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Workman's comp pay reduced/terminated
#1
Hi all...just found this site and am hoping to touch base with someone that understands some of the in's and out's of a work injury. 911 dispatcher for the Sheriff's Office since Nov 1999. I slipped and fell in the small locker room we have in dispatch on Oct 17, 2012. During that time I have been paid by my employers insurance company. I've had two failed back surgeries and am more than likely looking at a third (fusion on L5-S1), as my symptoms continue to get worse. The insurance company mailed a notice, the day before it went into effect no less, that my pay has been reduced from a little over $2,000 bi-weekly to $460 bi-weekly until the sum of $10,000 is reached. I still get direct deposit from the Sheriff's Office with $64.55. I have been employed with them since '99 and pay has never stopped in these last 15 yrs, just hugely reduced after my injury. My pay statements show that I continue to pay into CA OASDI/EE, but after applying for state disability, I was denied with the explanation "Your claim is not eligible to receive benefits. You must have earned at least $300 from which SDI deductions were withheld during a previous period." Going to the disability office in person....trying by phone is a joke. During this time, my employer has terminated all of my benefits (medical,dental,vision). Essentially everything I worked my butt off for has been stripped away. I do have a workman's comp attorney and just retained Binder and Binder to apply for Soc Security disability. Anyone that has gone through, or going through a similar scenario, I would welcome any feedback and/or suggestions. I'm still in a horrible amount of pain, but with this new development, I'm more scared at wondering how the heck I'm going to pay my bills!! It's frustrating that someone that stays gainfully employed and contributes to their community has next to nothing available to them. It seems that felons and undocumented have more avenues and options.
 
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#2
every state has different rules for their work comp program; without knowing yours specific information cannot be provided.
http://www.workerscompensation.com/forum...?tid=10146
many states have limited duration temporary disability benefits. if you reached the limit some states provide advances on permanent disability which often have a lower cap. benefit notices should be provided by the carrier explaining the benefits changes.
special terms and conditions for work injury benefits may also have been negotiated if you are covered by a collective bargaining agreement. if you have a union, contact them. every state has a website with comp information; when we know your jurisdiction we can give you a link.
Reminder :
........Each state has their own comp system; POST YOUR STATE to get accurate information. Use the search feature to find information from similar questions.
THANKS FOR POSTING.
 
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#3
(11-06-2014, 06:53 PM)1171 Wrote: every state has different rules for their work comp program; without knowing yours specific information cannot be provided.
http://www.workerscompensation.com/forum...?tid=10146
many states have limited duration temporary disability benefits. if you reached the limit some states provide advances on permanent disability which often have a lower cap. benefit notices should be provided by the carrier explaining the benefits changes.
special terms and conditions for work injury benefits may also have been negotiated if you are covered by a collective bargaining agreement. if you have a union, contact them. every state has a website with comp information; when we know your jurisdiction we can give you a link.

 
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#4
Thanks for replying. CA, unfortunately, has the limited duration, no matter what the outcome of the injury is. They (insurance company) has invested apprx half a mil into my back. Obviously all of my appointments, treatments, surgeries are covered under my claim. The notice I received notified me of the immediate income change and cited the suggestion to file for state disability under the CA Division of Workers Comp. Hoping to get some useful information tomorrow morning at the SDI Office. I am an SEIU union member and trading emails right now. More than a little frustrating that my energy has to go to this instead of my recovery and health.
 
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#5
yes california has 104 week limitation on temporary disability payments and it sounds like you reached it.
I suspect the payment reduction was because they automatically began making advance payments on any permanent disability you may have. the maximum weekly rate in califnoria is different from TTD to PD and resulted in the drop in payments.
these advances will be deducted from any permanent disability to which you may yet be entitled.
your direct deposit amount must be separate from your TTD and be something due to your employment contract or the result of another benefit system.
while SDI maybe available to some employees after TTD has exhausted, it generally requires recent wages from which SDI deductions were made.
without recent wages your SDI account has nothing from which you can draw. I'm sure you'll get more details from your visit to their office.
Under the law workers comp is a "no fault" system where both the injured employee and the employer are responsible for the costs/consequences; the employer has no negligence liability. with serious injuries the worker will have to bear some of the inevitable financial losses.
yes rush your SSDI request. it is available whenever it's likely someone will be off work for a year.
here is more information on workers compensation benefits in california
http://www.dir.ca.gov/dwc/iwguides.html
Reminder :
........Each state has their own comp system; POST YOUR STATE to get accurate information. Use the search feature to find information from similar questions.
THANKS FOR POSTING.
 
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#6


I would appeal a denial from state disability. They do give it to injured workers after TTD, and make exceptions sometimes. As long as your employer deducted from your paycheck for this. Sometimes state employees are different.

Is this a third fusion or you had two other surgeries and now your doctor wants to do a fusion?I do not recommend a fusion, unless you get some other opinions. This surgery is overdone in California work comp system and there are a lot of ortho's surgeons that do this surgery unnecessarily. I have no idea if this is your situation, just wanted to give you heads up.Many have worse results from it. Please, please get at least two other opinions first. Is your surgeon an orthopedic spinal surgeon?

I do not recommend that firm for SSDI at all. I don't know if I am allowed to refer you to another firm on this site.

Did your employer notify you of Cobra? With your current income you may qualify for free medical insurance. I would contact healthcare.gov

Good luck to you.





I am not an attorney.Anything I write should not be considered legal advice.I am writing from my own personal experiences,which is not from any sort of legal background. You should consult with an attorney over legal issues. In California, if you cannot get an attorney you can consult with an I&A officer.
 
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#7
Thanks California_Help! I welcome any and all comments as I have no problem admitting I'm pretty ignorant when it comes to this. I try to keep educating myself, but 4-9 Norco a day makes it difficult to focus. This would be the first fusion...last two were lumbar discectomies. When the disc originally herniated, a portion of the disc tissue broke off and settled on part of the nerve under the disc and grew throughout it. The first surgeon described it as tissue that had branched out and ended up causing some paralysis down my left leg. The last surgery was Feb of this year, and I was good for about a month, month and a half, then right back to square one. I do require a cane most days and at 35 I grumble when the weather starts to get cold or wet because, over achiever that I am, I feel it pretty bad in my bones. I fired my first surgeon after I went back to him after a couple months and told him how much pain I was in. I had completed all of two days of light duty and could barely make it to my car without crying out in pain. He said I was probably addicted to Norco and it wasn't the back injury any longer and there was nothing else he could do for me. Fast forward to 2nd surgeon who did the post op MRI that the first never ordered, and low and behold, re-herniation 4 times the size of the original. 2nd surgeon said he wasn't sure how I was still walking and promised not to do what the first surgeon did. Fast forward yet again, and 2nd surgeon told me that after a fall I had, it was neurological. I fell down the last 3 steps at home after I sneezed and couldn't catch myself. A sneeze will almost always bring me to my knees....feels like someone hits me in my lower back with a sledgehammer. That surgeon did propose fusion surgery to the insurance company, but there was this unexplained time line that the insurance company had.....I had to be in pain for a certain amount of time to show there was no progress...?? I still don't understand it and now that I'm no longer being paid, it almost feels like the delay was for this purpose. My most recent appointment was with a Neurosurgeon, and after looking at my MRI's he said he was hesitant to commit to saying I need the fusion. He had me see a colleague of his that specializes in deformed spines, which I guess I have now, and after he looked at everything, he gave me a 50/50 chance. 50 of improved symptoms, and 50 that I'll get worse. Not the numbers I was looking for, but I feel like I have to try. Some days I can't even walk myself to the bathroom and my boyfriend has to help me. TMI, I know. We want to get married and I want to have a child. I'll be 36 in a couple weeks and am pretty much mourning the fact that a baby isn't in the cards for me. I went to that firm only after a friend/old co worker of mine suggested them. He was an officer of mine and he's fighting his claim, having to prove certain injuries were from the job. I was hoping mine would be a little easier....pretty cut and dry about it being a work injury, documented surgeries, doc stating still unable to work due to uncontrolled symptoms for two years now, but as I'm learning, most of this is an uphill battle.
 
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#8


I will send you a private message. I suggest a Neurosurgeon who specializes in the spine, not brain. I also suggest at least two other opinions before you have a fusion. (JMO)
I am not an attorney.Anything I write should not be considered legal advice.I am writing from my own personal experiences,which is not from any sort of legal background. You should consult with an attorney over legal issues. In California, if you cannot get an attorney you can consult with an I&A officer.
 
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