weekly wage.

To answer your questions:

1. Can she continue care with the orthopedic surgeon she saw at the ER, or does she need a referral to a specific Dr? More than likely, the workers comp insurance company will want her to go to an orthopedic of their choosing.  In Florida, the insurance company gets to choose the initial medical provider.  Your state may be different.

You should contact the hospital's HR dept and have them fill out an incident report(called a 1st Report of Injury in Fla.)  This form is then sent to the Ins Co. who will get a claim set up, and contact your mother to get a doctors appt set up.  If the hospital won't do it, you can often find the name of the employers workers comp insurance company online thru your state, and report the claim yourself.  However, its better to go thru the employer.

Normally you need a referral to a specialist in workers comp, but because of the severity of the injury, the hospital recommendation to follow up with an orthopedic should be sufficient.

2.  How do we proceed with the claim?

Contact the hospital HR dept and ask them to help you get a claim set up.

3.  The only issue in your mothers case is that she was on break when the accident happened.  If it was a simple 10 minute break where she went outside to get some fresh air, worker comp should cover the injury.  If it was something more substantial, i.e. she left the premises and went to the local mall to shop for 1/2 hour - 1 hour, workers comp most likely will not cover it.  If for some reason WC denies the claim, she can always use her health insurance to get medical care.

4.  Lastly, once she finishes treating with the doctors, she may be entitled to a settlement where the insurance company will pay her a lump sum settlement to close out her case.

Workers Comp can be confusing, and extremely frustrating.  I recommend you contact an attorney in your area to make sure your mother gets all the benefits to which she is entitled.

Joseph M. Maus

The Maus Law Firm

(866) 556-5529http://www.mauslawfirm.com
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