ADJUDICATION OFFICER DECISION
Adjudication Decision Reference: ADJ-00000802
Complaint(s)/Dispute(s) for Resolution:
Act | Complaint/Dispute Reference No. | Date of Receipt |
Complaint seeking adjudication by the Workplace Relations Commission under section 13 of the Industrial Relations Act, 1946 | CA-00001188-001 | 01/12/2015 |
Date of Adjudication Hearing: 16/02/2016
Workplace Relations Commission Adjudication Officer: Joe Donnelly
Procedure:
In accordance with Section 41(4) of the Workplace Relations Act, 2015 following the referral of the complaint(s)/dispute(s) to me by the Director General, I inquired into the complaint(s)/dispute(s) and gave the parties an opportunity to be heard by me and to present to me any evidence relevant to the complaint(s)/dispute(s).
Complainant’s Submission and Presentation:
Medical expenses and Doctors Bills which were in line with policy and agreement were not reimbursed. The company claim that he did not fill in an accident report however the complainant has witnesses to say that he did and that the company lost the documentation. |
The accident occurred on 12 November 2011 while the complainant was inspecting the railway line at Enniscorthy. The Chief Medical Officer approved a course of physiotherapy, the total cost being €240.00. The complainant had attended a local practicioner who had been recommended to him. In addition, because of ongoing medical issues, the doctor who the complainant was attending locally (who was on the company panel) suggested an MRI scan which cost a further €190.00.
The accident report was completed and handed into management within a few days of the accident.
When the respondent company refused to pay these expenses the issue was taken up by the complainant’s union which sought an explanation for this refusal. A reply was received from the Infrastructure HR Manager stating that they could find no record of an accident report and consequently, because of this and the time expired, they could not reimburse these expenses.
Respondent’s Submission and Presentation:
The respondent’s representative informed the hearing that he accepted the complainant’s word that he had lodged an accident report.
The Chief Medical Officer had sanctioned six sessions of treatment with a Chartered Physiotherapist and would refund up to €40.00 per visit.
The complainant had attended a Physical Therapist and therefore, in line with policy, no payment could be made. This policy is designed to protect the individual employee from any further injury or mistreatment.
No sanction had been given for an MRI scan and therefore, as per policy, this expense could not be reimbursed.
These facts had been made known to the complainant prior to the intervention by the union.
The infrastructure HR Manager would not have access to the complainant’s medical file (due to patient confidentiality) and therefore would not be aware of these details.
Decision:
Section 41(4) of the Workplace Relations Act 2015 requires that I make a decision in relation to the complaint(s)/dispute(s) in accordance with the relevant redress provisions under Schedule 6 of that Act.
Issues for Decision:
N/A
Legislation involved and requirements of legislation:
N/A
Recommendation:
I note that the company has procedures and policies in relation to the reimbursement of medical expenses and that part of these would be that all treatment must be sanctioned beforehand. I understand the good medical reasons why any course of physiotherapy must be undertaken by a Chartered Physiotherapist. In this particular case, however, I accept that the complainant, in all good faith, attended someone who had a good reputation locally (including involvement with the county hurling team) and did not realise that they did not possess the credentials specified by the company. I therefore recommend, in the particular circumstances of this case, that the respondent reimburse the complainant with the sum of €240.00. As the MRI scan was not sanctioned I cannot recommend reimbursement of that fee.
I would also suggest that the Infrastructure HR Dept. liaise with the Chief Medical Officer’s Dept. with a view to developing a protocol for dealing with similar queries without breaching patient confidentiality.
Dated: 16th March 2016