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Looking for input - CA work comp *relapse
#21
Thank you for your reply. I was definitely a bit confused between your work comp and STD denials and hope I did not add to your stress by all of the questions. My main worry for you was missing a deadline. It sounds like you are taking care of things, and again if you are dealing with STD/LTD denial a ERISA attorney is who I recommend.

I am happy to read your QME is in your favor and hope that now you will be in a better position to heal and concentrate on getting yourself better and not worry about the legal stuff.

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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#22
I have posted updates via a new thread (two, actually) but just to update...I have reached P&S with a rating of 40% but the QME report had a typo so I just have to wait for that. I am currently under approved 'Reasonable Accommodation' with my employer, though I just submitted another work status update and not sure if that one will be approved or not. Since they likely are not going to be made aware I am P&S (due to the typo - which unfortunately contradicts my P&S status..sigh) then they won't know the recommendation is that I cannot go back to my 'former employment.' So now I wait to find out if they are letting me go before my QME is accepted by their attorney (again, pending updated report) or if they will hold on me long enough to get the report. I don't know if there is a difference at all - if they get the report and recommendation first, or if they let me go first - and can't find that info on if there are differences, what they are and how I'm impacted.

I continue to be frustrated and not get answers to questions, but I realize my case is complex. It has been a long hard road and I see why people give up.

I am still denied some benefits and take full responsibility for the fact that I do not understand how payments differ or how they are related. So for example I should be getting supplemental payments from one company, in addition to the work comp ins company, but I don't exactly know why, what the benefit is (have consistently been denied since initially injured in 2011) and my work comp attorney will not assist with those appeals and doesn't explain it so that I understand and is frustrated with me. I can appreciate my brain takes info differently, but I just don't get it. I am still appealing though. I have nothing to lose - just time and all I do is work on this stuff. Or think about it.

In some conversations my lawyer refers to my 'other benefits' and I have to remind him I'm not getting them...and he is confused. In other conversations when I bring it up he says I shouldn't even pursue it because maybe they overpaid me in the past and they will catch it and that could impact me. I don't know. I just don't freaking know.

I am trying to find another attorney - not for work comp, but for other factors related. One firm is looking at me now, and have tentatively said they are interested. They are reviewing some documents I gave them and will let me know if they want me as a client.

Anyway - this forum has been so helpful in many ways...I wish I had more to offer back.
 
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#23
Google Long Term Disability attorney or Erisa attorney if you need assistance with your Long Term Disability denial.  There are strict time periods for appealing these (it sounds like you have been appealing these denials on your own). I also recommend requesting a complete copy of your disability policy from your employer or from the disability company directly (supplemental disability policy you wrote about above). If your injury is a psych claim, you need to find out if this is covered under your disability policy and what their rules are on this. To answer your question should you get supplemental payments if receiving payments from WC and your disability policy...you have to read the language in your disability policy. Most LTD policies offset the WC payments so you may receive a small check or no check. You need to let your disability policy company know when you are receiving payments from work comp. They should have sent you form that ask about other payments. If you qualify for LTD payments it is good to still apply because their is a cut off for TTD payments from work comp and most LTD policies cover until age 65.

Can I ask what your feelings are with going back to work for your employer?

I do not know if your employer can legally let you go after a QME report, with a psych claim. This is something I have no knowledge of.It sounds like you have met with a labor law attorney...correct? This is the person I would recommend talking to if your employer does not allow you to return to work (if you want to return to this employer).
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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#24
California_Help - THANK YOU! That makes total sense! I will request copies of the policies immediately. That did not occur to me and you are spot on with that suggestion. Also, the way you explained it, I now understand the differences. I don't know how many people I have talked to but for some reason the way you wrote it...I get it. Whew. Ok I know what to do for this one - and yes I am still within all my time limits etc. I keep up. Or, I try.

Going back...I am very angry that I can't go back to my job actually. I didn't want to be that person that left by way of 'freaking out' and ended up just fading out of everyone's mind until someone asks what ever happened to....I'm angry for so very many reasons but mostly, rather than allow a safe work environment for me, they made me the problem. So my recovery has been especially hard because I'm fighting myself. I want to go back to where I'm not wanted and it won't be safe for my health. Even on leave they were harassing me. I've got a ton of documentation but there is no lawyer that I can find, that will talk to me. Well there is one actually and that firm is reviewing some things now to decide if they want me. If not...I'm out of places to call. The firm said they think I have three separate cases in addition to work comp, but they wanted time to look deeper.

I know I come off negative and just whiney...I am trying so hard to get to the end of this, and it is scary. I've been without benefits on and off for months the most recent being the sudden halt to benefits in December. So I went through the holidays with no benefits. For no reason. They caught me up after but the added stress of simply handling my claim, is overwhelming. The only party involved who does what he says, is the QME doctor. I can call his office even though I have an attorney and his offices tells me what's up. And they are always 100% straight with me. And meet deadlines etc.

Every other person or entity involved has had decisions appealed by me, and at every level I have had to learn more and more of what their functions are, in order to properly appeal and get them to handle my claim appropriately. My own company's work comp contact didn't file my second claim for 23 business days!! Payroll had no idea I was out of the office. Then she put in writing to me, that I was confused as to why I was out of the office so she had to wait until I clarified my leave intentions. Seriously. If I had another 2 days and 80 pages, I could tell you so much more (and bigger of a deal in the grand scheme of things) but...I'm close to being done. Just wondering what happens next.

I wish I never would have started this process years ago...I was too naive and had zero clue about this sort of thing. I had so many people at work come up to me saying oh you are so lucky how did you get them to approve your leave (the first time years ago) and I couldn't get past the oh you are so lucky comments...because I disagree. I would have been better off learning years ago that I wouldn't retire at that place, wouldn't reach any of my goals...because they decided to allow my boss to mess with me. Humiliate me. Bad mouth me. Contradict me. Discipline me. Ostracize me. You name it - it was done. After he got into trouble from comments I made to HR, he came at me harder and here again, they are making me the problem. All I wanted to do was my job. And my boss to do his job, not my colleague (who then started bullying me too)...Anyway - this is really all secondary to the main issue that I can't even bring up or mention anywhere so...for work...I don't even know what I'm going to do. I have no clue. I'm angry, and scared, that I have to come up with a plan B. Sad
 
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