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  1. #1
    Join Date
    Jul 2011
    Posts
    1

    Default Using Kaiser for Work Related Injury

    Hello everyone,

    My story is I got injured at work 3 weeks ago where a 400-lb dumpster enclosure gate fell on me and fractured my foot. My husband brought me to Kaiser ER because I am under his insurance. I got seen and had to be put on a splint and crutches. I just called my boss about the injury the same day as she was out of the office that day. I got referred to Occupational Medicine two days after since it was work related. I saw the workers comp MD and he placed me off work for 2 weeks. I gave my boss the DWC form for her to fill up but it turns out that she is uninsured! When the worker's comp MD found out about it, he said he cannot see me anymore since my boss was uninsured. He advised me to continue seeing my PCP/ortho for continued treatment since I am a member of Kaiser anyways. I saw the ortho guy again and he put me off work for another 4 weeks because the fracture is not healing. BTW, my boss verbally told me that she is willing to pay for all the expenses. I am also aware of the Uninsured Employers Fund. It just sounds too complicated and we have called a couple of law firms and they said they dont specialize in that. My question is, is it okay to use your own health insurance for a work related injury? How will I get reimbursed if I use my own health insurance?

  2. #2
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,011

    Default Re: Using Kaiser for Work Related Injury

    My question is, is it okay to use your own health insurance for a work related injury? How will I get reimbursed if I use my own health insurance?
    Yes..it is difficult.
    You are not boing to be paid TTD when any Dr say you are TTD... nor would they if you brought in a case load. Everything is preemity misxed...
    So..go awaay.


    ******** Monitoring**********
    Be aware this isn't Bvia

    Tony
    Last edited by tony; 07-02-2011 at 02:11 PM.

  3. #3
    Join Date
    Oct 2006
    Posts
    9,108

    Default Re: Using Kaiser for Work Related Injury

    if your health plan is aware that it is a work injury and they are willing to treat you then yes it is ok.
    maybe your boss will reimburse you.

    Bvia:
    if you can't helpl don't post.

  4. #4
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,011

    Default Re: Using Kaiser for Work Related Injury

    Bvia:
    if you can't helpl don't post.
    My question is, is it okay to use your own health insurance for a work related injury? How will I get reimbursed if I use my own health insurance?
    Yes..it is difficult.
    You are not boing to be paid TTD when any Dr say you are TTD... nor would they if you brought in a case load. Everything is preemity misxed...
    So..go awaay.
    That is NOT my response to this thread... I wasn't even home at the time it was posted...and, that response is not even related to the question...

    ---------- Post added at 06:18 AM ---------- Previous post was at 06:12 AM ----------

    The comp Dr you saw is not in any position to offer advice, legal or otherwise about a work injury claim, or what insurance coverage to use.
    BTW, my boss verbally told me that she is willing to pay for all the expenses. I am also aware of the Uninsured Employers Fund. It just sounds too complicated and we have called a couple of law firms and they said they dont specialize in that.
    Your ER is committing a fraud...it is illegal not to be covered by a liability policy/WC, or be self insured...it's not your option whether or not to file as the law requres...
    Kaiser is probably the first carrier to include exclusion of work injury in their GHP's... they can and will deny coverage, and billing. Other IC's even use Kaisers language in the EOC/Evicence Of Coverage....

    If your husbands GHP/Kaiser claims adjuster says "yes" to the coverage...get it in writing...or it does not exist.
    My question is, is it okay to use your own health insurance for a work related injury? How will I get reimbursed if I use my own health insurance?
    You won't be reimbursed unless you follow the law and file with the WCAB and UIF... nor would you be paid for TTD/wage replacement... WC is not an option, it's the law.

  5. #5
    Join Date
    Nov 2010
    Posts
    40

    Default Re: Using Kaiser for Work Related Injury

    Quote Quoting reign View Post
    Hello everyone,

    My story is I got injured at work 3 weeks ago where a 400-lb dumpster enclosure gate fell on me and fractured my foot. My husband brought me to Kaiser ER because I am under his insurance. I got seen and had to be put on a splint and crutches. I just called my boss about the injury the same day as she was out of the office that day. I got referred to Occupational Medicine two days after since it was work related. I saw the workers comp MD and he placed me off work for 2 weeks. I gave my boss the DWC form for her to fill up but it turns out that she is uninsured! When the worker's comp MD found out about it, he said he cannot see me anymore since my boss was uninsured. He advised me to continue seeing my PCP/ortho for continued treatment since I am a member of Kaiser anyways. I saw the ortho guy again and he put me off work for another 4 weeks because the fracture is not healing. BTW, my boss verbally told me that she is willing to pay for all the expenses. I am also aware of the Uninsured Employers Fund. It just sounds too complicated and we have called a couple of law firms and they said they dont specialize in that. My question is, is it okay to use your own health insurance for a work related injury? How will I get reimbursed if I use my own health insurance?
    If you have an uninsured employer, you may want to consider having a lawyer litigate it as a PI claim. You may have that right since there is no workers comp. jurisdiction. You may get a better settlement by going that route too. At least, if a Complaint gets filed in Superior Court, they only have 30 days to answer and it would cost them lots of legal fees to defend their litigation rather than them doing what lots of DA's do and that is to drag the Workers Comp. case on for years.

  6. #6
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,011

    Default Re: Using Kaiser for Work Related Injury

    If you have an uninsured employer, you may want to consider having a lawyer litigate it as a PI claim. You may have that right since there is no workers comp. jurisdiction. You may get a better settlement by going that route too. At least, if a Complaint gets filed in Superior Court, they only have 30 days to answer and it would cost them lots of legal fees to defend their litigation rather than them doing what lots of DA's do and that is to drag the Workers Comp. case on for years.
    Filing a claim with the ER for WC benefits is the exclusive remend...there is a reason for the UEF/Uninsured Employers Fund...to pay benefits where the ER is not leagally covered by a WC liability policy as required by law... the UEF goes after the ER.

  7. #7
    Join Date
    Nov 2010
    Posts
    40

    Default Re: Using Kaiser for Work Related Injury

    Quote Quoting BvIA View Post
    Filing a claim with the ER for WC benefits is the exclusive remend...there is a reason for the UEF/Uninsured Employers Fund...to pay benefits where the ER is not leagally covered by a WC liability policy as required by law... the UEF goes after the ER.
    This is not so, BvIA! Perhaps you should look at Labor Code Section 5500.5(a). This section decribes the right of an injured worker whose employer does not have insurance to cover them, to litigate via a civil complaint in Superior Court.

    Having been through hell with the Defendant's attorney doing everything possible to delay my case that has taken over 3 years thus far, I would have filed a civil action based on 5500.5(a) if I had it to do over again.

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