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Thread: workers comp, stdand, fmla Virginia

  1. #1
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    Default workers comp, stdand, fmla Virginia

    I have been on workers comp. since July of 2012 for a work related injury- torn left rotater cuff injury. I was getting my weekly check untill the 14 th of Jan 2013 when the adjustor called me and told me that she was going to stop my checks as I was not going to attend the work hardening program scheduled on the 15th (I had called the rehab center and told them that I would not be attending because the doctors (nephrologist and urologist ) treating me had decided to do some procedures and surgeries on the 7th and 11th and then the 18th) I called and informed the rehab center on the 4th about all this. This medical problem was not the reason that I was getting the workers comp. so when the adjustor learnt about it she decided to put a stop on my payments as it appears that I am not co-operating in the workers comp injury treatment.

    I then applied for STD ( private company administered) and they told me to submit the workers comp denial letter (which I have yet to receive) and then they would approve me for std. Yesterday I got a letter from the company Human resources and they have sent me the forms for FMLA. I called the HR AND THEY TOLD ME THAT i WAS NOT ELIGIBLE FOR fmla because I did not have hours worked in the previous year - as I have been on lost wages and on workers comp since July of last year. I have yet to speak with the STD personal about the STD benefits.

    The workmans comp adjustor told me that she would take me back on workmans comp after I have my unrelated medical issues resolved. Well it appears to me that I am in a big mess and I do not know How to proceed. Any advise???

  2. #2
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    FMLA eligibility is set by Federal law and the employer does not have the option of assigning your time off to FMLA if you do not meet the criteria. But just because you don't meet the criteria for FMLA doesn't mean that your time off is unapproved.
    The above answer, whatever it is, assumes that no legally binding and enforceable contract or CBA says otherwise. If it does, then the terms of the contract or CBA apply.

  3. #3
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    When you get the denial letter, submit to STD. According to what you posted, you will then be approved for STD. Once the medical conditions that caused you to apply for STD are repaired and you are able to follow the worker comp requirements, then contact the worker comp rep and restart that claim.

    How you are paid is unrelated to job security (which is FML). Even if you are termed by your job, the worker comp claim would continue.

  4. #4
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    It would also be considered insurance fraud for WC to pay you while you were off work for a non-work related ailment. If you are not treating for the shoulder, the legal way for the carrier to handle it is to cease TTD payments until such a time as you are disabled due to the shoulder and not some other condition.

    The STD carrier would approve or deny based on the medical conditions your doctor certifies are keeping you off work. If the shoulder is not, it should not be included. If the other conditions are not sufficiently disabling, it is quite possible you simply will not qualify for benefits.

    If you have been off work since last July, it is almost certainly the case that you have not worked enough hours to qualify for FMLA. You will need to ask your employer how much leave they are willing to grant. They have already granted more than the law would require even if you did qualify.
    I post with the full knowledge and support of my employer, though the opinions rendered are my own and not necessarily representative of their position. In other words, I'm a free agent.

  5. #5
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    Default disability eligibility

    I get around 225.00$ a week in work comp. but my household income per month is around 7000.00$. Am I eligible for any state or federal help if I am disabled and on dialysis or will I be denied because of too much income over the federal poverty level (family size of 3)

  6. #6
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    I don't think STD is going to pay, because your comp case is not denied. You have a dispute within the comp case regarding your ongoing eligibility for TTD payments. You need to talk to a local workers' comp lawyer and see if you can get that problem solved.
    Bob Bollinger, Attorney
    Board Certified Specialist in NC Workers' Compensation Law
    Charlotte, NC

  7. #7
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    You are going to need to contact the state and federal agencies and ask if you qualify. No one here can tell you that. It never hurts to apply. As you are now off work for a non-work related condition, WC will not cover you. SSDI might depending upon the severity and duration of your unrelated medical condition. SSDI is not dependent upon household income, only personal income.
    I post with the full knowledge and support of my employer, though the opinions rendered are my own and not necessarily representative of their position. In other words, I'm a free agent.

  8. #8
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    Default adjustor wants an independant evaluation

    My adjustor tried to deny my wc wages last month but it did not work. Now she has sent me a letter to get an independant evaluation from a doctor of her choice and she has told me to attend the appointment. Its been 7 months after my rotater cuff surgery. It has healed and is a lot better but the doc who is treating me wants me to do some more physical therapy before he signs me MMI. The adjuster wants me to join work soon but the doc has told her several times to wait. Now the adjuster is bypassing my doc and trying to get an evaluation from her doc. Is it legal? I have an appointment with my wc doc next month so as I have to see this second doc will his impression be valid before the VA Workers Comp. and do I even get to see my wc doc anymore?

  9. #9
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    It is not only completely legal to send you for the IME, but in many cases required.
    I post with the full knowledge and support of my employer, though the opinions rendered are my own and not necessarily representative of their position. In other words, I'm a free agent.

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    SSDI might depending upon the severity and duration of your unrelated medical condition. SSDI is not dependent upon household income, only personal income. .
    Eligibility for SSDI is not dependant on any income...personal or household. SSDI entitlement is based on phys/mental impairment and the inability to perform any work.
    SSDI may be subject to offset/80% rule based on other public disablity benefits. IE. workers compensation, State Disablity Ins etc.

    SSI/Social Security Supplemental Ins benefits ARE based on assets, including those of your household.

  11. #11
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    SSDI is based on personal income. If you are making over a certain amount in wages, you do not qualify. My Dad is receiving benefits from SSDI now and he must submit reports detailing how much he makes in wages for each month he receives benefits. They do not care how much my mother makes.
    I post with the full knowledge and support of my employer, though the opinions rendered are my own and not necessarily representative of their position. In other words, I'm a free agent.

  12. #12
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    I have to agree with Elle. I know an adult child (never worked) who is getting SSDI based on Dad's income at time Dad retired. (not household income)

    (though in this case, it's not personal income but Dad's income - however, is based on income & not household income)
    Last edited by Betty3; 02-26-2013 at 11:19 AM.
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  13. #13
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    507.1 When are you considered disabled?
    You are considered “disabled” and entitled to disabled worker's benefits if you meet the following conditions:

    A.You are unable to engage in any substantial gainful activity (see §603) because of a physical or mental impairment (see §601). You must not only be unable to do your previous work, but also any other type of work considering your age, education, and work experience (see §609);

    NOTE: It does not matter whether such work exists in your immediate area, whether a specific job vacancy exists, or whether you would be hired if you applied for work.

    B.Your impairment(s) must be established by objective medical evidence (see §§614-616);

    C.It is expected that your impairment(s) will either result in death or last for at least 12 months in a row (see §602.1); and

    D.You must meet the non-medical criteria needed to be insured by the program.

    http://www.ssa.gov/OP_Home/handbook/...book-0507.html
    When you are applying for SSDI, and working with average monthly wages of $1000+, you are not "disabled" under SSA rules.

    Once you have been granted SSDI entitlement, you can work, but again if you have average monthly wages of $1000+, your SSDI can be reduced or stopped until you become "disabled" again. SSDI can be started/stopped. Once you become Medicare eligible, and return to work, Medicare can continue up to 39 months.


    NOTE: The definition of disability also applies to persons applying for child's insurance benefits based on disability before age 22, for disability benefits payable after December 1990 as a widow, widower, or surviving divorced spouse and for adults (persons age 18 or over) for determining eligibility on the basis of disability under the SSI program.
    To qualify for SSI, you must be low income and retired, blind, or disabled. SSI is based on assets including household.

    SSDI is not based on assets but may be reduced due to income.

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