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Retroactive WC Claim

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  • Retroactive WC Claim

    I’m a long-time county government employee (state of California), and until the arrival of a new supervisor had an impeccable work history and attendance record.

    My new supervisor managed to change all of that. Within a few months she gradually became extremely abusive, and when I complained she simply escalated her viciousness. The work environment became so toxic that I started seeing a psychologist. Adding to the already existing stress, several months later I found out that I was pregnant.

    I was advised by my psychologist and gynecologist that if I continue working under the same conditions, I would be risking my own health and the life of my unborn child.

    Based on their advice, I decided to stay home on sick leave until the birth of my child. As a result, I ended up exhausting all my banked sick time hours. Having depleted my sick time, however, puts me in a precarious position - especially with the birth of my child.

    My dreaded supervisor has finally been removed and I have returned to work.
    Since my sick leave took place less than a year ago, one of my co-workers suggested that I should file a retroactive workers’ compensation claim for the period I was out on sick leave.

    According to my colleague, if my workers’ compensation claim is approved, my sick time hours would be restored, and my sick leave would be re-classified as “salary continuation payments.” In essence, I would be claiming that while I have not sustained any permanent disability, my stress leave was entirely work-related and therefore subject to be filed as a WC claim.

    Can I retroactively file a workers’ compensation claim and get my depleted sick time restored? If yes, does this still entail a lengthy process where I would have to jump through several hoops before my claim is approved?

    Thanks in advance for all your responses.

  • #2
    Sorry, but "stress" is not normally SOLELY related to work. There are nearly always other factors involved and your pregnancy would be one of them. If you were to try to get this approved as worker's comp, expect the insurer to dig into every aspect of your personal life, as well as your work life, especially since you didn't address this as a possible work-comp issue at the time. It appears that there is a unique SDI plan for state employees; don't know if you were covered or not. Did you ever look into that?

    California State Government Employees covered by
    State Disability Insurance for State Employees (SDI-SE) 1-866-352-7675
    Last edited by Pattymd; 05-24-2010, 02:25 AM.
    I don't respond to Private Messages unless the moderator specifically refers you to me for that purpose. Thank you.

    Comment


    • #3
      I think your colleague should read up on the WC statutes and intent of the system, as well as benefits provided, more importantly at times what benefits are not available.

      One, the basic premise of WC is liability of the employER for your industrial injury/illness. WC is not ''health coverage'', nor is the employEE the insured party.

      Two, If the treating physician/PTP, sees there is work related injury/illness, s/he is required to bill the ER/carrier, and/or actually file the DWC-1...First Report of Injury. Providers are precluded from billing or back billing the EE/IW for any services provided. Your Dr could not provide treatment and bill you or your GHP, and then claim WC. There are differences in the fee schedule for one thing, and again, it's about the party holding liability.

      Three... there is a one year SOL for filing a claim for WC benefits. That would be one year from the date there is reasonable knowledge of the industrial causation. Whether you fall within that timeframe isn't known right now.

      At any rate, IF your PTP felt there was to be time loss due to your psych issues, you should have been paid SDI/SE benefits, and not used your sick leave time. (if eligible)

      If you or your PTP filed the claim at that time, there would be a 90 day timeframe for the ER/IC to investigate the claim to determine compensability. That would still be the case if you file today.
      WC is not a substitute for using your ER provided benefits, ie sick time, or PTO, vacation etc. WC is a law. And, it's not your option whether or not to file.

      You can find more info on Calif WC here http://www.dir.ca.gov/CHSWC/Reports/...book-3rdEd.pdf

      If you file the claim now, you can expect to under go an extensive deposition, under oath, where the ER has the opportunity to ''develop the record''. As Patty has indicated, a depo in a psych/stress claim is not a 'pretty afternoon'.
      For there to be an award of indemnity in any WC claim, there must be a resulting disability/impairment due to the injury. In the case of stress/psych, you wou ld be carrying a "mental impairment" for a significant amount of time in your future.

      Comment

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