Caps on TTD Benefits

**bugmann** · 04-15-2012, 02:29 AM

Lets put it this way if your lawyer is worth their salt if a call to the IC wont jar the ins co off this ridiculous "cap situation" I predict a motion to reinstate TTD and Medical to be successful.

Maybe you could get something in writing from your employer explaining their WC "cap" on benefits?? If they are dumb enough to give you this then they get EVERYTHING THEY get coming.

Im unsure how NJ is set up as far as online WC info goes. Maybe you had to apply online to have access?? Just dont know. In any event you can call the Dept of Labor who is in charge of NJWC and ask them via phone then. Maybe when you have them on phone ask about online claim info. I will look into this to see if I can figure it out??

Stuff like a WC "cap" on benefits after getting your 1st check is a tell sign of resistance from your employer!!!!!!!!! If there is any chance of having a lifetime of residual effects from this WI then you may wish to consider going full bore for your WC benefits. On the other hand if your injury is superficial you may want to consider not filing especially if you have a great job but horrible supervisor. Its hard to say with knowing so little but my point is after considering your EM position taken they are clear to me in what they want from you. If your close to retirement or just love your job and want to keep it, you have a better chance at that by not pursuing your WC claim?

Yes it is unlawful to be fired for filing a WC claim, but NJ employers are EXPERTS at getting their way and there are countless ways around this law the most used or abused is what is called the "8 week rule" This is after you file a WC case and you have been on TTD there comes a day when the employer may begin to count weeks to be sure they are not sued for wrongful termination, for termination an active Injured worker, as an active employee. Yes you may be fired while under medical care for work injury. WC does not save your job and if you have no work agreement then you are considered an "at will" employee which means you can be fired as easy as you are permitted to quit under the law.

Some of my comments are speculation as I do not have case facts to nail down whats going on here but for sure SOMETHING SMELLS BAD with how this case has been handled by the EM.

BUG

**Joy6** · 04-24-2012, 09:57 AM

I finally have an update and an explanation. The "cap" talk was BS to begin with and was not true. Everything came to a head this week. I received a letter from WC, and they said that I am currently denied because of "insufficient diagnosis' of my injury. They are going to send me to one of their nuero-psychologists for another evaluation. I have already had an evaluation done by the doctor that I was referred to by one of THEIR doctors...WC has a copy of that report which is very thorough. This is wild considering that I have been diagnosed with the condition by two of their doctors already. They are trying to say that my initial hospital notes don't indicate the injury, but that is crazy because the EMT's that brought me there told the ER staff what was wrong with me. Its not my fault if they left out information or the doctor did not make appropriate notes. They did not act appropriately in that hospital to begin with and gave me a 3-4 minute examination and released me. I was in to much pain during the first few days to realize how screwed up my head was until the pain died down.

My lawyer has already talked to WC and received a response from the WC attorney, which he told me he actually knows the guy and is going to see if he can talk some sense into him. He said he knows what he needs to do, but if he ends up having to file a motion, it will take at least 1-2 months. In the meantime, I have applied for STD since my bills are adding up quick. Thank god I even have that option available to me. The lawyer said this is their typical nonsense....

My employer is completely in the dark about it from what I understand.....I work for a large company. The HR rep didn't know what was going on until I told her and she told me she is clueless about WC to begin with. They are no help here at all. I mean why would WC have even sent me a check to begin with?? why are they all of a sudden going to try to fight this and use crappy hospital notes as their ammo when I already have pages and pages of documented diagnosis and a 4 page report on my condition and recommended treatments. My assumption is because this is possibly going to be very costly treatment. I don't care what it is but I am not getting the treatment I need to intervene before this gets worse.

**bugmann** · 04-26-2012, 10:47 AM

Joy,

Yea, I thought you were getting BS from your EM!! Cap my butt!!
The one thing I find upsetting about NJWC is the fact that if the EM doesn't like the medical report from one of its Drs they can just send you to another one of their Drs till they have a report they can work with?

You will want to consult with a well known WC expert for advice. I can see where this is going!! Same place my EM took me!

Dont buy that crap your EM doesn't know anything. Make NO mistake someone from HR has been in touch with your office mgr or supervisor and has been given instruction. There is someone in HR who handles all WC claims and they work in concert with your mgr supervisor. Injuries that require the services of a psychologist are the most difficult to prove. I am willing to bet that your employer is self insured which means they are WELL INFORMED as they pay the bills as the rack up or they are supposed to. In cases like this the EM hire a company to push the WC paperwork while the EM pays the bills.

Its hard to pay for things they are in the dark about??? Think about it?

Good luck

BUG

**DMDRN36** · 10-06-2012, 07:23 AM

Joy6,
Hi there.. I am a New Jersey resident that was injured at work, was an RN, so I know a lot about medicine and so on... I was treated like a piece of dirt by the Workers Comp INsurance company after the adjuster refused to let the young lady who was handling the case to finish with it. THe adjuster who took over tried everything under the book to get me off compensation... sent me to WHORE DOCTORS that wore FILTHY whitish coats worked out of closets, even purgered herself on the stand with two doctors reports that I NEVER EVER SAW> well you NEED TO HAVE TO>>> GET a LAWYER that deals ONLY WITH workers compensation.. to protect you ... feel free to email me for any advise I can provide you... do not worry about paying the lawyer it comes out of the the Workers compensation...not you... it is a set fee for the lawyer unless he goes above and beyond and the Judge sees fit to give him more and then it is paid over time a little at a time... dont worry .... you need him... please let me knowl.
OHHHHH NEVER NEVER NEVER TALK TO THE INSURANCE COMPANY ONCE you have a Lawyer... let the lawyer do all the talking.....
the INsurance company is NOT your FRIEND> trust me... I am still getting medical payments paid for after 24 years from the date of my injury..... thanks to a fantastic lawyer.... and a check each month....