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Employee medical costs not covered by Worker's Compensation
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Employee medical costs not covered by Worker's Compensation
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We have had a few situations where our policy is that if an employee passes out we call 911 and they are transported to the hospital or if we feel that an incident needs further medical attention
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Forums » Topic Forums » Legal Forum » Employee medical costs not covered by Worker's Compensation
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Employee medical costs not covered by Worker's Compensation
posted at 8/13/2012 1:07 PM EDT
on Workforce Management
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Posts: 2
First: 8/13/2012 Last: 8/15/2012 |
We have had a few situations where our policy is that if an employee passes out we call 911 and they are transported to the hospital or if we feel that an incident needs further medical attention we insist the employee goes for medical attention. Our issue comes into play when Worker's Comp. rejects the claim due to pre-existing condition or other non-work related issue. The employee comes to HR saying they don't have insurance and didn't want to go but the company insisted, can we help with the medical expense. I would like to know what other company practices are relating to this type of issue. Do you pay the expense; if so up to a certain $ amount? Do you refuse to pay? It is much more difficult when you know the employee and their financial situation. We are trying to decide how to move forward with this. We have 100 employees and very few incidents maybe 1 a year. I would appreciate any information. Thanks! |
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Re: Employee medical costs not covered by Worker's Compensation
posted at 8/13/2012 1:44 PM EDT
on Workforce Management
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Posts: 148
First: 9/29/2011 Last: 12/10/2012 |
Definitely a situation of being between a rock and a hard place. Does your company offer medical insurance and the employee declined it? If so, then I think this is totally on the employee. You have a case in which an employee passed out and, given the potential liability of not doing anything, you took a prudent course of action. I don't think you have any reason to reimburse the employee - had this happened out of the workplace and an ambulance was called, you would not feel any responsibility for paying for any of the costs of care. It's just bad luck that it happened at work. |
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Re: Employee medical costs not covered by Worker's Compensation
posted at 8/14/2012 10:01 AM EDT
on Workforce Management
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Posts: 127
First: 9/21/2011 Last: 11/12/2012 |
Agree that I've never seen an employer reimburse. That is what personal insurance is for. Is health coverage available and the employee chose not to get it? Or is it not available? That said, I personally have to be careful with anemia. In the past, I have almost passed out due to that which is not a reason to need an ambulance. An ambulance would be way overreacting. Of course hindsight is 20/20, so when the issue of payment comes up you all know whether it was serious or not, but you can't know that at the time and it's easy to question why the ambulance was called for something minor. For the future, what I would look at is whether are times that someone passing out WOULD ever be covered under WC. Depending on your line of business, I could see that being a never or it could be a possibility. Is WC always rejecting the claim? If that is something that you know, then you might consider some type of alternative that the employee could pre-choose (notarized waiver perhaps...check with local counsel on this one) You are between a rock and a hard place. You have to overreact due to the liability of underreacting. So consider if and how you can limit that liability while still taking the employer's and employee's needs into account. |
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Re: Employee medical costs not covered by Worker's Compensation
posted at 8/15/2012 12:19 PM EDT
on Workforce Management
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Posts: 2
First: 8/13/2012 Last: 8/15/2012 |
In Response to Re: Employee medical costs not covered by Worker's Compensation: Agree that I've never seen an employer reimburse. That is what personal insurance is for. Is health coverage available and the employee chose not to get it? Or is it not available? That said, I personally have to be careful with anemia. In the past, I have almost passed out due to that which is not a reason to need an ambulance. An ambulance would be way overreacting. Of course hindsight is 20/20, so when the issue of payment comes up you all know whether it was serious or not, but you can't know that at the time and it's easy to question why the ambulance was called for something minor. For the future, what I would look at is whether are times that someone passing out WOULD ever be covered under WC. Depending on your line of business, I could see that being a never or it could be a possibility. Is WC always rejecting the claim? If that is something that you know, then you might consider some type of alternative that the employee could pre-choose (notarized waiver perhaps...check with local counsel on this one) You are between a rock and a hard place. You have to overreact due to the liability of underreacting. So consider if and how you can limit that liability while still taking the employer's and employee's needs into account. Posted by rrupert The employees are part time or seasonal and therefore not covered by our Health insurance policy. They do not have personal health insurance to submit the claims to. This is the reason we have been willing to help out when the bills have only been for a small amout but we are afraid of the potential of some large expenses and would like to have a policy in place. |
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Re: Employee medical costs not covered by Worker's Compensation
posted at 8/15/2012 12:46 PM EDT
on Workforce Management
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Posts: 148
First: 9/20/2011 Last: 12/12/2012 |
In Response to Employee medical costs not covered by Worker's Compensation: We have had a few situations where our policy is that if an employee passes out we call 911 and they are transported to the hospital or if we feel that an incident needs further medical attention we insist the employee goes for medical attention. Our issue comes into play when Worker's Comp. rejects the claim due to pre-existing condition or other non-work related issue. The employee comes to HR saying they don't have insurance and didn't want to go but the company insisted, can we help with the medical expense. I would like to know what other company practices are relating to this type of issue. Do you pay the expense; if so up to a certain $ amount? Do you refuse to pay? It is much more difficult when you know the employee and their financial situation. We are trying to decide how to move forward with this. We have 100 employees and very few incidents maybe 1 a year. I would appreciate any information. Thanks! Posted by sgrim2111 Two points to consider. First, if the company agrees that it should pick up the cost when an employee passes out or has a pre existing condition, would that affect how the company makes the decision to request medical assistance? I hope the answer is no Second, if the incident were to happen on the street and a "good samaritan" were to do the same thing, would the samaritan have any economic liability? I doubt it. |
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Re: Employee medical costs not covered by Worker's Compensation
posted at 8/15/2012 1:42 PM EDT
on Workforce Management
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Posts: 148
First: 9/29/2011 Last: 12/10/2012 |
Sgrim: I think you may be on a very slippery slope here. If you occasionally pick up the costs of medical care for uninsured employees, at what point do you say "yes, we will cover the costs" or "no, we won't"? Are you going to base that decision on cost? Extent of the injury/condition? What about the tax consequences to the employee - are you reporting payment of the medical bills as income? I can also see how you can be on the receiving end of some discrimination complaints because you provided more medical costs to one particular gender/ethnic origin/race/etc than others. There are multiple reasons why you're getting several "never done that" types of responses here. Your company's heart is in the right place, but as one old boss of mine said "In HR, no good deed goes unpunished." You have to ask yourself if the potential messes you could get yourself into is worth the good will. Perhaps you should check with your insurance broker to see if there is some kind of low cost insurance available for your seasonal/part time employees. But absent that, I'd end your practice of paying for uninsured employee healthcare until such time as our national healthcare program goes into effect. |
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Re: Employee medical costs not covered by Worker's Compensation
posted at 8/16/2012 11:45 AM EDT
on Workforce Management
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Posts: 9
First: 10/22/2011 Last: 9/8/2012 |
There are other situations where passing out in the workplace does not call for an ambulance. Very short seizures are another, or with a known diabetic who is unstable. Talking with the employee about their problem, and seeing if you can get an understanding of when an ambulance should and should not be called would be a good start. I would talk with your attorney about this as well. I suspect that if you call an ambulance when it is clearly not indicated as discussed previously, there could be some liability. You also need to seriously consider safety issues here. What is the employee's job? Is s/he working with machinery? Up on ladders? Driving? Unexpected unconsciousness can cause injury or death to the employee passing out, coworkers, bystanders and/or members of the general public, depending on job duties. I would have an additional discussion about this issue with your safety professionals, insurance carrier and attorney. |
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Re: Employee medical costs not covered by Worker's Compensation
posted at 8/16/2012 6:22 PM EDT
on Workforce Management
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Posts: 148
First: 9/20/2011 Last: 12/12/2012 |
In Response to Re: Employee medical costs not covered by Worker's Compensation: There are other situations where passing out in the workplace does not call for an ambulance. Very short seizures are another, or with a known diabetic who is unstable. Talking with the employee about their problem, and seeing if you can get an understanding of when an ambulance should and should not be called would be a good start. I would talk with your attorney about this as well. I suspect that if you call an ambulance when it is clearly not indicated as discussed previously, there could be some liability. You also need to seriously consider safety issues here. What is the employee's job? Is s/he working with machinery? Up on ladders? Driving? Unexpected unconsciousness can cause injury or death to the employee passing out, coworkers, bystanders and/or members of the general public, depending on job duties. I would have an additional discussion about this issue with your safety professionals, insurance carrier and attorney. Posted by slccom Managers and HR people are not medical experts nor should they be making decisions based on someone's medical history. Talking to the people and asking medical questions could easily be a HIPPA issue. If an employee passes out I am calling 911 every time and not trying to evaluate reasons or issues. After all what if the evaluation is wrong? |
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Re: Employee medical costs not covered by Worker's Compensation
posted at 8/23/2012 1:41 PM EDT
on Workforce Management
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Posts: 9
First: 10/22/2011 Last: 9/8/2012 |
Part of reasonable accommodations includes talking about what is happening with medical conditions. If the person explains to coworkers and HR that they have grand mal seizures and asks that the ambulance not be called unless the seziure lasts so long, this is not a HIPAA issue, nor is it involving any kind of medical evaluation,. The same with diabetic blood sugar dips. There should be no HIPAA issues when the person with the disability issue raises their needs to not be transported to the hospital every single time unnecessarily. |
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