Worker's comp claim denied

[bobru]

What is the name of your state (only U.S. law)? MA

I have been unable to work since the middle of August. I filed for workman's comp, and just got a letter Friday that I was denied. My doctor has said my injuries are work related, and I will not be able to go back for 6 months to 1 year. I have called my adjuster at least 10 times, and she has not returned my calls. I have not been able to collect unemployment because I am not fired, and I cannot go back to work because I am in too much pain. I just had to apply for emergency assistance and food stamps because I've had no money coming in since August. I am behind in my mortgage. Could someone please tell me the best course of action to take now?

 

[racer72]

Time to see a worker's comp attorney, the sooner the better.

 

[cbg]

While I agree that you do not qualify for unemployment, it's for a different reason that you think.

You do not have to be fired to collect unemployment. If you are not working and not being paid, you can usually collect.

In your case, however, since you are medically unable to work, you would not meet the definition of a qualified applicant. In order to collect unemployment, you have to be able to work, actively looking for work, and able to accept work if offered. You do not have to be fired; you only have to be able to work and not working. Someone who was taken off the schedule for two weeks due to no work is not fired, but should be able to collect as long as they are able to work.

Since we both agree that you do not qualify for UI, why am I bringing it up? So that in the event that you are medically able to go back to work but your employer does not yet have an opening for you, you will know that it is not necessary to be fired before you can collect.

 

[bobru]

Thank you for the response; that did also occur to me. It seems to me that my only options now are to apply for SSI and/or look for a workman's comp lawyer. Does that sound right?

 

[cbg]

I agree that you need to talk to a workers comp lawyer to see what options you have, but while I'm not going to tell you not to apply for SSDI, I should tell you that first, even if you are approved, it will be a long process. MA does not have a state disability plan and the Federal plan will not be either quick or easy. My BIL was approved on the first try, which is very unusual, but he had already been permanently disabled out of not one but two careers, and had attempted a third. Even so, it was months before he received his first check. Since you are expected to be able to return to work within 6 months to a year, you may not qualify in the first place.

Does your employer offer an STD or LTD program?

 

[bobru]

Yes, they have both STD & LTD, if you are referring to short and long term disability plans. That is what I initially contacted them about; but they put me over to Workman's comp....

 

[cbg]

What generally happens is that once a workers comp claim is denied, you can apply for the disability plans. You will have to include a copy of the workers comp denial letter. But it is rare that STD or LTD benefits are denied once workers comp has denied the claim (assuming that the illness or injury is covered on the STD/LTD plan in the first place). Not impossible, but rare.

 

[bobru]

Is getting workman's comp preferable to short/long term disability? If so, how?

 

[cbg]

It's not a question of one being preferable. It's a question of purpose.

For the most part, if you are injured on the job, it's workers comp. If you are injured off the job, it's STD/LTD. That's just the definitions of the two. However, most if not all STD/LTD plans will cover an injury that you consider work related, if they have written proof that the workers comp claim was denied.

 

[bobru]

My situation is the repetitive stuff I did at work led to ever increasing chronic back pain...and the doctor's report says that. I never slipped and fell at work or anything...I did call my work yesterday, and they gave me the numbers to call for the ST/LT disability...they are sending me papers. So, that should be my course of action, instead of trying to challenge the WC denial?

 

[cbg]

It's not necessarily either/or. But if you are hurting for money, a STD/LTD claim will take a WHOLE lot less time that fighting the w/c denial.

 

[bobru]

Sounds like a plan! If I were to call a WC attorney, would he likely try to convince me that going after WC first would be a better alternative? I'm just trying to feel my way around this maze...

 

[cbg]

Look.

You are out of money. You are having to apply for state assistance. You cannot work for several more months yet.

Applying for STD/LTD with a w/c denial is not a sure thing (nothing is) but it is far more likely to be approved quickly than fighting a w/c denial, which is by no means guaranteed to be approved at all, and if it is approved, will not be approved quickly.

You tell me. Is a responsible attorney going to set you on path that is not sure fire by any means (repetitive motions claims are not always easy under the best of circumstances because it is difficult to support a claim that ONLY motions made at work led to the trouble) or on one that has a very good chance of having a quick and positive resolution?

You can still fight the w/c claim even if the STD/LTD claim is approved. IF you ultimately prevail on the w/c, the worst that can happen is that you have to repay the STD/LTD payments.

 

[bobru]

The words "responsible attorney" are critical, I think! Thank you so much for your responses; I've just been trying to get a feel for the situation I am in and my best course of action. I truly appreciate the time you have taken to respond to me. Thank you so much (wish me luck!)

 

[cbg]

This hypothetical attorney has absolutely nothing to gain from discouraging you from applying for STD/LTD as opposed to fighting the w/c denial, since it is possible to do both. It does not benefit the attorney to have you do only the w/c denial.

So I really think you're overthinking this.

Good luck and let us know how it turns out.