When Does Private Insurance Pay And When Do You Claim Worker’s Compensation?

Joel Hamner, Attorney

Q. My husband was working Sunday night on a holiday weekend when he hurt his back. The supervisors and the company nurse were on vacation during the holiday. He told a fellow employee that he thought he had pulled a muscle in his back. He finished his shift and came home. He was off work the next two days. During that time, the pain in his back got considerably worse. When he went back into work, he told his supervisor what had happened and was sent to the company nurse. The company nurse said that because he waited to tell them about the injury until he returned to work that he would have to put this on his Blue Cross Blue Shield Insurance. My husband was scheduled for back surgery and the day before BC/BS called us and said they would not cover the cost because it was supposed to be covered by worker’s compensation. Worker’s Compensation won’t pay and neither will BC/BS. What do we do?
Carol, Decatur

A. Carol, it seems as though we are hearing this more and more that employers and the worker’s compensation insurance carriers are denying claims because the employee failed to give proper notice. The Alabama Worker’s Compensation Act states that an employee must give his employer written notice of an on the job injury within 5 days of the accident. The Alabama Supreme Court has stated, however, that if an employee simply gives oral notice of an accident and injury that he has met the notice requirements. In your husband’s case, he clearly gave “oral notice” to his supervisor within 5 days of the accident and he should be covered by the employer’s worker’s compensation insurance.

So many injured workers I talk to fall into the trap that you and your husband now face. Recently, I met with a man who had been hurt on the job, told his supervisor what happened, and the supervisor asked the injured worker if he would just use his own health insurance to get treatment. The employee, worried that he would lose his job, did exactly what he was told. When the employee found out he was going to need shoulder surgery and was going to be out of work for 6 weeks, he told his employer about the surgery and asked what he was going to do for an income. The employer said they knew nothing about the accident being work related and told the employee he was on his own. To make matters worse, his health insurance is refusing to pay for the surgery because it was due to an on the job injury. So now this poor man cannot work due to his shoulder and he is losing everything he has because he has no income coming in while we fight his case out in court.

I realize jobs are hard to come by these days and after 20 years of representing injured workers I know that most everyone wants to do right by their employer. But when you are injured on the job and you do not provide notice of the accident and injury to your employer or you agree to get treatment outside of worker’s compensation, the only person you are hurting is yourself and your family. You risk being bankrupt due to all the unpaid medical bills and you will have no income while you are recovering.

McCutcheon & Hamner, P.C.
2210 Helton Drive
Florence, Alabama 35630
Telephone: 256-764-0112
Facsimile: 256-349-2529