Left Light Duty Work Due to Injury, Benefits Cut Off

**sosdog** · 02-16-2012, 02:00 AM

I was injured in Oct 2010. After denying, delaying, 'losing' (my claim handler actually told me she lost my file and forgot about it for 4 months) for a year, i finally was accepted and started treatment. while getting treatment and wanting to re-enter the workforce (i hate not working) i conviced my doctor to release me back to work. very limited time, (5-7 hrs a week) and limted duty (no use of left arm) i accepted what i thought was a very low impact job. after a few months of trying to work, my OT and i agreed that the job was increasing the injury so i decided to leave the employment while awaiting a scope on my elbow to see whether or not it could be repaired surgically. when my work comp handler found out she discontinued my benefits saying that since i left work voluntarily that they were no longer responsible for paying my benefits. this after i had to deplete my entire savings, 401k (i was fired after being out on WC for 6 months) and have had to take several loans just to make ends meet in the year before they even started paying my benefits. is this the right decision? i dont feel that they should be able to discontinue my benefits because i cannot perform even the simplist of jobs. anyone else have any advice or experience?

**BvIA** · 02-16-2012, 03:08 AM

my OT and i agreed that the job was increasing the injury so i decided to leave the employment while awaiting a scope on my elbow to see whether or not it could be repaired surgically. when my work comp handler found out she discontinued my benefits saying that since i left work voluntarily that they were no longer responsible for paying my benefits.

is this the right decision? i dont feel that they should be able to discontinue my benefits because i cannot perform even the simplist of jobs. anyone else have any advice or experience?

Don't know what "OT" is.
You and your "OT" don't make medical decisions...your Dr does that. TTD/wage replacement is due when your DR says you cannot work due to your injury. When you and your "OT" decided a job was not available for you within your restrictions, or you could not perform those job duties, you go back to your Dr and get your status changed. Just like you did when you convinced your Dr to release you.

Yes, your benefist would be terminated when you voluntarily removed yourself from the labor market.

Why have you waited to depelet all your cash, and loan options to start asking about this...you should "lawyer up" now.
There is no cost for atty consultation.

**complwyr** · 02-16-2012, 02:49 PM

Sosdog, you have made multiple mistakes handling your case already and that is the main reason you are in this mess.

Please, please, get a competent work comp lawyer to help you before you make any more decisions on your own.

**sosdog** · 02-17-2012, 01:10 AM

my OT is my Occupational Therapist, the therapist doctor told me to see. And i have consulted a lawyer who is looking into it. As for going back to the doctor, i didnt know i had to go back to see him, but the benefits were withheld for 6 weeks before they even told me that i had to and my Dr appt isnt until next week. i guess my question would be arent i still entitled to the parial benefits if i was only cleared for very limited return to work in the first place?

**sosdog** · 02-23-2012, 08:00 AM

So I went to my Dr this morning and he agreed with my decision to leave my part time work. A little late for me to see any benefits any time soon now though because once I got the lawyer they sent it to legal (which is standard I agree) and wont talk to me at all.

Complwyr- Here is something that bothers me about what you said (and I have heard many times in the last couple of weeks) 'Sosdog, you have made multiple mistakes handling your case already and that is the main reason you are in this mess.'

Why is it only the 'Me' in this statement that makes mistakes? South Dakota has Good Faith law doesn't it? I worked with them in good faith and they have repeatedly decieved, mocked, yelled at me, delayed, conned, cajoled and stole (missing months and deliberate underpayment) what I was owed. How is it that I am responsible for any of this?

I guess thats one of my main concerns.

**BvIA** · 02-23-2012, 08:11 AM

Why is it only the 'Me' in this statement that makes mistakes? South Dakota has Good Faith law doesn't it? I worked with them in good faith and they have repeatedly decieved, mocked, yelled at me, delayed, conned, cajoled and stole (missing months and deliberate underpayment) what I was owed. How is it that I am responsible for any of this?

Technically speaking, "good faith" is granted to the insured party...that would be your employer. IW's are not "insured" in WC.
Your ER is liable, they must participate in the ND WC system. That limits their out of pocket costs, and guarnatees you will be provided benefits.
An insured party has the right to a speedy resolution of a claim, for you, that would be a claim made on your auto/home/life insurance policy... a quick offer to settle. All of those claims would settle by cash payment.

WC is about paying benefits you are eligible for... not cash settlement.
While your Dr may have agreed with you taking yourself off work, it's the Dr who must certify you cannot work, not you, or you won't be paid TTD/wage replacement. It's a medical determination. You may have been able to work a light duty job, where you would still be paid wages vs TTD.
Whether or not your atty can get you those benefits, will likely depend on what a judge says.

Why is it only the 'Me' in this statement that makes mistakes?

Cuz it's your thread, your story, your questions, and your past actions... mistakes were made by waiting to consult with a WC attorney. this after i had to deplete my entire savings, 401k (i was fired after being out on WC for 6 months) and have had to take several loans just to make ends meet in the year before they even started paying my benefits. is this the right decision? , that may not have been necessary, and there won't be any reimbursement beyond what benefits there may be awarded.

**ladyvol** · 02-23-2012, 09:37 AM

WC is a dirty crying shame in every state! Unfortunately you sound like an Honest Joe, and you trusted that your employer and the insurance company that handles WC for him would play fair. We all hate that these things have happened to you, and no one is trying to make you feel bad, but possibly giving you some tough love. I know everyone on this board hopes the best for you, and we share your pain, we have all felt screwed by this system too. Best of Luck!