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LawTalk, Attorney
Category: California Employment Law
Satisfied Customers: 36324
Experience:  I have 30 years of experience in the practice of law, including employment law and discrimination law.
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Workers Compensation question? My nephew broke his arm when

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Workers Compensation question? My nephew broke his arm when he was in our back storage lot (fenced in with seprate gate access,out side), his father and uncle own the busniess, the back lot is not used as part of the busniess however it is a storage area, where personal items are stored (rv, trailers, boats). My nephew had came over after hours around 6pm to get a trailer out of the back lot (he is moving and needed to retrive the trailer for that purpose), during that same time his father and uncle were inside the "shop" talking as they normally do, waiting for him to get the trailer so they can leave together. A vehicle that was in the shop rolled off its parking spot and my nephew "attempted" to catch it so it didnt crash into the trailer he was attempting to get. My nephew was the only one back there so this is comming from him. as he was attempting to stop the collision he got stuck on the rear of the vehicle that was rolling and caught his arm between the truck and its collision thus braking his arm. My husband (his uncle) and his father heard a commotion and ran out side and found him in pain, knowing something has just happened as he was in pain the immediatly took him to ER. Here is the issue...... The hospital assumed this is "work" related. I (his aunt) came in when he was being relesed and found they listed this as a workers comp issue, I explained to the nurse who was handing him the papers, he doesnt work there, he never has, he was simply in the wrong place at the wrong time. my nephew just turned 18 and graduated school, he has been to the shop before to pick up his father or meet up with us to go somewhere after we shop was closed. But has never worked there ever. The only ppl that work in the shop are indeed the 2 owners his father and his uncle. I (his aunt) come in when they are busy to help in the office once in a while, and I do the accounting from home. There nurse discharging him said oh well its written up that way now.

So now what do we do? my nephew has medical, (he did not even know that he had medi-cal at the time), The busniess does not have any workers comp insureance because there are no employees working, only owners. Ive called our insurance agent on this matter (or liability insurance) my agent says this is a grey area because he is related to us. His father just wants to pay the bill to the hospital which is $2200. and be done with it. They recieved a form from the hospital today cms-1500 health insurance claim form, and it has on the top "workers compensation 61" that they typed in. We are not submitting this to any form of workers comp because it is not a worker whom was injured, the hospital got the information wrong. When I talked to my nephew he explained to me that the nurse was asking him questions that he had no idea what she was talking about, my nephew asked me "what does marital status mean?". My nephew has a hard time articulating his words and explaining things.

What do we do?
can it be submitted to his medi-cal?
can his father simply pay it and be done with it?

Good afternoon,

I'm Doug, and I'm very sorry to hear of the situation. My goal is to provide you with excellent service today.

As he was not employed there, and was not an employee within the course and scope of employment is it not a worker’s compensation case. The health care providers will have to bill MediCal if they want to get paid.

The fact that they wrote it up wrong is their problem and MediCal will still pay the bills. Tell the hospital that they got it wrong, that it was not a work accident, and give them the MediCal number to bill. That is their only recourse---they have to accept it.

If you have additional questions, you may reply back to me using the Reply to Expert link.

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Customer: replied 3 years ago.

we just called medi-cal and asked them for his midi-cal number, as he doesnt have a card yet. They say his case is pending that one hasnt been issued yet, (its confusing because his medical worker says he does have medi-cal for emergencies, and the pending status is the new application we just filled out to convert it over to regular medi-cal, but we can not get a hold of the "worker" she wont return phone calls) we have a case number XXXXX medi-cal however not his Medi-cal number..... so what do I tell the billing agency? we have no reason to beleive he wont be approved for medi-cal, as he just turned 18 lives with us (not his parents) and is not employed. So technically do we tell the hospital there is no insurace, or do we give them the case number XXXXX medi-cal?


Medi-cal says once approved it will cover the bill up to 3 months prior (this happend 8-6-13), even if for whatever reason he is denied in the long run his father will pay it. But how do we make the corrections with the billing agency (as the bill is comming from a billing agency, not the hospital itself/directly)

Good afternoon Teresa,

He can apply for mediCal and have it cover his medical bills retroactively so long as at the time of his injury he qualified for MediCal.

For the time being, just let the hospital know that MediCal has been applied for and that when it is approved they will be paid.

The parents are not legally responsible for his medical bills if he was 18 at the time of his injury.

You may reply back to me using the Continue the Conversation or Reply to Expert link and I will be happy to continue to assist you until I am able to address your concerns, to your satisfaction.

Please remember to rate my service to you when our communication is completed.

I wish you the best in 2013,

Customer: replied 3 years ago.

Yes he was 18 (18th birthaday was june 5) at the time of the injury, his parents know they are no longer "responsible" for him in that aspect, however they don't want him start his "credit" negitively. He does not have a job and can has no way to pay right now. His parents are simply looking out for him (no matter the age he is always there baby) Smile. I see no reason why he wouldnt be approved, and yes at the time of the injury he was eligeable just as he is today, but its up to medi-cal to approve him or not in the long run. And yes I filled out the forms for him to apply for medi-cal on 2 weeks ago, his worker told him that his parents (when he was younger) applied for medical years ago (he had no idea) and that he was approved back then for emergencies however he never got a card. Now that he is 18 he should be ok for full medical benifits.

Hi Teresa,

I understand what you stated. Do you have a follow up question, because I don't see one.

Customer: replied 3 years ago.

yes I tried to correct it but you had answer before I was able to correct it.


Should we correct this issue with the actual hosptial (I attempted to correct this issue when I noticed the incorrect information upon my nephews dischard)? or the Billing provider info that is on this form which is "team Physicians of california" in Ohio?

Yes, absolutely, this young man needs to send the hospital a written communication stating that he was not employed and on the job at the time of the accident, and that he has no workers compensation insurance or any other kind of health policy and that he has applied for MediCal.

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I wish you the best in your future.

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