For My Sister

[UndercovrAngel]

My sister lives in CO. She has been on WC TTD since October due to an injury to her right shoulder (rotator cuff tear) and cervical spine (multiple cord lesions. Probable Demyelination and small right paracentral disc protrusion at C4-5 with moderate deformity of the right C5 root sleeve.). This all came from an MVA while she was driving her bus and another car blew through a stop sign, hitting another car which then spun out hitting my sisters bus.

She received PT and is still receiving massage therapy which is doing no good. She has paid for cortisone shots through her PCP and private insurance that have not helped. She is being prescribed pain meds and ambien to help her sleep.

Here are some questions I have in regards to her claim:

1. Is it legal for the IC to only pay her 60% of her wages at time of injury, even though CO wc law state 66 2/3rds?

2. She was referred by her WC Dr, back to her PCP to get an MRI of her brain. She was charged $356 for this. If she was referred by her WC Dr, shouldn't all costs be paid for by the IC and not out of her pocket ?

3. She was just informed today by her employer and an employee for the IC that her FMLA has been used up and that they no longer can hold her job. Which I understand. However, she received a copy last week showing that her FMLA WAS NOT approved until January 19th. Is this legal for them to go back retro-active and charge her FMLA back to Nov. 2nd when her supervisor signed the paperwork with the "recommended" box marked ?

4. During her meeting with employer/IC employee, she was told that WC was going to add monetary benefits to her TTD but then TAX her benefits and use that "TAX" money to continue paying her private health insurance through her employer. Is this not illegal ?? I thought that all WC benefits were not taxable. And how can the IC get away with paying for her private health insurance when she has not been terminated from employment ? (Her health insurance, other than $56 a month to cover her husbands dental, was always paid in full by her employer and deducted from her pay prior to taxes being taken out).

5. She never received her employee WC handbook when she filed her claim. She didn't even know one existed until I told her about it. So she didn't even know to ask for one. So she had no idea what her rights were.

6. When injured, she was told that she WOULD be going to see Dr. Ramaswameydingdongy. Was never given a choice as to who she would like to be treated by, although CO WC law states that she was to be given a choice of at least 2 Dr's to choose from. What can be done, if anything, in regards to this ??

7. CO law allows for a change of Dr's withing 90 days of the initial injury. But because she didn't receive her injured employee WC handbook, she never knew this. It is outside the 90 period, but she still hasn't been found to be MMI yet. Does any one know if she can still file for a change of treating MD ?

I know this is long, but I am trying to help my sister as much as I can. I finally convinced her to start looking for an attorney, using the "find an attorney" function from this sight. So far, she has been contacted by one attorney who told her she has an excellent claim, but that he couldn't help her as his practice has to many clients at this time.

Any advice would be greatly appreciated. I have completely read the entire Laws and Statutes for CO WC and could not find any of these questions addressed anywhere.

Angel ^j^

[1171]

TTD is capped and cannot exceed the maximum rate.

for any period that is not covered by the FMLA job protections the employee is open to termination. it would seem in her best interest to have her job protected back thru November.

your sister should have a choice on health insurance -does she not want coverage?

if the employee handbook is mandated by the comp law she should file a complaint.
if she was not given a physician choice she should file complaint with the comp board.

yes she can request a change of physician. she should do so in writing.

she should request reimbursement for any out of pocket expenses.

[Bummer Knees]

Angel

Just a few comments about your post.

I have the cervical injury with some of my injury being similar to your sister's injury.
I am going to physical therapy 3 X a week, traction & massage. On the days I have massage the pain levels go to a 9/10, the therapist has learned to do the massage close to the spine only and this has helped greatly to reduce the pain levels.

I agree with you, your sister needs an attorney.

When I was first injury and before I hired an attorney my employer would ask me to sign over my TDD check to them which I did and my employer would than pay me 100% of my wages.
I paid taxes for 100% of my wages, but also received my employee benefits.

I worked for a large college and the work comp policy was included in the employee's handbook.

Good Lck!

[UndercovrAngel]

(02-05-2011 02:16 AM)1171 Wrote:  TTD is capped and cannot exceed the maximum rate.

I understand this. But CO SAW is capped at 90%. It clearly states that they are to receive 66 2/3rds of wage before injury. Her paperwork showing what she gets bi-weekly states she is only receiving 60%[/color][/size][/font]

for any period that is not covered by the FMLA job protections the employee is open to termination. it would seem in her best interest to have her job protected back thru November.

If she fights this, can they go back retro-actively and fire her ??

your sister should have a choice on health insurance -does she not want coverage?

It's not that she doesn't want to keep her insurance. But when it comes to settlement (if it does) it will show that she was paid more than she actually was. And because they will begin "taxing" her TTD to "pay" for these benefits, she will have to file it on her income tax.

She has not been terminated, and as an employee, one of her benefits is supposed to be having her private insurance paid by the school district. This basically forces her to pay for that, as well as pay taxes on it.

if the employee handbook is mandated by the comp law she should file a complaint.
if she was not given a physician choice she should file complaint with the comp board.

yes she can request a change of physician. she should do so in writing.

she should request reimbursement for any out of pocket expenses.

Thank you for your help so far 1171

Angel ^j^

[1171]

they can't pay her 90% if it results in more then the maximum; the 90% is for those less then maximum.
unless your sister is under special contract provisions that allow extra benefits not specified in the work comp act.

if she believe she is being shorted her TTD she should review the maximum benefit rates and use the benefit calculator program
http://www.colorado.gov/cs/Satellite/CDL...8095315979
she can also review the employee guide
http://www.colorado.gov/cs/Satellite?c=P...DLEWrapper