Handling of Asheville Workers’ Compensation Claims at Hospital Questioned

A state investigation found that a local hospital improperly handled a number of Asheville workers’ compensation claims.

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The state’s department of insurance conducted what is called a “market conduct examination,” and wound up citing the hospital for breaking three state laws regarding workers compensation.

According to the Asheville Citizen-Times, a hospital spokeswoman called those violations “a few ministerial missteps.” Our Asheville workers’ compensation attorneys are disturbed by that characterization, particularly when these are cases that involve the lives and well-being of employees whose hard work allows the facility to stay in business.

According to the Citizen-Times, the state looked at workers’ compensation claims made between the beginning of 2000 and the end of 2009. They found some concerning trends regarding a lack of proper documentation.

For claims that were denied, 26 percent were lacking the appropriate forms. In more than half of the claims, documents that would have showed outgoing workers’ compensation payments were missing. And in 15 percent of cases, documentation showing whether a claim had been denied or not was not in the file.

The investigation was kicked off after the North Carolina Industrial Commission, which oversees the state’s workers’ compensation program, found major errors in how the hospital handled a number of recent cases. In six of those seven cases, the commission compelled the hospital to pay attorneys’ fees for the workers because it was determined the hospital was unfair and overly-litigious. The seventh case, which involved a sexual assault, the hospital was made not only to pay the workers’ attorneys’ fees but also the cost of coping with an appeal, which the hospital ultimately lost.

In a statement released to the media, though, the hospital tried to spin the truth. A spokeswoman was quoted as saying the investigation had uncovered no obvious pattern of “stubborn litigiousness” or bad faith or fraud on the part of the hospital.

However, in a particularly eye-opening tidbit uncovered by the newspaper, more than 7,000 incidents were reported at the hospital from 2003 to 2009. These would include anything from a cut or scrape to a major injury that might result in hefty medical expenses or time off work. Of those, nearly 1,100 were reported as workers’ compensation claims. Of those, a large percentage – almost 1,070 – were approved for a payout. The rest were denied.

For the entire nine years of the review, more than 40 claims were denied.

The state determined that although the hospital has certain procedures and guidelines in place for how these workers’ compensation claims were to be handled, those rules simply weren’t followed.

Hospitals, in particular, can be treacherous places to work. By their very nature, they harbor illness that can be spread and unexpected hazards can arise. Hospital administrators must have protections in place for workers, and when those fail, proper procedure should be followed to ensure workers aren’t made to suffer further.

The attorneys at Lee & Smith serve clients in workers’ compensation cases in both South and North Carolina. For a free consultation regarding your workers’ compensation case, please contact us by phone or email.

Additional Resources:

Asheville’s Mission Hospital: State finds no ‘bad faith, fraud’ in workers’ comp probe, By John Boyle, The Asheville Citizen-Times

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