Employer funded medical benefits

What is the name of your state? Employee goes to hospital on 11/10/03 for back pain on own time. Uses compnay provided insurance. Hospital staff asks lots of questions about what he does for a living. He is a delivery driver but tells them nothing at work caused his back pain. Flash forward to 4/4/04. employee does hurt his back on the job. Filed WC all goes smoothly. Placed at MMI on 7/8/04. Falsh forward again to 7/29/04. He is contacted by a collection agency regarding hospital bill from 11/10/03. He contacts insurance agency and they are denying his claim on that date stating it is a WC injury. It wasnt one. The isnurance compnay now states that his company must file a WC claim and once its denied send them the denial letter and then they will pay it. Can they do this? It seems to me they could just say that about every injury and draw out every claim they ever have. What can we do?

In my experience (and I have plenty of experience with employer-sponsored health plans, believe me) you cannot beat this. Just do what they say; apply for w/c and get the denial letter. I've seen this scenario plenty of times and the bill always gets paid as soon as the denial letter is a part of the file. You can fight it but that's just going to drag the whole thing out and you're still going to lose in the end. It's a shame that the two injuries happened close enough to each other to trigger this but them's the breaks. Trust me, the fastest way to resolve this is just to go ahead and go through the motions they dictate. Good luck.

BTW, nothing they are doing is illegal.

Ok, I that is what we will do. What should we put on the 1st report of injury as there was no accident that happened?

Put down whatever it was that caused the injury. Even if that's long hours sitting in one position. Just answer the questions as best and as honestly as you can. The more obvious it is that it's not a work related injury, the faster w/c will deny it and you can get the bill paid.