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Self Insured Company won't pay doctor bills

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ssssssssstina

Junior Member
What is the name of your state? Ohio

The large hospital I work for has an off-site office building that they lease.
There is a designated employee parking lot, which is also leased. The parking lot is marked for use by *** hospital.

2 months ago the building owners tore up the parking lot, and over a course of 2 weekends were re-paving it. During the weekdays the parking lot remained under construction of sorts.

On one of those days, I parked in the designated parking lot, was walking to work, and tripped and fell on the uneven pavement caused by construction work.

I filed all the reports, employee incident, etc. and followed up with my chiropractor. I filed a Bur. Workers Comp claim at my chiropractor's office. I learned that my hospital is self-insured, and uses a service company to manage its workers comp claims. The nice folks at the service company indicated to me that everything seemed to be in order, but that they needed to review the info from the chiropractor, etc.

My chiropractor has been treating me 3x/week. I made initial gains, but then health progress stalled, and I remain in constant pain (lower back). My doc. recommends an MRI as he suspects a bulging disc (which wouldn't show up on a regular xray).

When he contacted the adjuster at the service company, he was told that
they had not made a decision about whether my claim would be covered because *the hospital does not own the parking lot where the injury occurred.* They would get back to him by mid week of this week.

When I saw the chiropractor on Wed (mid week) he hadn't heard from them.
I called and left a message on Thursday, they did not reply.
On Friday I called the Hospital's legal department, and spoke with the legal assistant who was handling the hospital's end of the claim. She told me that due to the question of whether the hospital was liable, they had not received a decsion from the service company. In fact, the matter was sent out to a private firm for consulation.

I told her that my medical treatment is being held up and I remain in constant pain, unable to move forward with treatment as we wait for this decsion. she then made the decision to authorize the MRI.

TOday I received a letter from the service company (dated 11/16/05)
that stated "at this time, your claim is not being certified based upon certain facts. Since your claim is being contested, the Bureau will schedule a hearing in the near future."

My questions are:
1. What does the fact that the hospital LEASES the parking lot vs. OWNING the parking lot have to do with the fact that they directed me, an employee, to park there -- and as a result of that, I fell and am injured?

2. What recourse do I have available? I really don't want to have to sue the owner of the building, I would prefer, of course, that my employer take responsibiltiy for me as their employee. If that is my only recourse, then I will sue the building owner, but I'd rather force my employer to handle this for me.

I'm furious! I am open to all advice/suggestions.
 


tjr5150

Member
Laws differ from state to state, but in most cases when the employee is coming to or leaving work(of the clock) your employer is not responsible..
Again this is my opinion..
 

ssssssssstina

Junior Member
thank you for your reply.

It's interesting... that's what I would have guessed was the issue... but
for some reason they seem more concerned about who owns the parking
lot. Ill let you know how this turns out.
 

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