Detective denied workers’ comp: Was injury work-related?
February 27, 2012 by Fred HosierPosted in: Back/lifting injuries, In this week's e-newsletter, Injuries, Latest News & Views, Workers' comp
PDF A police detective faces months of unpaid leave in a dispute with his employer over whether an injury should be covered by workers’ comp.
Adam Toops, a police detective for Montclair, NJ, had spine surgery in December 2011. It was his third work-related back surgery. He says Montclair assured him that he would be paid during the time he was out because the injury occurred in the line of duty.
But now Toops’ pay has been cut off. Not only that, he’s been asked to refund the township for 12 days’ pay he already received.
Toops slipped on ice in an unplowed lot where Montclair police parked. He says his head snapped back “in a whiplash effect.” He later discovered the accident disturbed part of his spine where doctors had performed surgery in 2009 after Toops was injured searching for suspects in an armed robbery.
In the 2009 incident, Toops and another officer were jumping fences and climbing over sheds, chasing suspects.
As a result of that chase, doctors later discovered a spinal disc in his neck had torn out of place and his backbone was leaking spinal fluid.
Toops says he tried to get by with just pain management, but eventually had to have surgery.
Montclair’s workers’ comp insurer refused paying for his medical care, saying Toops had not reported the injury within the required 90-day period. Toops’ lawyer says he has documentation showing the detective did report it within the required time period.
The injured detective turned to his regular medical insurer, but that company refused to pay, arguing the township was responsible since the injury had occurred while Toops was working.
Toops’ lawyer filed a lawsuit in workers’ comp court. The case hasn’t been resolved.
As for the re-injury connected to the icy parking lot, the township’s Human Resources director said Toops’ absence wasn’t being classified as an injury in the line of duty. She said Toops was burning through his vacation and sick time, which has now run out. Once he exhausted that time, he was placed on unpaid leave.
Toops says he could face another two months off the job to heal from the surgery and a related infection.
The Human Resources director says Toops never filed the proper paperwork for the icy parking lot incident.
Toops’ lawyer says the paperwork was filed. The Montclair Times obtained a schedule for the Montclair Police Department’s Detective Bureau dated Feb. 5, 2012, which shows Toops had the entire month off due to a line-of-duty injury.
Toops says he’s a dedicated officer and he loves his job.
In 2002, a local nonprofit that helps families of police officers and firefighters killed in the line of duty named Toops “Officer of the Year” for helping rescue people from a burning house before firefighters arrived.
Toops wants to go back to work. “I believe I am going to heal to the point where I hope I can do my job,” he told the Times.
This is where Toops stands now: Both workers’ comp and regular health insurance have refused to pay for his medical bills, saying the other is responsible. And the township has cut off his pay.
What do you make of this situation? Let us know what you think in the comments below.
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Tags: back injury, in the line of duty, slipped on ice, Workers' comp
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February 28th, 2012 at 11:07 am
That Troops is a police officer, dedicated worker and loves his job has nothing to do with his responsibility to follow instructions and be responsible for his care following an injury. Based on this report there is nothing that needed to be done that he could not have done for himself by following reporting and follow-up procedures. The fact that he obtained a lawyer is a flag to me. It has been my experience that when a claim gets to this stage, there is lots to sort out and didicated worker is not one of them.
February 28th, 2012 at 12:56 pm
It sounds like a cash-strapped town trying to dodge an expensive medical bill. As a former law enforcement officer, I take exception to the commenter who said hiring a lawyer is a red flag. In any dispute, the first thing you do is bring in the union, and if you don’t have a union-or on their advice-you bring in a lawyer. That’s the first thing the employer does, isn’t it?
February 28th, 2012 at 6:47 pm
Lawyers and the Union will get you make you share your benefits. Workers Compensation is a cut and dried pay. It is the rare in civil court that judgements are made. From the article, copper doesn’t stand a chance. Had he merely worked with his company and his claims adjuster, filed all the required requests everything would be fine. Why depend on someone else to do something you can do perfectly well for yourself? Lawyers and Unions belong in the same pile.
March 6th, 2012 at 8:38 am
I thought if you have a medical claim and have medical insurance, your medical insurance is required to pay, then sort out the details if it is workers comp or not later. Your medical insurance must pay your medical claims as long as they are covered by the policy, then they can subrogate against another party if it is appropriate. Especially if the Workers Comp has already denied the claim, what grounds is the medical insurance using for not covering this claim? What if it were a car accident, your medical insurance would pay then subrogate back against the car insurance, right?
March 6th, 2012 at 9:35 am
Workers compensation is never cut and dried!! I know from experience!!! I was required to attend doctors visits all over the state. Due to a sever spinal injury (compressed vertibra) i had trouble traveling 30 miles to the closest doctor without sever pain. However the insurance company required me to attend several appointments over two hundred miles from my home in an attempt to get me to refuse to attend. Which would have ended my work comp weekly payments. When i contacted the insurance company to request a closer doctor i was told that they could send me where ever they wanted and i had to attend. It was only after this statement that i talked with an attorney which was too late to reschedule the appointment. Thus i had to attend. Also this appointment was for a meylogram which introduces a dye into your spine. After the procedure you are required to lay in the hospital for four hours in case the site of the injection leakes spinal fluid. Upon release i was told to go directly home to bed. When i told the doctor where my home was he told me to get a hotel room i could not drive or ride the distance to my home because leakage of the site would kill me before i could get to a hospital. I had no money or relatives in this city to either rent a hotel room or spend the night with so i was forced to go home and take my life into my own hands. What is cut and dried about Workers Compensation is the fact that all the insurance company and the employer care about is the bottom line (MONEY) period. I would wager with your attitude you work for the insurance company!!!!
March 6th, 2012 at 1:23 pm
I agree with the comments that trying to show the detective as a dedicated “hero” are not applicable. These are the distractions usually put up by the union or the detective’s attorney. As a side note, not all cops are honest or “good”. We had several officers that had YEARS off work for one injury after another - because they didn’t want to work. Thankfully most officers are good, hard working employees.