Idaho Worker's Compensation - Help For Injured Idaho Workers

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  1. #1
    Join Date
    Apr 2012
    Posts
    1

    Default Would Workers Comp Pay for Psychologist's Visits Until Deductible is Met

    I have worked in the same profession for 15 years, and with the same employer for the past 10. This last year has brought several life stressors (relationship break up, bankruptcy, death of loved one, foreclosure, son in hospital for chronic illness, both adult sons and grandson moving in with me, first year of menopause, etc.) that have made me vulnerable to the the added stresses of my job being eliminated, me being reassigned and then placed on probation after my first unsatisfactory job evaluation ever. My family physician has now put me on 3 anti-depressants, but they haven't helped. I received a scathing evaluation of being "flat" and "joyless" (I am a teacher) and I decided to take sick leave (I have 50+ days accrued). I understand that under the ADA they can't fire me, however, I have been told by my family physician that I should see a psychiatrist if I need to pursue and legal issues with my leave, and I have a $1000.00 deductible for mental illness through my insurance that must be met before they will pay 80% of the charge. Under the terms of my bankruptcy settlement, I have to make a $900.00 a month payment to the trustee and have only $200.00 a month discretionary money left every month. Can I file a Workers' Comp claim to pay for the $1,000.00 deductible? I can document that I didn't need the 3 anti-depressants until this last year.

  2. #2
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,017

    Default Re: Would Workers Comp Pay for Psychologist's Visits Until Deductible is Met

    You can file a injury/comp claim any time you/your treating physician feel your job functions contribute/cause your stress/depression.... BUT... you must also show, with medical evidence, a preponderence of your condition/injury/illness is caused by your job duties.
    This last year has brought several life stressors (relationship break up, bankruptcy, death of loved one, foreclosure, son in hospital for chronic illness, both adult sons and grandson moving in with me, first year of menopause, etc.)
    Due to the other contributing factors, you have a uphill battle in proving 51%+ of your stress/psych claim to be compensable under WC.

    WC doesn't just pay the deductible you may have...and claiming industrial/occupational causation would eliminate use of your own insurance coverage for services/treatment to a work injury.
    I understand that under the ADA they can't fire me,
    I think you may have been misinformed, or misunderstood. ADA does not provide job protections...
    An individual with a disability is a person who:

    Has a physical or mental impairment that substantially limits one or more major life activities;
    Has a record of such an impairment; or
    Is regarded as having such an impairment.
    A qualified employee or applicant with a disability is an individual who, with or without reasonable accommodation, can perform the essential functions of the job in question. Reasonable accommodation may include, but is not limited to:

    Making existing facilities used by employees readily accessible to and usable by persons with disabilities.
    Job restructuring, modifying work schedules, reassignment to a vacant position;
    Acquiring or modifying equipment or devices, adjusting or modifying examinations, training materials, or policies, and providing qualified readers or interpreters.
    ADA provides for reasonable accommodation, if requested.
    An employer is required to make a reasonable accommodation to the known disability of a qualified applicant or employee if it would not impose an “undue hardship” on the operation of the employer’s business. Reasonable accommodations are adjustments or modifications provided by an employer to enable people with disabilities to enjoy equal employment opportunities. Accommodations vary depending upon the needs of the individual applicant or employee. Not all people with disabilities (or even all people with the same disability) will require the same accommodation. For example:

    A deaf applicant may need a sign language interpreter during the job interview.
    An employee with diabetes may need regularly scheduled breaks during the workday to eat properly and monitor blood sugar and insulin levels.
    A blind employee may need someone to read information posted on a bulletin board.
    An employee with cancer may need leave to have radiation or chemotherapy treatments.
    An employer does not have to provide a reasonable accommodation if it imposes an “undue hardship.” Undue hardship is defined as an action requiring significant difficulty or expense when considered in light of factors such as an employer’s size, financial resources, and the nature and structure of its operation.
    More on ADA is here http://www.eeoc.gov/facts/fs-ada.html

  3. #3
    Join Date
    Feb 2007
    Location
    Charlotte, NC
    Posts
    3,009

    Default Re: Would Workers Comp Pay for Psychologist's Visits Until Deductible is Met

    The question you have to answer is this: Why would your condition be due to a work related injury? You have already listed all the other non-work related reasons for it.
    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

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