B
brookelea
Guest
I am in Washington State.
Sorry this is a bit long, please read it though!!!!
My employer provides benefits for Short-Term and Long-Term Disability through a third party insurance company. Short-Term covers up to 26 weeks for a qualifying disability. I was approved and verified specifically multiple times with my case manager for that original claim when the ending coverage date was. In my recollection it was March 23rd, which was a Friday so I was released by my Doctor to return to work that following Monday March 25th.
I was back to work for almost 10 weeks when I got a mysterious stomach illness. According to what I read under the short-term disability guidelines after exhausting your 26 weeks of benefits you must meet a return to work period of 13 weeks before qualifying for a new set of benefits. I was out a few days at a time during this illness as the Doctor's kept treating me for something I did not have and they did not know what was going on. I knew at the time I could not apply again for STD. Also my companies definition of one occurence (absence) is from the first day you are absent to the day you return to work. No matter how many days total it is, as long as it is for the same reason it qualifies as one occurance against the attendance policy. After four total occurences I was given a first written warning. I was gone again due to the same illness as it progressed and got more severe to the point I could not get out of bed. I was gone 5 days and my supervisor called and informed me that the HR department was stating that the rule was I must file under STD after being absent that many days.
I in turn informed him and HR that I did not qualify to apply and explained the return to work period. They both stated they had never heard of this guideline and it is the rule after 5 days of absence, so I had to apply. They would research the 13 week thing and get back to me, but in the meantime I had to submit a claim. So I did what my employer told me as they made the point clear that if I did not submit a claim that day they would have to terminate my employment.
My HR representative did not contact me back. I left numberous messages regarding the matter, but no return call. I left another message for her regarding where exactly the information was located in our company handbook so she could read it for herself. I also informed my supervisor I had found the information and had let HR know where it was located. I had to keep calling to reach my HR rep and I finally got her to answer the phone on one attempt in which she stated she hadnt yet had time to find out the information and requested that I read it to her over the phone, I did so. She was very confused as if she had never heard of this before. (isnt that her job as a human resources representative to know this information).
Meanwhile I myself called the third party disability company and the agents I talked with could not find any information on this 13 week qualifying period. HR finally researched it and I once again had to call her to get the information, she stated that it wasnt something they required, but was something they could chose to use on a case by case basis.
I finished out my treatment with my doctor under this STD claim and returned to work. The case manager for the claim approved it and I was paid.
I was forced again to file another STD claim about 5 weeks later due to an episode of panic attacks that had started and unable to get under control. Since the previous claim was approved after all the controversy over the 13 weeks, I was sure this meant that I qualified for a total of 26 weeks again. My doctor would not let me return to work for a minimum of 2 weeks due to sedating medication I was put on.
This claim went on to a third case manager who came up with an issue that I didnt fulfill my original 13 week return to work period therefore I didnt qualify for benefits. But he had to get the information from my Payroll department as to what hours total I worked to determine this. He got the information over 2 weeks ago, but was still waiting on my final medical documentation to make a determination. I faxed my medical information to him and then 24 hours later he made the determination that I not only was not qualified for my 2nd STD claim and was overpaid, but that a portion of my 1st claim was overpaid and should have been referred on to Long-Term disability.
I have quite a few questions on this matter. First of all. Why, if his issue was the amount of hours i had worked under the return to work period to determine if I qualify, was he holding off to make a determination until he had all of my medical documentation? My medical information should not have held any weight as to whether I worked enough hours to qualify for benefits or not.
Second, if the 2nd case was approved how can a third case manager on a seperate claim not only reverse the 2nd but also chop into the 1st one as well?
My employer, based on the denial of benefits from the third party insurance, has now terminated my employment.
Do I have ANY recourse in this matter??
I was not fraudulently abusing my benefits. I had valid illnesses that were covered by this policy and my employer forced me into a corner where I had no choice. I am not going to blatantly disregard my what my employer informs me I must do. But then the information they give me, in the end they are not accountable for. And I am the one in the wrong and now they get to send me a bill for overpayment?
My job performance had nothing to do with their attitude towards me on this other than my attendance. I excelled in my performance at work and they were quite impressed with my work.
Any advice will help! Although I dont need nor want to hear flaming from anyone. I have tried to research on our state labor and industries website but cannot find anything nor on the federal site either. I have not consulted any lawyers yet, I wanted to see if I got any advice here that warranted I put the effort into it or if its just better left alone and move on. Thank you!!
Sorry this is a bit long, please read it though!!!!
My employer provides benefits for Short-Term and Long-Term Disability through a third party insurance company. Short-Term covers up to 26 weeks for a qualifying disability. I was approved and verified specifically multiple times with my case manager for that original claim when the ending coverage date was. In my recollection it was March 23rd, which was a Friday so I was released by my Doctor to return to work that following Monday March 25th.
I was back to work for almost 10 weeks when I got a mysterious stomach illness. According to what I read under the short-term disability guidelines after exhausting your 26 weeks of benefits you must meet a return to work period of 13 weeks before qualifying for a new set of benefits. I was out a few days at a time during this illness as the Doctor's kept treating me for something I did not have and they did not know what was going on. I knew at the time I could not apply again for STD. Also my companies definition of one occurence (absence) is from the first day you are absent to the day you return to work. No matter how many days total it is, as long as it is for the same reason it qualifies as one occurance against the attendance policy. After four total occurences I was given a first written warning. I was gone again due to the same illness as it progressed and got more severe to the point I could not get out of bed. I was gone 5 days and my supervisor called and informed me that the HR department was stating that the rule was I must file under STD after being absent that many days.
I in turn informed him and HR that I did not qualify to apply and explained the return to work period. They both stated they had never heard of this guideline and it is the rule after 5 days of absence, so I had to apply. They would research the 13 week thing and get back to me, but in the meantime I had to submit a claim. So I did what my employer told me as they made the point clear that if I did not submit a claim that day they would have to terminate my employment.
My HR representative did not contact me back. I left numberous messages regarding the matter, but no return call. I left another message for her regarding where exactly the information was located in our company handbook so she could read it for herself. I also informed my supervisor I had found the information and had let HR know where it was located. I had to keep calling to reach my HR rep and I finally got her to answer the phone on one attempt in which she stated she hadnt yet had time to find out the information and requested that I read it to her over the phone, I did so. She was very confused as if she had never heard of this before. (isnt that her job as a human resources representative to know this information).
Meanwhile I myself called the third party disability company and the agents I talked with could not find any information on this 13 week qualifying period. HR finally researched it and I once again had to call her to get the information, she stated that it wasnt something they required, but was something they could chose to use on a case by case basis.
I finished out my treatment with my doctor under this STD claim and returned to work. The case manager for the claim approved it and I was paid.
I was forced again to file another STD claim about 5 weeks later due to an episode of panic attacks that had started and unable to get under control. Since the previous claim was approved after all the controversy over the 13 weeks, I was sure this meant that I qualified for a total of 26 weeks again. My doctor would not let me return to work for a minimum of 2 weeks due to sedating medication I was put on.
This claim went on to a third case manager who came up with an issue that I didnt fulfill my original 13 week return to work period therefore I didnt qualify for benefits. But he had to get the information from my Payroll department as to what hours total I worked to determine this. He got the information over 2 weeks ago, but was still waiting on my final medical documentation to make a determination. I faxed my medical information to him and then 24 hours later he made the determination that I not only was not qualified for my 2nd STD claim and was overpaid, but that a portion of my 1st claim was overpaid and should have been referred on to Long-Term disability.
I have quite a few questions on this matter. First of all. Why, if his issue was the amount of hours i had worked under the return to work period to determine if I qualify, was he holding off to make a determination until he had all of my medical documentation? My medical information should not have held any weight as to whether I worked enough hours to qualify for benefits or not.
Second, if the 2nd case was approved how can a third case manager on a seperate claim not only reverse the 2nd but also chop into the 1st one as well?
My employer, based on the denial of benefits from the third party insurance, has now terminated my employment.
Do I have ANY recourse in this matter??
I was not fraudulently abusing my benefits. I had valid illnesses that were covered by this policy and my employer forced me into a corner where I had no choice. I am not going to blatantly disregard my what my employer informs me I must do. But then the information they give me, in the end they are not accountable for. And I am the one in the wrong and now they get to send me a bill for overpayment?
My job performance had nothing to do with their attitude towards me on this other than my attendance. I excelled in my performance at work and they were quite impressed with my work.
Any advice will help! Although I dont need nor want to hear flaming from anyone. I have tried to research on our state labor and industries website but cannot find anything nor on the federal site either. I have not consulted any lawyers yet, I wanted to see if I got any advice here that warranted I put the effort into it or if its just better left alone and move on. Thank you!!