Fired from work after injury, insurance denying coverage...

by A

I started a new job in Sept 2013, as a surgical technologist in labor and delivery, after being out of work for 3 years. On Dec. 1, 2013 on a busy night I was walking quickly behind the nurses station and accidentally stepped on the leg of a rolling chair. The chair went one way and my foot/ankle went the other, twisting and stretching.

The charge nurse saw the incident and requested I fill out an injury report and asked if I wanted to go to the ER. I filled out the report but did not seek medical treatment because I thought the injury was not that bad. It was very sore but not that bad to go to the ER.

I told her if I needed I would see my own Dr. I kept my foot elevated as much as I could during the rest of my shift and was walking with a limp. I had the next day off so I figured I would be fine. I received a call from employee health asking how I was and what happened. I told them I was sore but am keeping off it today. They said if I needed to seek medical treatment I should.

I was in my "probationary period" and I didn't want to loose my job, but the pain was getting worse. I was about to make an appointment with my dr when I was fired on Dec 29, 2013. I was devastated and not thinking about the pain in my foot at that point.

I applied for unemployment and was denied because I didn't work 2 quarters. After the shock of being fired settled in after a couple of days, I thought now at least my foot would heal since I was off it.

Jan and Feb passed still having pain and in March I made an appointment with my PCP for April. He wanted me to see a foot and ankle specialist and have an EMG, since I was having pins and needles as well as pain. My insurance denied the EMG, stating this was a work related injury.

In May I went to the specialist and told her what happened. She sent me for an MRI which was denied by my insurance as well, but I went anyway. The pain was getting unbearable.

The MRI found a partial tear in the medial cord of the plantar fascia, an "atypical plantar fibroma", a bone island in the medial cuniform bone, and synovial cyst in ankle area.

This is where I'm at right now. I don't know if I'm still eligible for workers compensation benefits since I was fired and didn't receive treatment for 5 months? If I am eligible, how will me not seeking treatment right away affect my case? Is there anything else I can do? Thank you.

Visitor Question:
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ANSWER for "Fired from work after injury, insurance denying coverage...":

A (USA):

You have a right to medical coverage under your former employer's workers' compensation insurance. The controlling issue in matters of work related injuries is the circumstances under which the injury is sustained. In most cases, if a worker is injured while in the performance of his or her work duties, the worker is eligible for workers' compensation coverage.

Such coverage normally includes the worker's medical bills, out-of-pocket expenses such as medications, and about two-thirds of the worker's lost wages during the recovery process. Pain and suffering is not recoverable in workers' compensation claims.

It's incumbent upon you to supply proof your injury occurred while you were working at your previous job. This can be accomplished by producing a copy of the incident report you completed at the insistence of the charge nurse. Additionally, you will need a medical narrative (or letter) from your treating physician stating your injury occurred during the period of time you were employed.

With these documents in hand, ask your former employer to produce the documents required to file a workers' compensation claim.

If your employer won't cooperate, contact a workers' comp attorney. Your attorney can subpoena the records in question, and can present a strong claim for compensation. Your previous employer can't ignore a subpoena.

The above is general information. Laws change frequently, and across jurisdictions. You should get a personalized case evaluation from an attorney licensed in your state. Find a local attorney to give you a free case review here, or call (888) 647-2490.

Best of luck,

Judge Calisi

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Comments for Fired from work after injury, insurance denying coverage...

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by: Law Guy

By all accounts you deserve to be covered under the hospital's workers' compensation insurance. Unless you had a prior injury to your ankle or a preexisting medical condition which would have caused or exacerbated your injury, you should be covered.

Here's the dilemma...

On the one hand it's simple: you were injured on the job. On the other hand, it's been 5 months since the injury occurred.

To convince your former employer and her insurance company that you were actually injured on the job will require clear and unequivocal medical evidence. This will be a challenge.

Your PCP or a referred physician will have to date your injury backwards until December 1st, 2013.

Speak with your PCP. Ask her to write a medical narrative which will directly link your injury to the events of December 1st, 2013.

If she will do so, you need to take that narrative to your former employer and ask your employer to submit a WC-1 form to the insurance company.

If your doctor and employer comply with your request, you should be able to get coverage. If your doctor or employer won't cooperate, it will be time to consult with a workers compensation attorney.

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