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  • Powerless to do anything California

    Employer is not turning in claims for injured workers and paying for medical care and surgeries direct for employees. HR Mgr is NOT a Certified Claims Administrator and will tell employee we are "self insured" which we are NOT! HR Mgr will deny a claim based on how she feels about the employee or the injury. HR Mgr has harrassed injured workers; denied medical care stating either the employee was at fault for the injury - or - that is was an exacerbation of an injury not related to their work...like they did it at home and only furthered it by an action at work. When the injured employee is off TTD for an injury, she places them on FMLA without their knowledge. In one instance, the FMLA was used up for the work injury and when the ee needed FMLA later, they could not receive it. Employees are lied to and deceived by this woman. What recourse is there?

  • #2
    http://www.dir.ca.gov/DWC/dwc_home_page.htm

    Regarding FMLA, the employer MUST designate the time as FMLA is the employee and the condition qualify. Unless something has changed in the most recent amendments to the law, notification that FMLA is being invoked is not required by the law.
    I don't respond to Private Messages unless the moderator specifically refers you to me for that purpose. Thank you.

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    • #3
      Placing an employee on FMLA while on a work related injury is the correct way to use it. They can run concurrently.
      They do not need to be certified claims administartors, just knowledgeable of the laws. But apparently they are not. This is ilegal and you may contact the DIR for more information :
      http://www.dir.ca.gov/dwc/InjuredWorker.htm

      This seems like a very ignorant employer form all your posts, maybe it's time to look for other employment Good luck!

      Comment


      • #4
        Originally posted by angel_28 View Post
        This seems like a very ignorant employer form all your posts, maybe it's time to look for other employment Good luck!
        Of the law, not necessarily; of fairness and employee morale, I mostly agree.

        However, of all this poster's threads, this is the only practice (the Work Comp approval process, not the FMLA policy) he has communicated to us that might actually be a violation of law.
        Last edited by Pattymd; 09-15-2010, 02:47 PM.
        I don't respond to Private Messages unless the moderator specifically refers you to me for that purpose. Thank you.

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        • #5
          Regarding FMLA, the employer MUST designate the time as FMLA is the employee and the condition qualify.
          I think this applies IF the ER/employer intends to run the WC leave concurrently with FMLA, there would be no mandate that requires the ER to do this...
          FMAL is actually a federal mandate benefiting the employee...it's genearlly at the EE descretion to use that unpaid leave benefit, Calif has a Fam/Med leave act stronger than the fed mandate.
          Should the employer give the employee any special notification under the FMLA?

          In order to deduct the time spent on WC leave from an employee’s annual FMLA leave entitlement, the employer must notify the employee in writing that the WC leave is designated as FMLA leave and will count against, and run concurrently with, the employee’s 12-week entitlement. The notice to the employee must detail the specific obligations of the employee while on FMLA leave and explain the consequences of a failure to meet these obligations. Most employers use the Department of Labor’s Form WH-381 to comply with these notice requirements. If the employer does not provide the notice, it cannot count the WC leave towards the 12-week FMLA entitlement. Therefore, the employee may be entitled to an additional 12 weeks of FMLA leave at a later date.

          If the employee has been on WC leave without being placed specifically on FMLA leave, the employer should send notice to the employee immediately so that the FMLA clock starts running. However, the employer may then only designate the leave from the date written notice to the employee is provided. It cannot retroactively designate the time spent on WC leave against the FMLA entitlement.
          HR Mgr is NOT a Certified Claims Administrator and will tell employee we are "self insured" which we are NOT!
          ?... how do you know you are not legally self insured?. IF in fact the HR person is making these statements with the intent of denying benefits to an EE injured in the workplace, it is/could be construed as fraud. Punishable by fine up to 50K and/or up to 5 years jail time. ER fraud is rampant in Calif, would have to think ''as goes Calif, so goes the nation" on this one would apply.
          HR Mgr has harrassed injured workers; denied medical care stating either the employee was at fault for the injury - or - that is was an exacerbation of an injury not related to their work
          Regardless of the other 'illegal'' activities here... there is a mandatory UR/Utilization Review process in place in Calif... ALL ER/IC are required to have a UR plan, and approved by the DWC Medical/Administrative Director.
          Whether there is a legally selfinsured ER, or a WC carrier providing benefits, the UR plan applies. ONLY a ''doctor" may modify, delay, or deny a request for treatment in Calif. Not a CA/Claims Adjuster.

          There are differences in CE/Claims Examiner, CA/Claims Adjuster and/or CA/Claims Administrator.
          Any carrier providing WC coverage and adjusting claims, even TPA/Third Party Administrator for self insured ER's, must have a CA/Claims ADMinistrator in the state of Calif. CA/Claims ADJuster may be located at the convenience of the carrier/ER. Though youd have to question the business practice of maintaining a CA here, and a CA there... (but then, that's not my problem)
          There are state requirements on claims examiners/adjusters/administrators for continuing education classes. I don't recall exactly what those are today... but available at the Calif Dept of Insurance site.
          she places them on FMLA without their knowledge.
          There has to be a dr cert, the EE/IW has to sign the document/request for FMLA, the ER cannot back date the FMLA leave...there are too many variables here to go after this one.

          I would also have to ask... where are you getting all this information. your ''facts'' regarding this HR persons actions...? And have you actually taken these issues to a higher authority in- the company ?
          Rants on a message board are doing no one any good, and a poll of what your next step should be won't resolve this... file your complaint with the WCAB, DWC, DOI fraud hotline... or if you have a industrial injury claim... FILE it, and move through the process.

          Comment


          • #6
            Great information

            First...let me clarify. I know for a fact this is happening as I have been subpeona'd, given two depositions and tried to warn upper management many time and to no avail. Quite honestly, just want to stay below the radar until another opportunity presents itself. I'm not ranting..I'm concerned for the employees health and well being. I know we are not self insured because I know our carrier, what is involved in being self insured and unfortunately our 500+ employees are going to be at risk of losing their jobs. Just quickly adding the fines and legal fees from the small bit of information I know (not heard) it will be significant. Once the three employees that reported them start talking...then you will see the other 20-25 previously injured employees come forward.

            All of these issues have come as a result of hiring and having direct reports that are related. Yes..our employee manual strongly discourages it but when it is the leadership...that's a form of job security we would all want...maybe.

            Comment


            • #7
              First...let me clarify. I know for a fact this is happening as I have been subpeona'd, given two depositions and tried to warn upper management many time and to no avail. Quite honestly, just want to stay below the radar until another opportunity presents itself. I'm not ranting..I'm concerned for the employees health and well being.

              All of these issues have come as a result of hiring and having direct reports that are related. Yes..our employee manual strongly discourages it but when it is the leadership...that's a form of job security we would all want...maybe.
              I guess...and with all due respect... what are you doing on a message board with this...?

              You say you want to ''stay below the radar''... (?) ... barring an article in the LA Times, or FOX News... you can't get much more ''out there''...
              Are you providing other EE's the information you post/ask here, and suggesting they follow suit?
              Just quickly adding the fines and legal fees from the small bit of information I know (not heard) it will be significant.
              You say your ER has 500+EE's... the likelyhood of their affording 1M in fines/penalty is probably up there with the best of em....there is a ER in Chino CA... recently charged with fraud against SCIF... over a period of about 10 or 12 years if I remember right... $1.2 million in retro premiums... case hasn't resolved yet... but fraud penalties in CA run three time the 'fraud', up to 50K fines and/or 5 years jail time.
              On top of that... I'd have to imagine your ''large'' ER has legal counsel on their actions... maybe, maybe not. At any rate... the claims will be investigated, and if action is warranted... it would be addressed by the Dist Atty and/or Dept Of Insurance commissioner.

              That still leaves the question of ''why/what'' your intention here?

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