Hello There, Guest! Login Register
Index    |     Search    |     Members    |     Help

Thread Rating:
  • 0 Vote(s) - 0 Average
  • 1
  • 2
  • 3
  • 4
  • 5
Looking for input - CA work comp *relapse
#11
Hi - thank you for your questions, I'll do my best to answer as best I understand your questions...but bear with me, please. I'll start with your last questions first, as that provides the chronological order and may be easier to follow.

**updating** be back shortly
 
Reply
#12
(05-28-2015, 10:45 AM)California_Help Wrote: I am a little confused on your current situation. Is it a STD (short term disability) policy that has denied your claim? If so you need a ERISA attorney. Work comp attorney's know very little about STD/LTD policies, and thier job is only to represent you in your work comp claim.

I also have a question about who took you off of work, as you wrote your doctor would not take you off of work so you took yourself off. Is this correct?

You may be able to qualify for state disability. Have you applied?

Why are you not receiving TTD if you have been taken off of work from a doctor for a work related injury?

Also, you wrote they are allowing you to use your own doctors for your work related claim. Is the work comp carrier paying for these doctors visists, your medications etc or are you useing your private insurance?


Also wanted to ask/clarify - it is my understanding, that if my QME results supports me being out of the office, that it won't matter that I'm currently denied benefits, as upon approval the work comp insurance company should then compensate me back to my original date of out of office. Do I have that right?


Or, are you saying regardless of whether the QME is in my favor or not, I should seek counsel with an ERISA oriented atty for being denied benefits for both claims (that are under one claim number - as instructed to do by the ins co).
 
Reply
#13
Did you appeal the STD denial? Usually there are strict time limits to appeal short term disability denials. I highly suggest meeting with an ERISA attorney over your STD denial. They will want to review your policy and possibly all correspondence with your LTD company. Every policy is different, and no one on a message board can answer your questions about your STD claim as it is dependent upon what your policy states.

I also want you to be aware some of our laws have changed since you settled your claim in 2011, and it did affect stress claims.If you cannot get a hold of your attorney, I suggest making a in person or phone appointment with him.

Most work comp attorney's do not know very much about STD/LTD and are representing you in your work comp claim and possibly why he is not returning your calls about STD questions.

I highly recommend not to discuss any of your claims with other employees, ever.

It is normal for a employer to advise the employees not to talk to an employee who is out on a stress claim.Please do not take it personally. This is the policy of eery company I have worked for. Even though I was in management I was not allowed to speak to one of my employees after they filed a psych claim or a workers compensation claim, even though I wanted to check on them to see how they were doing I was not allowed.
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.
 
Reply
#14
(05-29-2015, 07:40 AM)California_Help Wrote: Did you appeal the STD denial? Usueally there are strict time limits to appeal short term disability denials. I highly suggest meeting with an ERISA attorney over your STD denial. They will want to review your policy and possibly all corispondence with your LTD company. Every policy is different, and no one on a message board can answer your questions about your STD claim as it is dependent upon what your policy states.

I also want you to be aware some of our laws have changed since you settled your claim in 2011, and it did affect stress claims.If you cannot get a hold of your attorney, I suggest making a in person or phone appointment with him.

Most work comp attorney's do not know very much about STD/LTD and are representing you in your work comp claim and possibly why he is not returning your calls about STD questions.

I highly recomend not to discuss any of your claims with other employees, ever. It is normal for a employer to advise the employees not to talk to an employee who is out on a stress claim. Do not take this personally.

Hi sorry I thought I answered this sometime in the night...I have insomnia and tend to be forgetful on nights I don't sleep...anyway I am familiar with the employees not speaking to me regarding my case, and that is true of all employees, what I refer to is different, but I do appreciate the comment as I'm sure that does come up.

**updating** be back shortly
 
Reply
#15
Hi,


I recomend applying for state disability if you have paid into it, since you have been denied STD.

I still do not understand why you are not receiving TTD from work comp for your stress. You can only get this if your work comp doctor has taken you off of work for it and you need to see this doctor at least every 6 weeks and get a note of TTD. If your claim has been denied, I can understand they do not have to pay you until a QME opines. I would refer this to your work comp attorney.

Again, watch out for STD/LTD denial deadlines. If you miss the deadline to appeal you may lose it permenently. There are a lot of nice ERISA attorney's out there.

Good luck to you on everything.
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.
 
Reply
#16
I have made some modifications and will just post here some answers from the last couple of posts from California_Help that are better summarized. Thanks for the heads up about content - I have nothing to hide and I think my problem is that I am just too damned honest (and trusting), but regardless it was good feedback and I appreciate it.

From the last two questions you asked me...
Yes, my company's work comp insurance company, paid for all medical and salary (or I believe for long term it was 66% of salary) for about 2 years and only medical from my return to work date (declared perm & stat). The only coverage I have now is my medical co-pays. There is nothing I pay out of pocket with that claim. But time missed at work isn't paid for either. It is my understanding that all of the missed time these past couple of years will be captured with this new claim - and with the assistance of my work comp atty. In my original claim it states I can see my doctors that I had already been seeing. As the main doctor has left my med ins provider, I had to find a new one, that I eventually fired and now I have yet another new one. I suppose this time I may be asked to see different doctors, I didn't know that was a thing, since last time was different...

So when I relapsed recently, I didn't have anyone to take me out, so I took myself out and that caused problems, because the work comp person through my company refused to work with me for several days, then refused to provide me the ppwk to file, and then refused to return any of my calls or answer any of my questions by phone/email/fax - just refused to get back to me even with my calls for intervention from her superiors.

As a result of her lack of communication, I didn't provide work (HR & work comp/benefits) with documentation that was required of me (I didn't know). As I didn't do that part, work has not authorized my leave and my benefits have ceased.

Also while I've been out on leave, I had a second claim (but under the same claim #) that is also denied simply by default because my first claim is denied.

I was getting state disability but that also has stopped.

So I have two total claims. One open with medical only and the current one, which as a dual purpose, and is currently in the denied status. The ins co is who told me to put both purposes under one claim #. I think if the QME results supports my claimed injury, then I will merge the two and just have my original claim opened up further, but no one can tell me definitively how that works.

As far as I know, nothing was 'settled' with my first claim, as it is still open so there was no additional benefit to me from the still open claim, and I have 180 days to file my appeal on this denied (relapse) claim.

It is the appeal that I need help with, because I feel like I'll only get one shot at it and I want to do it right, but searching for answers online only adds to my concern that I am not the appropriate person to be filing this appeal.
 
Reply
#17
(05-29-2015, 07:40 AM)California_Help Wrote: Did you appeal the STD denial? Usually there are strict time limits to appeal short term disability denials. I highly suggest meeting with an ERISA attorney over your STD denial. They will want to review your policy and possibly all correspondence with your LTD company. Every policy is different, and no one on a message board can answer your questions about your STD claim as it is dependent upon what your policy states.

I also want you to be aware some of our laws have changed since you settled your claim in 2011, and it did affect stress claims.If you cannot get a hold of your attorney, I suggest making a in person or phone appointment with him.

Most work comp attorney's do not know very much about STD/LTD and are representing you in your work comp claim and possibly why he is not returning your calls about STD questions.

I highly recommend not to discuss any of your claims with other employees, ever.


It is normal for a employer to advise the employees not to talk to an employee who is out on a stress claim.Please do not take it personally. This is the policy of eery company I have worked for. Even though I was in management I was not allowed to speak to one of my employees after they filed a psych claim or a workers compensation claim, even though I wanted to check on them to see how they were doing I was not allowed.

I have been advised I have 180 days to appeal the denied benefits.
 
Reply
#18
Is this the STD denial or work comp denial? Either one, I would make sure you appeal before any deadline. If this is about STD/LTD then contact an ERISA attorney.

Reading through your posts again, I think there may be some overlapping issues and some confusion in some of my replies because you have several complicated issues dealing with a disability policy combined with a non work injury and work related stress claim.

I would be very careful about leaving work without a doctors note. I would discuss this with your attorney.

I hope you are able to find some professionals that can help you with these legal issues. Best case scenario is you will recover from your surgery and stress issue and you can return to work. Hopefully your employer will work with you on this.
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.
 
Reply
#19
(06-04-2015, 06:57 PM)California_Help Wrote: Is this the STD denial or work comp denial? Either one, I would make sure you appeal before any deadline. If this is about STD/LTD then contact an ERISA attorney.

Reading through your posts again, I think there may be some overlapping issues and some confusion in some of my replies because you have several complicated issues dealing with a disability policy combined with a non work injury and work related stress claim.

I would be very careful about leaving work without a doctors note. I would discuss this with your attorney.

I hope you are able to find some professionals that can help you with these legal issues. Best case scenario is you will recover from your surgery and stress issue and you can return to work. Hopefully your employer will work with you on this.

Hi, sorry I've been off the forum a bit. I was pretty stressed out there and just needed to stop talking about it, as I was getting pretty sick and nauseous while working on my appeal, but it is submitted. I'm not sure it will matter though, because I received my QME report, and it was again in my favor. The doctor has me listed as "temporarily, totally disabled based on psychiatric illness and symptoms." Since this is an extension of my existing claim, which was never closed or settled, but was limited to medical only, I don't think the period I was denied really even needs to be appealed, because now I'm basically covered for any time from 4 years ago to current. At least that's how I understand it. My lawyer is checking on it for me. I have only been paid SDI through last week, then that was cut off. I was cut off from the rest of my benefits in early April, and since work comp ins will have to reimburse the disability ins co, then for the time unpaid the work comp co will just pay me to catch me up...at least I think so.
 
Reply
#20
Since I was here last, I filed my appeal, and had the QME doctor's report come in, placing me as temp and totally disabled. The verbiage is as I mentioned in my reply to California_Help. I believe the reason my benefits were denied, was because my work denied me. My company has been messing with me since I went out on leave. I am not at work and took myself off months ago, so I apologize I didn't make that part clearer. So many thoughts and key things to try to convey without writing a novel! So I'm not at work, now under work comp again, so I should start getting paid regularly, and I don't think there is anything further work can do to mess with me right this minute. I have all of their follies documented, and recently informed them that communication going forward would need to be in writing. I know that was not nice but I couldn't take it anymore. I was accused of ignoring requirements supposedly told to me during a meeting we never had. No one ever returned any of my calls or my emails asking for information including what else was needed. Unreal. I sincerely feel harassed while on leave for harassment. I still do, but feel a bit better now that the QME was to my favor. Although, the report is very heavy to put me on meds again.
 
Reply
  


Possibly Related Threads...
Thread Author Replies Views Last Post
  Work comp adjuster changing doctors CA kibby 12 1,582 06-13-2019, 12:37 PM
Last Post: richard_girling
Shy Work related/induced stress & workers comp heartworkerNC 7 5,546 02-20-2019, 08:16 AM
Last Post: TerryLewis
  ust now Can I quit my job and do freelance work during workers comp? caworkerscompqs 1 1,049 01-30-2019, 04:32 PM
Last Post: 1171
  Drawing umemployment off your work comp Bets 8 1,459 01-12-2019, 02:41 PM
Last Post: tbear6410
  Work Comp Lien with Fradulent Amounts samistheman 5 4,612 10-29-2018, 05:10 PM
Last Post: 1171
  NY WORK COMP BOARD EXPANDING DRUG FORMULARY.... 1171 0 669 10-24-2018, 02:10 PM
Last Post: 1171
  Work comp overpayment Golfgod00 2 1,256 07-28-2018, 06:45 PM
Last Post: 1171
  Virginia Work Comp/ Forced surgery Kedward7 4 1,879 04-12-2018, 02:36 PM
Last Post: 1171
  Work Comp SSDI Offset-Hartman formula kong 5 12,921 03-17-2018, 02:20 PM
Last Post: Seeking Help
  Who pays for surgery if work comp is denied Dayneliski 3 3,806 02-27-2018, 02:48 PM
Last Post: Cashiered Too

Forum Jump:


Browsing: 1 Guest(s)