| Vice President Scott Nicholas
As a follow-up to my last article, I want to share some additional information and some reporting requirements.
Prompt reporting is the best way to get your claim accepted. One of the most common reasons for a denial is that the timelines for the injury or exposure were outside the reporting requirements. In most cases, officers say they felt like they hurt something during their shift but thought it would feel better in a day or two, so they failed to report it, only to find out a week or so later that they suffered an injury that requires medical attention — maybe even physical therapy or surgery. Now, on top of being on modified duty and facing the potential loss of income from lost overtime, they will also be out of pocket for the co-pays and deductibles associated with rehabilitation.
So, if you feel like there is something hurting you or you “tweaked your knee” or some body part during a call, or just about any way that is sudden and violent during work, then document it on a C-1. If you are unable to complete the paperwork, have a supervisor or a dependent complete a written notice that an injury occurred during the course of employment. This must be reported within seven days of the incident.
The second step in getting your claim accepted is seeking medical treatment. In addition to the initial reporting requirements, you must seek medical treatment within 90 days of the incident. Your claim will likely be denied if you do not meet these standards. You will have this documented on the C-4 form.
Here are a few examples of claims that get confusing.
PTSD claims: Anyone who has had a career with the Metro knows we go to some horrific crime scenes. We never know how these crime scenes affect us during our careers, or maybe they don’t affect some people at all. The point is, when do you document this on a C-1 form? My suggestion is to err on the side of caution and fill one out every time. This could be for a traffic accident, a homicide, a sexual assault case involving a child or even a murder at CCDC. Whatever the situation, it is important to have documented the call. If you chose not to document the call within the seven days because you are not feeling like you are immediately affected, it might be OK, because technically you might not feel the effects of the call for months or even years — and when you do seek treatment, the clock starts at that time, so you would still be covered if you identify the call or calls that are troubling you. Most of the calls you go on are easy to find, but as years pass you may struggle to remember when the situation occurred or even the year it occurred. It is up to you, but I would document each call just to be sure.
Lung claims are a little tricky under the heart and lung bill as well. Lung issues can take years to develop, and it may be hard to identify which call caused the lung illness or injury, so if you are involved in any type of situation that could potentially cause a lung illness or injury, you should document it on a C-1 to protect yourself in the future. You must show what caused the illness or injury. For example, perhaps you stopped for a traffic collision with a burning vehicle and inhaled a lot of smoke helping a citizen, or maybe you walked into a home where someone was cooking meth and were exposed to toxic air without proper gear. These are just some examples to think about so that you will be covered in the future if you were not affected immediately.
If anyone has questions or concerns regarding a workers’ compensation claim, don’t hesitate to contact me or a PPA rep to help you understand the process.
Health and Safety is committed to helping our members work through their claims and has assured the PPA that they will continue to work with our members so they won’t have to hire an attorney.
CCMSI seems to be easier to work with these days, and when you are not represented by an attorney they can speak directly. There are a lot of cases where CCMSI just needs more medical records or something answered, but by law they can’t just pick up the phone and call you or ask you any questions. Once you have an attorney, you are at the mercy of the attorney returning phone calls or getting the information from you to give to them, etc. At the end of the day, some cases may require hiring an attorney, especially when there is an appeal or a denial. Ask yourself this question: If you file your paperwork in a timely manner and your claim is accepted, why would you pay an attorney thousands or tens of thousands of dollars? I have never seen an attorney turn down the potential to make some easy money, so slow everything down and give Health and Safety an opportunity to work for you. If a time comes when we see that our members are not getting the service and help they deserve, I’ll be the first to put them on blast.
Thank you for your membership. Please be safe.
