Billed for an ER visit after a work injury, and a shift you can no longer work

Attorney Answer

The emergency room bill should not end up with you if the injury goes through workers' compensation, but the protection depends on a claim form being filed. California makes the employer responsible for treating a work injury, and once a claim form is on file, a provider that knows the claim is pending may not collect from you. If no claim form has been filed, ask your employer for one now. Time off is a separate question: workers' compensation pays for time the injury keeps you from working, not for time lost to a schedule change or childcare.

Treatment is the employer's responsibility. Cal. Lab. Code § 4600(a):

(a) Medical, surgical, chiropractic, acupuncture, licensed clinical social worker, and hospital treatment, including nursing, medicines, medical and surgical supplies, crutches, and apparatuses, including orthotic and prosthetic devices and services, that is reasonably required to cure or relieve the injured worker from the effects of the worker’s injury shall be provided by the employer. In the case of the employer’s neglect or refusal reasonably to do so, the employer is liable for the reasonable expense incurred by or on behalf of the employee in providing treatment.

The claim form starts the protection. When an employer learns of an injury that needed treatment beyond first aid, Cal. Lab. Code § 5401(a) requires it to hand over a claim form:

(a) Within one working day of receiving notice or knowledge of injury under Section 5400 or 5402, which injury results in lost time beyond the employee’s work shift at the time of injury or which results in medical treatment beyond first aid, the employer shall provide, personally or by first-class mail, a claim form and a notice of potential eligibility for benefits under this division to the injured employee, or in the case of death, to his or her dependents.

Once you file that form, Cal. Lab. Code § 5402(c) requires the employer to authorize treatment while it decides the claim:

(c) Within one working day after an employee files a claim form under Section 5401, the employer shall authorize the provision of all treatment, consistent with Section 5307.27, for the alleged injury and shall continue to provide the treatment until the date that liability for the claim is accepted or rejected. Until the date the claim is accepted or rejected, liability for medical treatment shall be limited to ten thousand dollars ($10,000).

And if the employer does not reject the claim in time, § 5402(b) presumes it is covered:

(1) If liability is not rejected within 90 days after the date the claim form is filed under Section 5401, the injury shall be presumed compensable under this division.

The bill. Cal. Lab. Code § 3751(b):

(b) If an employee has filed a claim form pursuant to Section 5401, a provider of medical services shall not, with actual knowledge that a claim is pending, collect money directly from the employee for services to cure or relieve the effects of the injury for which the claim form was filed, unless the medical provider has received written notice that liability for the injury has been rejected by the employer and the medical provider has provided a copy of this notice to the employee. Any medical provider who violates this subdivision shall be liable for three times the amount unlawfully collected, plus reasonable attorney’s fees and costs.

That protection has three conditions. A claim form must have been filed, the hospital must actually know the claim is pending, and it ends if the employer rejects the claim in writing and the hospital gives you a copy of that notice. So once your claim is filed, tell the hospital's billing office in writing that the visit is a workers' compensation injury, and give it the claim number and the claims administrator's name.

Time off. Workers' compensation replaces part of your pay while the injury keeps you from working. Cal. Lab. Code § 4650(a):

(a) If an injury causes temporary disability, the first payment of temporary disability indemnity shall be made not later than 14 days after knowledge of the injury and disability, on which date all indemnity then due shall be paid, unless liability for the injury is earlier denied.

And Cal. Lab. Code § 4653 sets the amount:

If the injury causes temporary total disability, the disability payment is two-thirds of the average weekly earnings during the period of such disability, consideration being given to the ability of the injured employee to compete in an open labor market.

In practice, those payments depend on a treating doctor saying the injury keeps you from working, or limits you to work your employer does not offer. Missing work because a new shift conflicts with caring for your children is not a disability, however real the problem is. If the schedule changed because you reported the injury or said you would file a claim, that is a different matter: Cal. Lab. Code § 132a bars an employer from discriminating against a worker for filing, or saying they will file, a workers' compensation claim.

The stress. Stress at work can be the basis of a claim in some circumstances, but California sets stricter requirements for a stress claim than for a physical injury, and that is a question for a lawyer.

What you can do

1. If you have not filled out a workers' compensation claim form, ask your employer for one in writing, complete it, return it, and keep a copy showing the date you turned it in.

2. Send the emergency room bill, with the date of the injury and your claim number, to your employer's workers' compensation claims administrator.

3. Tell the hospital's billing office in writing that the visit is a workers' compensation claim, and keep every bill and collection notice it sends.

4. If a doctor has said you cannot work, or can work only with restrictions, get that in writing and give it to the claims administrator.

5. Keep a record of your old and new schedules and any message about the change.

6. If you have questions about the process, the information and assistance unit of California's Division of Workers' Compensation answers injured workers' questions at no cost.

7. Most lawyers offer a brief initial call at no cost, and a few minutes on your specific facts is worth more than any general guidance, including this page.

⏱ Time limits apply. Cal. Lab. Code § 5400 calls for written notice to the employer within 30 days of the injury, although an employer's own knowledge of the injury counts as notice under § 5402(a). Other workers' compensation deadlines run from dates in your file, so have them checked rather than counting them yourself.