NY Workers' Comp Claim

A friend of mine (a Cop, if it makes any difference) was recently injured on the job. (They're OK).

The claim (broken clavicle) is working its way through the Workers' Comp system.

In the event that the NY Workers' Comp system should deny a surgical intervention, would his health insurer (Blue Cross) be entitled to rule a surgical claim an elective surgery; hence, not covered?

Thanks for any help.

TomR



Any help would be appreciated.

TomR


This would be a question for his union rep and the comp. attorney he hires. 

I don't mean to dismiss the seriousness of your inquiry but that is where the answers would be found.


I know a former police officer turned NJ Workers' Compensation attorney that may know the answer or refer you to a NY attorney that would.  Daniel Geddes (908) 810-0660


Jerseyjack,

The P.D. surgeon has recommended surgery, and I'm sure the union rep will back the officer. None of which means that the Comp board will agree.

The officer is presently adverse to, in his words "going under the knife"; so the query was more in the nature of curiosity on my part.

But I do appreciate the response.

--------

chalmers,

In the event he changes his mind, thanks for the name and phone number.

Again, thanks to you both.

TomR


Two points:

He may not be covered by Workers Compensation as we generally think of it.  Some municipalities, such as the City of New York,  are self insured for workers compensation benefits.  His Personnel Office can advise.

Whether the surgery needed to repair his broken clavicle is covered by his health insurance policy (should the Workers Compensation claim be denied) depends on his health insurance policy.  Again, he should check with his personnel office (if a group policy through his employer) or with the insurance company for more information regarding the specific plan.  



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