Don’t Know Much About Worker’s Comp.
January 22, 2010 12:30 PM Subscribe
Don’t Know Much About Worker’s Comp. -- Last week I went to my doctor to talk about the symptoms of my work-related stress, he diagnosed me as depressed and gave me a prescription and a note to my employer requiring a two-week leave of absence. Because this is work-related, his office said the visit will be covered by worker’s compensation. That’s fine with me, although I have health insurance to cover the visit. I’m on leave from work now, resting, considering my options, and waiting for the meds to kick in. I’m paying for this leave with my sick time and vacation time. They will be tapped out when it’s over. I don’t anticipate a need of more time off, though I suppose this shouldn’t be ruled out.
Yesterday, I got a phone call from a representative of SAIF, the insurance company that pays worker’s comp, to talk about the investigation into my claim. It seems they assume I’m making a claim as if I was hit by a fork lift and can’t work anymore. That’s not the case. I can work and intend to work, though perhaps not for my present employer. I've never said I’m filing a claim of any kind. Suddenly, the papers are filed and and the claim is active. So, given that I don’t need help paying the doctor, and I don’t intend to draw long-term workmen’s compensation, can I call SAIF and say that I don’t want to file a claim? Will this somehow affect the payment to the doctor by my health insurer? What else do I need to know about this? Thanks in advance for your help.
Yesterday, I got a phone call from a representative of SAIF, the insurance company that pays worker’s comp, to talk about the investigation into my claim. It seems they assume I’m making a claim as if I was hit by a fork lift and can’t work anymore. That’s not the case. I can work and intend to work, though perhaps not for my present employer. I've never said I’m filing a claim of any kind. Suddenly, the papers are filed and and the claim is active. So, given that I don’t need help paying the doctor, and I don’t intend to draw long-term workmen’s compensation, can I call SAIF and say that I don’t want to file a claim? Will this somehow affect the payment to the doctor by my health insurer? What else do I need to know about this? Thanks in advance for your help.
Also, there are a lot of potential issues brought up by your question with regard to your employment -- Family Medical Leave Act (or state equivalent), Americans with Disability Act (or state equivalent), disability policy issues, etc. You should try and find an employment/workers' comp atty to speak with about this regardless of your state.
posted by seventyfour at 12:39 PM on January 22, 2010
posted by seventyfour at 12:39 PM on January 22, 2010
This all depends on the state you're in, but I suspect that in any state if your doctor says your diagnosis is work-related then your private health insurance won't pay for it. That's why the workers comp carrier gets involved.
posted by amro at 12:48 PM on January 22, 2010
posted by amro at 12:48 PM on January 22, 2010
I'd let it keep going. This may turn out to your advantage, frankly and you have no way of knowing if you would actually need more time off in future.
I mean, if you cut your hand at work, wouldn't you just as soon let worker's comp handle it?
posted by St. Alia of the Bunnies at 12:50 PM on January 22, 2010
I mean, if you cut your hand at work, wouldn't you just as soon let worker's comp handle it?
posted by St. Alia of the Bunnies at 12:50 PM on January 22, 2010
I would just go ahead and let Workers Comp cover the cost of the visit.
posted by Bornatnight1 at 1:05 PM on January 22, 2010
posted by Bornatnight1 at 1:05 PM on January 22, 2010
IAAL and IAAWCL, even, and:
1) It depends on the state; and
2) Contact a workers' comp attorney in your area. S/he should provide you with a free consultation so you can get some answers on how to proceed with this; and
3) Do not turn down your workers' comp benefits. If your situation turns out to be more serious and more expensive than you thought, possibly leading to a loss of income and insurance (it happens. Might not happen to you, but it happens), you absolutely do NOT want to be on the hook for all of those bills, plus why do you want to burn up all your vacation and sick time when you could (possibly, depending on where you are) be getting temporary total disability benefits instead? Save your vacation time for when you feel better and want to go on vacation; and
4) There's a good chance that your group health insurance will not pay for your treatment, because it is work related. If an insurance company can find a way to avoid liability, they will do it. If there's somebody else who can pay, the group health carrier will deny benefits. If you turn down your comp benefits, and the employer's workers' comp carrier uses that to prove that your condition is not really work related, guess who gets stuck with the bill? You. and, finally
5) You absolutely 100% cannot look at this as a situation in which you and your employer are reasonable people and you just want to do this above board and not involve lawyers because you're not the kind of person who goes running to lawyers every time you slip on the sidewalk, etc. etc. and here is why: this is not you and your employer. This is a giant, for-profit insurance company that only makes money by refusing to pay out claims. This insurance company doesn't know you, or your work history, or your personal relationships, and it is going to go to great lengths to avoid paying for any of your treatment. It cannot be reasoned with, nor can you appeal to its human side, because it has none. This is not to say that you are going to have problems - sometimes insurance carriers pay out claims and everything is smooth sailing - but if you approach this situation like you can just be a reasonable, nice, honest person and everything will be okay, you could get into some serious trouble. That's what workers' comp lawyers are for: being assholes so nice, honest people like you don't have to.
You may not need to hire a lawyer, but you do need to call one and talk to him or her about the situation to make sure you are making an informed decision, and are aware of the ramifications of what you want to do.
posted by jennyb at 1:31 PM on January 22, 2010 [8 favorites]
1) It depends on the state; and
2) Contact a workers' comp attorney in your area. S/he should provide you with a free consultation so you can get some answers on how to proceed with this; and
3) Do not turn down your workers' comp benefits. If your situation turns out to be more serious and more expensive than you thought, possibly leading to a loss of income and insurance (it happens. Might not happen to you, but it happens), you absolutely do NOT want to be on the hook for all of those bills, plus why do you want to burn up all your vacation and sick time when you could (possibly, depending on where you are) be getting temporary total disability benefits instead? Save your vacation time for when you feel better and want to go on vacation; and
4) There's a good chance that your group health insurance will not pay for your treatment, because it is work related. If an insurance company can find a way to avoid liability, they will do it. If there's somebody else who can pay, the group health carrier will deny benefits. If you turn down your comp benefits, and the employer's workers' comp carrier uses that to prove that your condition is not really work related, guess who gets stuck with the bill? You. and, finally
5) You absolutely 100% cannot look at this as a situation in which you and your employer are reasonable people and you just want to do this above board and not involve lawyers because you're not the kind of person who goes running to lawyers every time you slip on the sidewalk, etc. etc. and here is why: this is not you and your employer. This is a giant, for-profit insurance company that only makes money by refusing to pay out claims. This insurance company doesn't know you, or your work history, or your personal relationships, and it is going to go to great lengths to avoid paying for any of your treatment. It cannot be reasoned with, nor can you appeal to its human side, because it has none. This is not to say that you are going to have problems - sometimes insurance carriers pay out claims and everything is smooth sailing - but if you approach this situation like you can just be a reasonable, nice, honest person and everything will be okay, you could get into some serious trouble. That's what workers' comp lawyers are for: being assholes so nice, honest people like you don't have to.
You may not need to hire a lawyer, but you do need to call one and talk to him or her about the situation to make sure you are making an informed decision, and are aware of the ramifications of what you want to do.
posted by jennyb at 1:31 PM on January 22, 2010 [8 favorites]
Seconding everything jennyb said. You may find the state-by-state info at workerscompensation.com helpful. Also, here is a scholarly article about workplace-related depression with a section on workers' comp.
-you should pursue the workers' comp claim
-keep very good documentation of everything (every doc visit, every call w/ your insurance, the workers' comp board, your employer, etc)
-be prepared for a fight - workplace-related depression is a "new" thing (in terms of diagnosis and awareness), and it seems likely that your employer will try to have it not covered.
posted by melissasaurus at 1:39 PM on January 22, 2010 [1 favorite]
-you should pursue the workers' comp claim
-keep very good documentation of everything (every doc visit, every call w/ your insurance, the workers' comp board, your employer, etc)
-be prepared for a fight - workplace-related depression is a "new" thing (in terms of diagnosis and awareness), and it seems likely that your employer will try to have it not covered.
posted by melissasaurus at 1:39 PM on January 22, 2010 [1 favorite]
Virtually everything that has been said above is true and my purpose is not to contradict any of it. That said, there are other issues that you might consider. First, if I read correctly, you walked into the doctor's office and stated that your symptoms were "work-related stress." This made the doctor immediately assume that this was a Worker's Compensation case. He knows that he will be paid 100% by WC as opposed to some lesser percent by your insurance. Easy call for him. He contacted your employer and asked for your carrier and billed his fees to them. This is what opened the file.
You have the right to decline WC coverage. As has been rightly mentioned above, doing so closes the door on further coverage for this illness and, possibly, later recurrences of your symptoms. Consider this carefully. Accepting the coverage of WC for this issue will get you some coverage for lost wages (restoring vacation and sick leave) but wll probably not cover your full wage. Also, accepting coverage will likely give the WC carrier the opportunity to require you to return to work with "less stressful" duty. If you refuse to return and the employer can show that such duty is available, it can impact your benefits.
Lastly, you state that you "intend to work, though perhaps not for my present employer." If this is the case, why not just quit and get another job? I ask this because getting another job after having just taken WC benefits may be difficult. There are routine methods to determine whether an applicant for employment has filed a stress claim that, while shady and underhanded, are technically legal and it is done all of the time. If you want to avoid this, I would suggest that you either decline the claim and quit immediately or accept the claim and plan to work at your present employer long enough to show that you have overcome the issues that caused the claim. Then you can honestly state to a prospective employer that you had some problems with the stress of the job and overcame them.
Most importantly, you do not have to decide today. Take some time to sort out your feelings and to assess how your treatment is progressing. SAIF can and will wait for a few days.
posted by Old Geezer at 2:14 PM on January 22, 2010
You have the right to decline WC coverage. As has been rightly mentioned above, doing so closes the door on further coverage for this illness and, possibly, later recurrences of your symptoms. Consider this carefully. Accepting the coverage of WC for this issue will get you some coverage for lost wages (restoring vacation and sick leave) but wll probably not cover your full wage. Also, accepting coverage will likely give the WC carrier the opportunity to require you to return to work with "less stressful" duty. If you refuse to return and the employer can show that such duty is available, it can impact your benefits.
Lastly, you state that you "intend to work, though perhaps not for my present employer." If this is the case, why not just quit and get another job? I ask this because getting another job after having just taken WC benefits may be difficult. There are routine methods to determine whether an applicant for employment has filed a stress claim that, while shady and underhanded, are technically legal and it is done all of the time. If you want to avoid this, I would suggest that you either decline the claim and quit immediately or accept the claim and plan to work at your present employer long enough to show that you have overcome the issues that caused the claim. Then you can honestly state to a prospective employer that you had some problems with the stress of the job and overcame them.
Most importantly, you do not have to decide today. Take some time to sort out your feelings and to assess how your treatment is progressing. SAIF can and will wait for a few days.
posted by Old Geezer at 2:14 PM on January 22, 2010
You seem reluctant to use worker's comp. Is there a reason for that? There are many benefits to using it and I can think of relatively few drawbacks (particularly if you're thinking about leaving your current employer and thus don't have to worry about retaliation-- which is totally illegal, but still I know it would worry some people) but I'm curious if there are other reasons you have.
And yeah, you really should to contact a mod and tell us what state you're in if you want good advice, there's a great deal of variation state-to-state.
posted by EmilyClimbs at 2:49 PM on January 22, 2010
And yeah, you really should to contact a mod and tell us what state you're in if you want good advice, there's a great deal of variation state-to-state.
posted by EmilyClimbs at 2:49 PM on January 22, 2010
I work with health insurance at a large hospital which I believe is in your state, because you mentioned SAIF and i talk to them on a regular basis. Anyway, I just wanted to say that jennyb is right on but especially about your group health insurance potentially not covering what they deem to be a workplace-related condition. They will deny payment and tell your provider to bill workers comp.
posted by DrGirlfriend at 3:14 PM on January 22, 2010
posted by DrGirlfriend at 3:14 PM on January 22, 2010
I've just settled my work comp stress case - 20 months after the incident. I had to get a lawyer (not easy, few lawyers want to touch stress cases). At one point I had no income and no medical care for several months. I am presently unemployed and have a small margin of time to decide what to do next. I am just very happy to be out of my previous job and able to look at the world with 'new eyes'. It has been a long haul.
As jennyb said, do NOT assume that the insurance company will be fair, reasonable or humane. Do not assume anything about your ex-employer. Both will be in defense (attack) mode. The process to get ongoing work comp coverage can be even more brutal. The IME (independent medical exams) are devised to break you down. I bailed out before it all went to trial; I couldn't take it anymore.
Old Geezer's advice is really good. If you think you can handle your stress enough to get back to work somewhere else, do it. It would be healthiest for you to just move on. I couldn't do that myself, and so I had to endure attacks that actually extended my illness.
As for the threats of being 'unemployable' after a work comp claim ... I guess they were a minor consideration for me. I always assumed that future employers would have access to information about my stress claim and that I would be 'blackballed' from any similar work. Somehow that ddidn't scare me.
Being in a workplace with people who are dangerously stressed but afraid to do anything about it because of threats to their career scares me.
posted by Surfurrus at 8:21 PM on January 24, 2010 [1 favorite]
As jennyb said, do NOT assume that the insurance company will be fair, reasonable or humane. Do not assume anything about your ex-employer. Both will be in defense (attack) mode. The process to get ongoing work comp coverage can be even more brutal. The IME (independent medical exams) are devised to break you down. I bailed out before it all went to trial; I couldn't take it anymore.
Old Geezer's advice is really good. If you think you can handle your stress enough to get back to work somewhere else, do it. It would be healthiest for you to just move on. I couldn't do that myself, and so I had to endure attacks that actually extended my illness.
As for the threats of being 'unemployable' after a work comp claim ... I guess they were a minor consideration for me. I always assumed that future employers would have access to information about my stress claim and that I would be 'blackballed' from any similar work. Somehow that ddidn't scare me.
Being in a workplace with people who are dangerously stressed but afraid to do anything about it because of threats to their career scares me.
posted by Surfurrus at 8:21 PM on January 24, 2010 [1 favorite]
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posted by seventyfour at 12:34 PM on January 22, 2010