Workmans Comp denied claim for on-duty injury.

[Aequitas237]

I work for a 40 officer dept, in a suburb of KCMO. We recently had an officer tear cartilidge from his knee while getting out the car at a call. He reported it directly after the call and filled out the proper paperwork. He is 30 yrs old with no prior knee problems and in good physical condition. To make it quick he was denied by workmans comp, they stated he was not covered because it could have happened while off-duty. Has anyone else ever ran into the BS?

[mrc27]

I hate that kind of crap.

[BC1260]

Typical Workers comp BS. Now he has to get a lawyer and fight them and make them prove that it happened off duty. They will let the trailor park mut claim workers comp for streigning a muscle at work while smoking a cigarette. But, will crucify a legitimate LEO claim.

[exComptonCop]

He is 30 yrs old with no prior knee problems and in good physical condition. To make it quick he was denied by workman's comp, they stated he was not covered because it could have happened while off-duty.

Try looking at this as would your city's risk manager...your friend is thirty years old, with no prior knee problems in good physical condition, who injures his knee getting out of his car. You see where I'm taking this? If this is a career ending injury, perhaps your friend should seek legal advice from an attorney who specializes in WC.

[ComicGuy]

Yep. Lawsuit city. Goddam bureaucrats.

[The Dude]

I believe the way it's supposed to work is they go ahead and fix his knee and pay him the comp, then if they can prove that he is falsifying a claim they can hold him liable civilly for the money and criminally for failing a false insurance claim. The rules vary from state to state. I know out here in CA, workers comp companies have investigators that actually perform surveillance on claimants for exactly that purpose, to see for example if Officer Smith continues to barefoot water ski while waiting for his knee surgery to take place.

I had a similar experience in 2000, and it seems it's commonplace now, for either the employer or the insurer to try initially to bully people (especially those with good benefits) to take care of it outside of workers comp. You might be surprised at how many people just roll over and accept it.

Workers comp is very expensive and hard on employers, and each claim jacks up the rate even more. Police Officers have a high rate to begin with (called an X-Mod), so you can see the motive for that type of activity. BC1260 is on target, in that, impossible to prove "back injury" claims by people too tired out by the stress of part time burger flipping cost the insurance companies so much money that when an honest dude tries to get coverage for a legit claim, they give him the runaround as if he was a faker and a liar.

This kind of situation p's me off I guess, because of personal experience, and the fact that if a guy's going to do a dangerous, physical job, and sacrifice his body (particularly joints and back) over the years, they could at least let the insurance do it's job so the man can go back to work. It's not like he's looking for a free vacation, he volunteers to go in harm's way for a living for crying out loud, and they think he's faking a claim? Gimme a break.

[Bushranger]

I've experienced similar in my previous job with one Commonwealth Government agency. Very slow to recognise my claim and only paid up after a long paper trail between the the department that handled compensation claims and the submissions sent by myself and my departments medical staff.

Typical bean counter reaction by staff in the Compensation area - I had the impression that those staff were paying compensation out of their own pockets and how dare I injure myself on duty and then put in a compensation claim.

This and other experiences reinforced my belief that government departments are slow to pay out and very damn quick to garnish your pay if some anonymous incompetent beaurocrat overpays you or deposits money in your account that you never submitted a claim for.

[kshock]

It must have something to do with the KC Metro area. I know that another KC Metro officer in a larger department fell on the ice in the back lot of the PD (secured by a fence and electronic gate), breaking his leg in 8 places and screwing up his knee (reguired 2 surgeries). Workmans Comp was denied in that case also with the city citing that the officer was not in the building yet therefore was not on the clock, therefore not their problem. I can assure you that an attorney is involved in that fiasco.

[Aequitas237]

Very helpful info, to pass along, thanks guys!