I received a call the other day from a police officer who was injured on duty when he slipped and fell at a home where he was searching for a suspect. One of his complaints was very familiar to me; he couldn’t get treatment for his IOD injuries because the Town’s insurer denied benefits. The reasons for denial vary – either the insurer doesn’t consider the injury to be the result of an on duty incident or the insurer thinks the recommended treatment isn’t appropriate and won’t approve payment. I have heard this many times and the source of an injury, i.e. a cruiser accident, or from a suspect resisting arrest, or other types of injuries.
In reality, the insurer’s denial should not affect your status or treatment. It is the town’s (or city’s) responsibility to pay your wages and pay for your medical bills that relate to an on duty injury. If the insurer is denying benefits, it only means that the town won’t be reimbursed later, but the insurer’s denial does not absolve the town from its responsibility to pay your wages or medical bills.
Chapter 41, §100 relates to payment of medical bills and says in part:
Upon application by a fire fighter or police officer of a city, town… the board or officer of such city, town or district authorized to appoint fire fighters or police officers, as the case may be, shall determine whether it is appropriate under all the circumstances… to indemnify such fire fighter or police officer for his reasonable hospital, medical, surgical, chiropractic, nursing, pharmaceutical, prosthetic and related expenses and reasonable charges for chiropody (podiatry) incurred as the natural and proximate result of an accident occurring or of undergoing a hazard peculiar to his employment, while acting in the performance and within the scope of his duty without fault of his own….
Chapter 41, §111F relates to payment of wages and says in part:
Whenever a police officer or fire fighter of a city, town, or fire or water district is incapacitated for duty because of injury sustained in the performance of his duty without fault of his own.. is so incapacitated because of injuries so sustained, he shall be granted leave without loss of pay for the period of such incapacity….
Both of these statutes place the burden on the city or town to pay your salary or medical bills for an IOD injury, not the town’s insurer. The statutes do not allow the town’s insurer to make the call about whether the injury is the result of an on duty incident or whether the prescribed treatment is reasonable. Too many towns abdicate their responsibility to the insurer and follow whatever the insurer says about payments. Payment to you (or your medical provider) is your issue with the town. Whether the insurer reimburses the town, is a fight between the town and the insurer and should not affect your status or treatment. In short, the statutes make these payments the town’s responsibility and you should not accept the town’s excuse that their insurer won’t cover it, as a reason for denying your claim.
You can contact me at firstname.lastname@example.org.