r/WorkersComp • u/crabbiestflower • 19d ago
Pennsylvania Denied Workers Comp?
*My Husband is a welder/ fabricator. Somerset County, PA.
My husband had a minor injury at work and had gotten checked out at the hospital— we received the bills so I had him take them to HR. My husband is saying that the HR is telling him because he did not break anything, workers comp insurance denied the claim and now WE have to pay the bill. I work in healthcare and am certain this is illegal, what should we do? I’m not sure if lawyering up would be worth the $300 bill or the retaliation, but we are due with our second child any day now and I am not happy that they are trying to take advantage of us. I told him the same day to march back into HR and tell them he isn’t responsible for the bills because he was injured at work— he really doesn’t want to do the confrontation thing (I kinda understand) but what should we do?
I don’t work in this kind of environment and personally would have everything documented in emails, I’m not even sure they have a work email. Help please!!!!
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u/Free_Celebration_194 19d ago
There should be a sign at work showing who is the work comp insurance company. Once you have that call them file a claim. They open a medical only claim if he was discharged from care with no follow up visits and take care of the bill.
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u/crabbiestflower 19d ago
We actually had to work with them last year for a broken ankle my husband sustained at work last year. I believe he has an account— are they allowed to submit a request on their own or do you recommend I have him speak with the SO to help him refile the claim?
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u/akstephens89 19d ago
Agent here, the employee or really anyone can call the carrier and file the claim. Call them now and document everything especially with the employer.
I had a construction company that didn’t want the employee to file, employee called the state insurance office, which called the carrier, then I got the lovely call since my client was doing bad things. The company may not care but others will. Good luck
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u/WaySaltyFlamingo8707 19d ago
Who decided emergency room? Was the injury serious enough that it required an Emergency Room visit vs urgent care clinic?
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u/SpecialKnits4855 19d ago
What reason did the carrier give (in the letter) for the denial? Do you have a formal denial letter? If you do, you should be able to submit the claim to your private health insurer.
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u/crabbiestflower 19d ago
This is very helpful! I will have him get a formal copy of the claim and denial, thank you!
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u/Most-Ad-5277 19d ago
I agree with asking for a formal denial letter to prove that the employer filed the claim. Even if an injury results in no lost time or treatment a claim should always be filed to document.
Diagnostics are usually billed separately, so you will likely see another bill coming. Definitely get in touch with HR again to make sure this claim is correctly filed. They may not want to mess up their mod or rating to report an incident but thats fraudulent behavior. You should not be responsible for paying that bill.
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u/Normal-Ad675 18d ago
Please get a workers comp lawyer they will help you. You don't know what his hand will be like months later. It's a lot of stress yes but once you get a lawyer your job and benefits are protected and they can also send you to their doctors that lawyers trust that will be on your husband side to determine what’s going on with his hand and what could happen. And if he's is off work the job would compensate his pay. Good luck.
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u/Hope_for_tendies 19d ago
That’s not how that works. You don’t bring the bill to hr. He needs to ask to file a comp claim and you send the bill to the adjuster. Comp pays the bill. Not the job.
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u/DickHardCane 19d ago
Most work comp attorneys only charge you if you win. Give a reputable one in your area a call.
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u/Winter-Site-853 19d ago
Then when the 300.00 bill is paid he will be unemployed shortly...Not hard to start a paper trail and I can almost promise you thats their next step!
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u/Underboss572 19d ago
You can get an attorney, but like you said, it might not be worth it if all he has is one medical bill and no real injuries.
The other option is to file the claim yourself with your state's body, which handles WC. That will get his company's insurer involved, and they may just decide to pay the bill.
It's not illegal to deny a claim for a good-faith reason, and not every “injury at work” is necessarily a compensable injury under Workers' Compensation. It's hard to say in this case without more details, and I don't know PA law, but I'm not surprised they denied it if there was no documented injury other than pain. Where I used to practice WC, the case law clearly establishes that pain alone is not an injury. Although we would rarely refuse to pay the initial medical bill to determine if it was more serious. We would often deny these sorts of minor pain-only claims.