Question
What is the name of your state? Nebraska
Hi everyone. My fiance Nolan worked in construction a few months ago. His employer was a contractor who owned his own business. My fiance was his only employee.
One day at work, Nolan got something lodged in his eye at the jobsite. His employer took him to the urgent care clinic- not the ER, just an open-door clinic. They dislodged the particle and the incident was billed to the employer's business insurance.
It is now many months later, and his old boss has closed down his business. Nolan just received a bill from the clinic for the full amount. The bill says that the company insurance paid zero dollars.
Does anyone know what happened here and if he has any legal recourse? It seems as though 1. the company's insurance was worthless?? or 2. the insurance did not cover Nolan as an employee for some reason. It seems fishy and it's a substantial bill.
A big problem here is that the former employer is not a nice guy... really screwed Nolan on his W2s, in a way I suspect was illegal. Calling him and asking him nicely to cover this bill is NOT going to work.
Please help!
Answer
Have you contacted the health insurance for more information? What was the reason they are not paying and have you asked to appeal the denial?
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I'm not sure who to contact. The bill says "(Construction Company) WC" followed by a number and Filed, then 0.00 paid. It also says "Contacted Employer for Payment" followed by Payment= 0.00.
The employer never gave Nolan a company name for his insurance, just said that his employment insurance would take care of it.
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Sounds like this should be workers comp not health insurance. Which is possibly why the health insurance denied it.
You can call the clinic and ask what insurance company they submitted it to (well he would probably have to call).
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ecmst12 is right on the money. It's not that the insurance is worthless; it's that injuries that happen on the job are not covered by the insurance - they're covered by the workers comp carrier. It would have stated right in the policy that they are not responsible for work-related injuries.
Depending on your state law, you may still be able to file a claim (some states require that a claim be filed within x number of days). Contact the state workers comp commission for further information.
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Thanks guys. Can someone explain worker's comp to me in basic terms? Is this something that his employer would definitely have had? Is it required? I'm wondering why it wasn't submitted to worker's comp in the first place if that is the case.
Apologies for all the questions. He is currently out of town for a month and I'm in charge of the bills, and trying my best to handle this correctly.
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Workers compensation is a form of insurance that is required in 49 out of 50 states (Texas being the exception - some very small businesses are exempted in other states as well) which is available ONLY when an employee is injured on the job or becomes ill as a result of conditions on the job. It pays medical bills and provides a certain amount of income replacement when warranted.
State law varies wildly as to workers comp. In some states the employer is required to file; in other states either the employee or the employer can file. In some states the employee may use the doctor of their choice; in other states the employer must use a doctor designated by the employer. As I said, in some states a claim must be filed right away; in other states you can file months after.
I've no idea why it was not filed with workers comp from the beginning. It might have been an honest mistake - it might have been that the urgent care clinic did not understand that it was a work related accident - it might have been that the employer either innocently or deliberately opted not to submit the claim that way.
Your state workers comp commission (look in the phone book under State of Nebraska) will be able to tell you whether you have any chance of getting the bill paid by the workers comp carrier at this time.
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It may be that the employer was not required to provider WC insurance. The OP mentioned her fiance' was the only employee. Some states have a minimum of 3 employees before WC is required coverage.
The employer may be personally liable for the medical bills if WC was not in place.
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Or, he may(should?) be able to appeal the denial by the health insurance company by providing proof of no workers comp coverage.
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Nothing in the thread indicates a health insurance company was involved. There is a reference to a WC filing, but not health insurance.
If the employer did not have WC coverage, the employer is still liable.
If the employer does not pay then it is up to the patient to be responsible for the bill. If the patient elects to pursue civil action against the employer for recovery he may do so.
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I will contact the workers comp commission and see what they have to say, and take it from there. I'm getting the sinking feeling the employer has chosen to make this difficult. Thanks for the information all.
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I found some info on the NE workers comp website. Apparently he is not required to have it, as although number of employees is not a factor, it does say that independent contractors are not required.
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Even if he does not meet the minimum number of employees, does not mean the employer is not liable. The employer is not REQUIRED to carry WC, but may do so at his/her option.
If your fiance' was a W2 employee there is a good possibility the employer can be held liable. If he was a 1099 employee, proving liability becomes more challenging.
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Nothing in the thread indicates a health insurance company was involved. There is a reference to a WC filing, but not health insurance.
If the employer did not have WC coverage, the employer is still liable.
If the employer does not pay then it is up to the patient to be responsible for the bill. If the patient elects to pursue civil action against the employer for recovery he may do so.
I am not sure the OP knows if it was filed under WC insurance or some other insurance. The OP stated "business insurance" and the only mention of WC was in the bill from the health provider. Apparently the doc knew it was work related but the employer would have to either file it himself or give the provider the correct info to get it paid.
The problem here is the employer "closed down his business". Can anybody here tell the OP what to do if the business is a business no more? And if the employer will not pay for whatever reason, can the provider actually legally force the OP to pay the bill?
(just my observation of what the OP actually needs to know)
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Of course the provider can force the OP to pay. Ultimately, the responsiblity for any bill is always with the person who received the services. If there is an insurance plan of any kind that will pick up part of the cost, that's wonderful but the receiver of the services is the one who owes the bill in the bottom line.
State law varies on what will happen if the employer cannot be found, so that's a question she needs to ask of the workers comp commission.