California Worker's Compensation - Help For Injured California Workers

• California Worker's Compensation - Quick facts about worker's compensation law, benefits and lawyer fees.

• California Worker's Compensation Resources - Links and resources for injured workers.

Results 1 to 5 of 5
  1. #1
    Join Date
    Feb 2012
    Posts
    3

    Default Worker Comp vs. Primary Medical Plan

    My workers compensation claim was made in the State of: California
    My primary medical insurance is asking if my recent visit with them is part of an auto accident during work. Am I obligated to provide this information? If I do not give them the information, what would happen? Thanks.

  2. #2
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,017

    Default Re: Worker Comp vs. Primary Medical Plan

    Of course you must divulge the reason for your claim on GHP/Group Health Plan, work injury is expressly exempt from coverage in GHP.

    If the injury is from MVA and work related, your ER's WC coverage should be providing benefits/treatment. They will place a lien on any recovery you may see from the PI/MVA case. Refusing to cooperate with the GHP could/would result in denial of coverage.

  3. #3
    Join Date
    Feb 2012
    Posts
    3

    Default Re: Worker Comp vs. Primary Medical Plan

    Thank you for your reply. I understand that primary insurance wants to recoup their cost from WC insurance. Could primary insurance use the WC medical info one provides to them to later (down the road) deny treatment for reasons that future medical issues resulted from a previous WC injury?

  4. #4
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,017

    Default Re: Worker Comp vs. Primary Medical Plan

    Yes. Your GHP covers you, and non industrial injury/illness....your ER is responsible for treatment to your work injury.
    Knowing your GHP expressly exempts coverage for a work injury, and permitting a provider to bill for services could be construed as an attempt to defraud the GHP...you don't want that to happen.\

    If anyone at the GHP tells you to go ahead and use the coverage... GET IT IN WRITING.
    If you settle the WC claim, and take a lump sum payment for future medical reibursement, then use the GHP, it would be double dipping...again, fraud.

  5. #5
    Join Date
    Feb 2007
    Location
    florida
    Posts
    625

    Default Re: Worker Comp vs. Primary Medical Plan

    If you knowlingly do not provide information that is essential to the payment of benefits, then you are committing insurance fraud. You can be prosecuted for this crime.

Similar Threads

  1. Medical Malpractice Against Worker's Comp
    By Rvan1961 in forum California
    Replies: 2
    Last Post: 08-03-2011, 07:30 PM
  2. Replies: 11
    Last Post: 04-18-2010, 08:07 PM
  3. Second Job with Workers Comp from Primary Job
    By mimitippitt in forum Mississippi
    Replies: 1
    Last Post: 03-15-2010, 03:08 AM
  4. Can't Find Primary Physicial Who Accepts Comp
    By injured on the job in forum Medical Issues
    Replies: 0
    Last Post: 01-28-2010, 03:18 PM
  5. Replies: 0
    Last Post: 07-01-2005, 01:43 PM

Bookmarks

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
 


Find a Lawyer