Another debate regarding which insurer should pay for the medical bills makes headlines. On April 12 nad 14, 2009, Pasadena hospital nurse, Amelia Mendoza, suffered traumatic brain injury when a patient repeatedly violently struck her in the head. A week following the attacks, Amelia (52 years old) collapsed with a stroke. Amelia’s private insurer, BlueCross is denying coverage, stating that it was an on-the-job-injury. Amelia’s employer, Huntington Memorial Hospital, is also denying coverage, stating that the stroke, which occurred on April 20, was not due to the patient’s attacks.
As Amelia remains in a vegetative state and her husband cares for her through feeding tubes, hopefully the courts will get involved quickly enough to help interpret the California workers’ compensation statute.
Similar coverage principles apply in Washington State. If one is injured on the job, treatment for those injuries must be paid by workers’ compensation. If not an on-the-job injury, then health insurance should cover the treatment for the injury.
Coverage issues are common in automobile cases, specifically where the health insurance carrier paid out benefits before learning that the injuries were caused by a car accident and that there was an alternative form of primary insurance available, e.g., personal injury protection (PIP). In these situations, the PIP carrier reimburses the health insurer and everyone is satisfied. No courts. No delays. No issues.
Until the law changes, insurance carriers will continue to deny coverage unless a court orders otherwise.
To prevent an impasse with your insurance carrier, you should be careful with paperwork. Most paperwork you complete at a doctor’s office and any records the office completes on your behalf are sent to your insurance company for consideration of paying for your visit (claim). You probably recall in-take sheets asking you if the injuries are due to a car accident, on-the-job injury, or other. If you are unsure, before checking the box, have an open conversation with your health care provider about the issue. Only once you feel comfortable with the origin of your injury, report it on the intake form with the health care provider’s office. This can save major future financial headaches.
Ms. Filutowski has a track record of recovering over $3.0 million dollars for her clients through negotiations, arbitrations, mediations and trial.
