Caught in Limbo With Injury - Worker's Comp or Not?
August 27, 2014 12:24 PM   Subscribe

Caught in Limbo With Injury - Worker's Comp or Not?

Last Friday, I bumped into a doorway at work. It happened so quickly I'm not sure what exactly happened, but I think I banged my hip bone into a corner/edge of a doorway. I was at work, and heard the microwave ding that my hot water for tea was ready, and got out of my chair to head out the door. I'm naturally clumsy, so I of course bumped into the doorway as I was heading out. I immediately felt a sharp pain, which then subsided to a dull ache. However, a few minutes later I noticed that the area below my hip bone was numb to the touch.

I called my Primary Care Physician's office to ask if this was normal or if I should come in to see her. I spoke to a nurse who asked me, "Are you at home right now?" and, not thinking, I replied, "No, I'm at work, that's where it happened." The nurse said they don't do worker's comp cases, and I told her it wasn't really a work related injury. She said she'd confer with the doctor and call back. She asked if I could still walk okay (yes), still had full range of movement (yes), and if there was any bruising (no). She called back later to say the doctor said the symptoms should resolve in a few days, but if they didn't, I should call back.

Over the weekend I thought I was feeling a bit better. But then on Monday night I slept on my stomach (which I don't usually do) and this must have put pressure on my hip because it's been sore since yesterday (Tuesday). And I've noticed that there is still some numbness. So last night I decided I would call the doctor to make an appointment.

I called this morning at 8am, right when they opened, and spoke to a receptionist, or whoever answered the phone. She looked at my records and said, "I see this happened at work. We can't see you for it because that's worker's comp." I told her again that it wasn't a work injury and could have easily happened at a doorway at home. She told me, "But you've already said it happened at work and now it's in your record." She told me I'd have to see the company doctor. Well, we don't have one because we're a tiny office. She said then I'd have to file a worker's comp claim at work, and recommended a local practice that does handle worker's comp cases.

Just to make sure I had the facts right, I called my health insurance's customer service. They referred me to an expert in their claims department. I described how the injury happened, and she said that a doctor is within their rights to refuse to handle worker's comp cases if they choose. However, she also said there could be some leeway as to whether or not this was a workplace injury, since it didn't happen in the capacity of performing work-related duties. However, She asked me to talk to my HR person and ask if they wanted to file a claim. Then call her back and let her know.

Our HR person felt that this was not really a workers' comp issue. She said if I had slipped on spilled water, or injured myself moving heavy boxes that was one thing, but "clumsiness" wasn't the same thing. So I called the woman at the insurance company, and she said she would call my doctor and tell them that my insurance would cover it, and they would not have to consider it worker's comp. I called back a little later to find out what happened. She said the doctor's office gave her "a hard time" but that she had her supervisor call and speak to the billing manager, who agreed to let me make an appointment and that she would call me.

I admit I was getting impatient then, so I called the doctor's office and tried to make an appointment. After looking at my record, the receptionist had to confirm things with the billing manager. She came back and said that the billing manager had to first confirm with their "administrator" to get the OK, because even though the insurance said it was OK, they didn't want this to "come back and bite them." She said the billing manager would call me as soon as she hears.

So at 3:20pm, that's what I'm waiting for now. I spoke to our HR person again and asked if it would still be possible to file a worker's comp claim if the doctor still refuses to see me, and she said we could, but I may have to wait for that to be approved before I can see a doctor about it.

Any other thoughts on what I can do? Another co-worker suggested trying a local urgent care center and telling them it happened at home, but since I already have a record at my PCP saying I told them it happened at work, I don't think that's a good idea.

I live in New York State, if that makes a difference. Any suggestions on what to do if my doctor's office still refuses to see me?
posted by LaurenIpsum to Health & Fitness (7 answers total) 3 users marked this as a favorite
I'm sorry you're having to deal with this. Worker's comp issues are the worst.

I agree with your HR rep that the worker's comp claim, if filed, is unlikely to be approved. If you can't/don't want to wait for your PCP's office to figure that out, your remedy is to find another doctor who is not as skittish about injuries that might or might not have occurred at work. Since your insurance knows that the injury occurred at work and has already said that they'll cover it, it doesn't matter what you told your PCP.

If you do go to an urgent care center or another practice, feel free not to mention where the injury took place. You can just say "I walked into a door." It doesn't matter where the door was located.

Good luck!
posted by donajo at 12:44 PM on August 27, 2014

Go to a Doc-in-the-Box, urgent care center. Just say, "I bumped it in a door frame."

See where that takes you.

Honestly, what a hassle. I might change PCP over something like this.
posted by Ruthless Bunny at 1:00 PM on August 27, 2014 [4 favorites]

File a report of injury. Big employers will send you to their worker's comp specialist, but you'll get good care, or may let you go to your provider. Your insurance will want to bill wc because it happened at work, so do the paperwork.
posted by theora55 at 1:48 PM on August 27, 2014

This is not work comp. You weren't performing any work related duties, you were going for your tea. If the doorway was hazardous in some way that work change this, but I'm assuming it was a normal doorway.

Your doctor is being ridiculous about this. If I was you, I'd go to an urgent care place and just tell them I bumped into a doorway.

If your insurance freaks out that this injury is work related, your HR person can call them and let them know it's not. Very simple
posted by Attackpanda at 4:35 PM on August 27, 2014

This is not work comp. You weren't performing any work related duties, you were going for your tea. If the doorway was hazardous in some way that work change this, but I'm assuming it was a normal doorway.
The conclusion that it isn't work related is a legal one and you should ignore most everything that has been said here about it. I know of a case where the employee was on their unpaid lunch break and was injured in the company cafeteria in slip and fall and it was ruled worker's comp because the on premises cafeteria was designed to save time and benefit the employer. In general, pretty much anything that happens while you are being paid at work falls under worker's comp even things like playing catch in direct contravention of company policies and a whole lot of things that happen in the office when not being paid (like an after hours company party, for instance).

There are some variations from state to state, but I'd be astonished if clumsiness was an exception anywhere in these United States. The standard for it to be not qualified would be more like reckless, dangerous and wholly inappropriate conduct by the employee. Workers Comp laws are almost always no-fault and don't get into questions of clumsiness or inappropriate footwear or attire.
posted by Lame_username at 10:44 PM on August 27, 2014

Response by poster: I never heard back from the billing manager, so I called myself, and was told they will not see me. I kept asking why since the insurance will cover it, and all they will say is "it's our policy."

So if I go to an urgent care center, what do I say? Why am I going there during the day when my normal doctor's office should be open? Why did I wait so long to get care? Should I say my Dr's office is closed today?
posted by LaurenIpsum at 6:00 AM on August 28, 2014

I hope you've already gone to the urgent care clinic, but you don't have to tell them anything about your regular doctor's office. You tell them that you walked into a door frame and you're concerned because you're still in pain and that's it. They won't interrogate you.
posted by donajo at 7:19 PM on August 28, 2014

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