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WC denied pay for missed work

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Rhiannon10

Junior Member
What is the name of your state (only U.S. law)? California
I need advice what to do ...I am a 66 year old woman and work for a non-profit serving developmentally disable adults in a day program. We access the community by transit busses and lots of walking. June 21, while walking with my group I tripped over a raised part of a new sidewalk. I fell hard and called my immediate supervisor and advise her and that I will file an injury report which I did.
This was Friday, by Sunday I was in so much pain I knew I could not work (which is only 3 days a week) I called my office and asked where I was to go and was sent to a prompt care that handles most of the workman's comp injuries. I saw a male doctor, sent me for x-rays, then a woman doctor said I had a severe chest contusion. Come back in 2 days to see occupational nurse. She said after re-examining the x-ray it showed a fractured sternum, (by the way my sister in law drove me there as I was unable to drive). She asked a few questions had me raise my arms told her my pain level at 9 and sometimes 10. She wrote out my
report as modified duty and lift no more than 5 lbs. I was to ice my chest, take Relifen (which did not help much for the pain)
and maybe carry a pillow to my chest. went to my office and talked to my supervisors (who are inexperienced and never handled a workmans comp complaint before) they said they did not have any work to do in the office, and as it said on my report not to lift more than 5 lbs. I could carry a small bag, holding the required documentation and medical releases for my consumers. I called the next day and told them that I could not even drive, felt like a knife going through my chest, okay so I was off work for 2 1/2 weeks until I felt I could drive safely as the sharp pain was gone. One of my job responsibilities also was transporting a DDS consumer 30 miles so any strong pain killer would have made me DUI. A few days later I got the denial from workmans comp that says I was able to do light duty and denied benefits. BULL! I talked to my HR person and Workman comp people and they said they go by what the doctor put on the report. I had more xrays by the way and they did not show much improvement. My HR person is in an office 300 miles away. She doesn't return my calls, and she stands by what the report said that I now can lift 15 lbs. and she hopes that helps and she doesn't even realize that I have been back to work since July 11. On Aug 5 went back for my next appointment and I was going to really let this nurse have it by saying I could not work with this type of injury. She was nice and said that if I could not work then it is protocol for my supervisors to send me back to her to be re-assessed.
This nurse has seen lots of workman comp patients from our agency and it is protocol but like I said my supervisors are at fault.
Tried to reach my HR person today twice, emailed twice, she may have been out of office but at this point I don't know what to do.
Any advice?
 


OHRoadwarrior

Senior Member
It appears you did not miss work due to WC. It appears you missed work because you did not want to go to work while feeling discomfort. Your employer appears to have allowed this, because you said you did not feel you could drive back and forth. That is not a WC issue. I suggest you either return to work or file for CA disability and SS retirement.
 

commentator

Senior Member
If you were released to light duty and you yourself decided not to go in though your employer was able and willing to accommodate you, you do not get Worker's comp pay for the time you were out of work. You still got the medical treatment, but not the pay for being off work, because you were not supposed to be off work, regardless of what YOU thought was appropriate for you. The medical person who evaluated you decided you could work light duty, and your company was willing for you to come in and do this light duty work and be paid your full salary to do it. You could have refused to drive once you got to work, if they had been crazy enough to ask you to drive as part of your light duty, explaining that you were taking pain medication that would interfere with your driving. But a whole lot of people who are on worker's comp would prefer to stay home, which is one of the reasons companies try very diligently to find them the light duty work to do. It really cuts down on the length of time people stay on worker's comp if they have to get up and report to work every day, even if all they have to do is read the newspaper in the break room.

"Letting the nurse have it" because you don't think you're able to work, and insisting your supervisors are in the wrong is not going to help much.
 

Rhiannon10

Junior Member
re: denial of workman's comp

Yes I have come to realize it is not a workman's comp issue, but an employer issue...2 inexperience supervisors, never handled a workman's comp issue and no HR person to talk to and no help whatsoever of informing me or Prompt care of my job description and sending me back for re-assessment which the doctor said is protocol. No one talked to me of options or what to do, I could have gone to an orthopedic doctor but thought I just need to go where they said..no help whatsoever from my agency. Now does that sound right? I got better advice from online about sternum fractures and the care..how anyone can do anything with that type of injury is beyond me. Any opinions on this I would appreciate.
 

OHRoadwarrior

Senior Member
No one here can over-ride the medical opinion of the doctor, based on their firsthand treatment at the time. No competent doctor would retroactively diagnose a patients condition from months ago. I'm sorry.
 

commentator

Senior Member
You could have also gotten some fine advice from the CA Dept of Labor Worker's comp site if you'd googled it as you went along. You are trying to put all the blame on inexperienced and uninformative supervisors at your place of work. How do you think it should have been handled differently?

If you thought you should have seen an orthopedic, you could have asked for a referral to one from the medical facility they sent you to. Read the website, CA lets you see your own doctor under certain circumstances. While it is required that all businesses have a poster up informing you of your worker's comp rights and how to file a claim, there is no requirement that they be experts or that they solve your problems for you in the manner that you prefer.

As your treater did not think you were too severely injured to return to light duty work, and you disagreed, you might have, at that time, demanded to see another doctor for another opinion. But the ship has pretty much sailed on that particular situation. What are you now wanting to have happen? More treatment? Some time off? I don't see as they are going to go back and change your diagnosis and availability rating for those two and a half weeks you were off before.

You can, of course, hire an attorney, but they will require payment, which will be coming out of your salary or your worker's comp money, whether you win an appeal or not. There's a very fixed amount that Worker's Comp will pay, and an attorney cannot get you one bit more than that, though they might help you appeal a decision you disagree with if you cannot figure out how to do that yourself.
 

Rhiannon10

Junior Member
re: denial of workman's comp

I would have gone to another doctor or back to Prompt care if I had known that I would not have received pay for time lost but did not know until over 3 week later. Is it too late then now...my HR department is suppose to help their employees aren't they? I did not know anything about how workmans comp work and did not know that I wasn't going to be paid for lost time....all I want is my lost pay...nothing else...I don't want to sue anyone I just want them to do their jobs right and help their employees..the nurse said it is protocol to send someone back for reassessment and they failed to do that...
 

cbg

I'm a Northern Girl
HR's job is not to pay you for time that is not payable under workers comp rules (which are set by the state and not by your employer). They are doing their job - they're following the rules. "Helping employees" does not mean giving them something to which they are not entitled.
 

commentator

Senior Member
The problem came when they said they didn't have any office work available and that they wanted to you go on with your regular duties, carrying the client's paperwork in a small bag that weighed less than5 pounds, and that you would be required to drive. That was pretty dumb of them, since your medications would make it unsafe for you to drive, and being asked to drive, using your arms to make steering motions would probably have been the very most painful thing for your chest and might have deterred healing. I agree, this was probably not appropriate light duty work for you. They are inexperienced, pretty clear they didn't know how to set up a light duty work assignment that would accommodate your particular situation in a reasonable manner.

But the thing for you to do at this point would have been to inform the HR people, the medical professional, AND worker's comp that you did not think this light duty work was appropriate, though you were available for appropriate light duty work. But since you didn't return to the doctor, didn't request to see another doctor, just protested their idea of "light duty" by not showing up for it, well, I don't know. Maybe a worker's comp attorney can get you an appeal of your decision not to accept the light duty work they had available for you.

It was really your responsibility, and it would've been very much better if you had begun asking questions when the light duty was offered and you decided not to take it, not now after the whole situation is over. Did you ask them, when you decided you weren't coming back in to do it, if you'd be paid by Worker's Comp if you stayed home? Did you ask anybody about this? Why did you assume you'd be paid, even though you refused the light duty and didn't provide evidence of why you shouldn't have to do it, should be off during this time? Talk to an attorney and see if there's any way you can get a do-over on this situation.
 

cbg

I'm a Northern Girl
Just want to be sure it's clear that there is NEVER an obligation to create appropriate light duty work. If there is no light duty work that fits the employee's restrictions, there are no circumstances whatsoever under which an employer is required to make some up.
 

commentator

Senior Member
If the employer cannot provide adequate light duty within the restrictions the employee is then eligible to be off work and receive temporary partial disability through worker's comp. Some savvy employers will always come up with something, just for the sake of getting the employee out of the house and not giving them any free time away from work. They've found it frequently shortens the time that the worker is on W.C. And worker's comp money is always less than their regular pay which they'd be getting for light duty, so some people really would prefer it. This lady's health care provider did not give her complete disability for any period, sent her right back to work with restrictions, so unless they had conceded they had nothing for her, she really wasn't going to be staying home for a few days unless she could produce another doctor's opinion.

Of course the employer and the employee can certainly disagree as to whether the restrictions are appropriate or not. My sources suggest it would then be a good idea for the employee to ask to speak to the worker's comp insurance carrier in this situation.. But of course few people are this conversant with the way to go about resolving such a situation. Maybe there's an appeal available for this person, maybe not. But going home without protest because she wasn't able to do the light duty they came up with wasn't quite the way to go.
 
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Rhiannon10

Junior Member
re: denial of workman's comp

That is just it, One supervisor said they did not have any work for me in the office, they expected me to do what I do but carry a light bag. Carrying a light bag was not an issue, the pain was intolerable and when I called and told them they said ok and never heard from them or HR and I missed 6 scheduled work days and went back to work with a lot less pain. I did one thing right I think, I sent in the request for a QME from workman's comp and did talk to someone from a nearby office for Workmans comp and he is sending me some forms and I can request a adjudication. So I am still going to try, and it isn't the money, I can live okay without it, it is the way this was all handled, I think I deserve for pay for lost time, I left 2 messages with my HR person hundreds of miles away and she does not return my calls, no email replies to my emails. It is like she washed her hands of this whole issue.
 

commentator

Senior Member
Remember, it was not the employer's responsibility to carry you through your worker's comp situation exactly the way they should have done it, according to you. They're not really your friend when you have a workplace injury, as I said, they're obligated to tell you about worker's comp, but it's not a benefit offered by the company like sick leave or vacation pay. It's something they are required to carry by federal law, and they are charged worker's comp insurance rates based on how many and how expensive the claims they have are. So they're not thrilled about having to pay it, and they're not in the business of getting things set up for you in worker's comp the way it works best for you. There are a horde of worker's comp attorneys out there advertising their services to people who have been injured on the job. That is because the employer isn't obligated and is probably not going to spoon feed you your rights and services and help you work things out exactly as you want them worked out.

In California, the worker's comp system isn't quite so employer friendly. You need to be getting some good advice and working to get what you are entitled to, to appeal this denial, but quit misdirecting your anger at the employer, specifically their HR because you were not treated especially well by them and not informed of things they weren't obligated to tell you. As for "it's not about the money, its the way they treated me..." that's hooey. You are either entitled to be off work and receive the temporary partial disability pay or you are not.

And usually you have to be off a certain number of days before that pay begins..in CA I believe it is 3 days. If you only missed 6 days, you may not be entitled to very much TPD. It is 2/3rds of your regular salary. So it may not be very much money that you're entitled to for the time you were off. But good luck, hopefully you'll be able to appeal the denial ruling.
 
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