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  1. #1
    Join Date
    May 2007
    Posts
    95

    Default Short- and Long-Term Disability vs Worker's Comp

    My employer has both short and long term disability for full-time employees. I was full-time at the time of my injury and was out under worker comp until recently for about 9 months. I called HR at the time I was injured and inquired about the disability benefit and was told they would send me the paperwork but that you could not qualify for disability if you were receiving w/c benefits. My question is this: I have read that you had to be on short term before you could apply for long term. I believe that at some point wc is going to assume liability for all of my injuries. How does all this work? Is everything separate or are benefits co-ordinated? Oh,and w/my work restrictions I was only able to work part-time at this point. Since I was full time at the time of my disabling injury, my current part-time status wouldn't interfere,right? Thanks..

  2. #2
    Join Date
    May 2007
    Location
    Calif
    Posts
    483

    Default Re: short,long term disability vs worker's comp

    Good morning Julie, Roofs wife here:

    If you haven't already done so, you should obtain a complete copy of the LTD/STD policy from your employer and look at the section pertaining to any or all exclusions - where the policy may not apply and then the section about limitations [this is where you would normally find the information about coordination, if applicable]

    Most LTD/STD policies provide lost income due to illness, and may not apply to a work related industrial injury however there are situations where LTD/STD policies due coordinate benefits [you paid a premium for the insurance] just like you do for private health insurance, but again the carrier may limit their exposure if other insurance is applicable or primary.

    I would not rely on your HR person to give you the details about the LTD/STD policy, most often they are just general overviews and not right on point.

    You have nothing to loose by submitting a claim form to the LTD/STD carrier for determination [just make sure that you have not eliminated your right to file for these benefits due to the time that has elapsed].

    As with any insurance, they seem to find ways to deny rather than extend, so read carefully and read between the lines, any word that is defined can normally be found in the preface of the policy.....

    Also, you might want to check with the Dept of Ins. for your state, as each state is different with regards to how insurance policies are required to coordinate benefits, if applicable.

    Have a good day.

  3. #3
    Join Date
    Feb 2007
    Location
    Charlotte, NC
    Posts
    3,030

    Default Re: short,long term disability vs worker's comp

    Anytime you need to get the full copy of an insurance plan that the employer provides, you need to send the Human Resources director a letter asking for a copy of the "summary plan description." Under Federal law they have a certain period of time to get that to you, I think 60 days, but you must ask for it in writing to trigger the law. Keep a copy of your letter and send it certified mail, return receipt requested, so you have some proof of delivery.

    I have no idea how your state may offset STD and LTD. Here in NC, they give a credit to the employer or work comp carrier for the STD and LTD benefits paid on a week for week basis (not dollar for dollar). That is in our work comp law. Other states may handle it differently, and your STD/LTD policy may assert a right of reimbursement. IF they do that, check the law and make sure you have to pay them back. Their claim may not be legally enforceable.
    The North Carolina Court of Appeals has held that "In contested Workers' Compensation cases today, access to competent legal counsel is a virtual necessity." Church v. Baxter Travenol Labs, Inc., and American Motorists Insurance Company, 104 N.C. App. 411, 416 (1991).

    Bob Bollinger, Attorney at Law

  4. #4
    Join Date
    May 2007
    Posts
    95

    Default Re: short,long term disability vs worker's comp

    Hey,comp, I live in NC. The reason I am looking into long term disability is that wc only paid for anything pertaining to my left knee injury and I am getting ready to fight w/them on my other injuries. I was out on TTD from the time of the injury until 9/07. Since they haven't excepted liability from my other injuries(using almost every excuse they could) my NCM asked my doc only about my left knee and he agreed that my left knee was at MMI and w/very little restrictions. He then told her it was very difficult to put that knee out of" context" as I had several other injuries and that he would be including that in his statement to them. The only question that mattered to IC was that if I HAD only that left knee injury ( required surgery) would I be able to work 40 hrs. a week. He responded "probably so" . He left my overall work restrictions the same and told her that when triage went to a standing-up position that "she will fall apart" and that with all the problems I had, they would be dealing with a "ball of twine". Since that visit things have gotten very bad and I am just before calling his office and tell him that I cannot work even in triage as I am in EXCRUTIATING PAIN when I work. I am in tears when I leave work, my knees and legs are so swollen,stiff and hurting that I have to sit down and lift my legs one at a time to get in the car. I am becoming so upset on the days I have to work based solely on anticipation of the pain! Can my doc change his rating? I am looking into long term disability because wc will probably not pay a dime if he doesnt change his paperwork putting me back out of work due to my left knee. However, if he deems me to be disabled I shoud qualify for it. Since that insurance from work is offered to full time employees wouldn't they have to go back and see that the reason's for my disability occurred when I was working full-time? I am going to request the poicy like you said to do.

  5. #5
    Join Date
    Dec 2006
    Posts
    2,165

    Default Re: short,long term disability vs worker's comp

    Julie, sorry to hear that you are in so much pain just trying to do "modified" Triage work.

    Julie, have you considered finding an EXPERIENCED WC attorney who can help you sort this all out? If you OTHER leg/knee are acting up, it is well-established that "compensating" for your BAD leg/knee can INDEED cause further injuries...these are called "compensable consequences" of the original injury, and a good atty can help you get these othe injured body parts ACCEPTED.

    Perhaps helping you to also find a different Primary Treating Physician? Do you have a good rapport with your current PTP, or dows the NCM put a heck of a lot of PRESSURE on him? You certainly do not sound MMI, your legs are WORSENING, and if you aren't able to reform the modified work, then you should be back on TTD.

    When is your next Doctor appointment? Perhaps in the interin, you should prepare a "Daily Diary" that documents pain levels, activites associated with the pain levels and increased symptoms etc. And, at the appointment, you DO have the right NOT to have the NCM in the exam room, breathingf down you and the Doctor's neck...she can have a discussion with him about his findings and opinion AFTER you have had private time with your PTP....

    In the meanwhile, I would again encourage you to consullt with several experienced WC attorneys, and retain an EXPERIENCED one who knows the WC laws in your State, and how to best protect YOUR interests.

  6. #6
    Join Date
    May 2007
    Posts
    95

    Default Re: short,long term disability vs worker's comp

    I don't believe the NCM is coming back as at this point they are not accepting liability on any of my other injuries. I do have an atty. He is one we have used recently when we had to file lawsuit against our small town because sewage from their antiquated system backed-up into a rental house we own,causing the property to be condenmed. We won the suit. He is very aggressive. The wc carrier denied my right knee even after my doc (w/c doc) stated it was from overcompensation, which he agreed w/you in that it is very common. They denied it "it was caused by a previous problem diagnosed before her employment". They have to be talking about a chemical injury to a sensory nerve in my right lateral thigh from 1991! My right knee problems arose from the medial (inside) aspect of my knee. I have worked ever since then and it has never caused me any problems at work. I have been treated by the same pain clinic all this time and don't even take anywhere near the same meds I took way back then.In any event they still have to cover it if it caused an exacerbation in an existing problem. Then my right lower back they denied stating "the mechanism of injury wouldn't cause right lower back pain". I slammed down on concrete with a twisting to the left fall! Even so, my doc sent me to his partner because "I don't do backs" and he dictated that the fall "caused an exacerbation of existing back problems". . Anyway when we were leaving the last visit, my NCM said she wouldn't be contacting me anymore unless I had any questions or if wc assumed liability for the other injuries. She told me to just try to relax and let my atty. take care of things.

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