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  1. #1
    Join Date
    Feb 2009
    Posts
    2

    Default A Question of Eligibilty

    I injured my cervical spine at work last April 2008. I never filed a W/C claim or injury/incident report because I thought it was something I could manage on my own using my health insurance. I did however tell the E.R. doctor and all the other doctors involved that it happened at work . My boss and coworkers are all aware that it happened at work as well. I was out of work for a month, went back on light duty for 6 weeks and was out again for nearly 3 months. I went back part time a few months ago and now my symptoms are getting worse. I am currently out again until god knows how long.

    I am confused about what my options are. Am I eligible to claim W/C this far into the injury and without ever filing any claim this far? My employer has been really good about all the time I have had to take off, but I am not sure if there are alterior motives behind that. I have tried to be a good employee as they are a great company to work for. I feel like I am letting my coworkers down every time I am out with pain and on pain meds. As a nurse there is no way I can go to work on pain meds. Did I screw myself for trying to be prudent?

  2. #2
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    17,943

    Default Re: A Question of Eligibilty

    It would stand to reason your ER would not be upset here... by using your personal health care coverage you are releiving the ER for the liability of the cost to treat you...and, you are not receiving temporary disaability benefits for the time you are off work due to your injury. This means the ER's WC policy premiums have not been affected.

    By using your own coverage and knowing this is a work related injury, you are attempting to shift liability to the other IC vs your ER. That is why the laws mandate you report a work related injury to the ER, and the ER file the claim with their IC.

    You, and your private pay coverage are not liable for any of these costs to treat you.
    Now you need to file the claim with your ER, the private pay IC will file a lien for costs they have advanced, and your out of pocket costs are a 'maybe'....because only the treatment that is medically necessary and reasonable to the injury are compensable when the claim is accepted.

    I am confused about what my options are. Am I eligible to claim W/C this far into the injury and without ever filing any claim this far?
    If you are within the SOL for filing a claim....
    Notify your ER, and they will handle filing the claim with their IC.

    MA WC information is here...http://www.mass.gov/?pageID=elwdsubt...Claim&sid=Elwd

    Instructions for filing a claim is here...http://www.mass.gov/?pageID=elwdterm..._how&csid=Elwd

    I have tried to be a good employee as they are a great company to work for. I feel like I am letting my coworkers down every time I am out with pain and on pain meds
    I don't know that there is 'prudence' here... you were injured on your job, you are entitled to benefits under your ER's WC plan... be a good EE and file your claim.
    Your ER is covered for this loss, and that's what they pay a premium for.

  3. #3
    Join Date
    Feb 2009
    Posts
    2

    Default Re: A Question of Eligibilty

    What do you mean by SOL?

    Today I spoke to a lawyer who did not sound very hopeful that I had a case. Told me to get a second opinion because the initial injury was last April and it would be too difficult to link my current condition to last April ??? Does this sound right?

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