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Thread: W/C Claim

  1. #1
    Join Date
    Jan 2009
    Posts
    11

    Default W/C Claim

    OK my claim was accepted and my cardiologist is talking about bypass surgery, Is it possible that SAIF could pull the plug after the surgery?

  2. #2
    Join Date
    Jul 2008
    Location
    ca
    Posts
    857

    Default Re: W/C Claim

    Cant,

    I dont have the answers, but with work comp anything is possible. Is the bypass work related? If it is, sounds serious and I would at least talk to a couple work comp specialists, it wont cost you anything up front.

    Good luck to you..

  3. #3
    Join Date
    Jan 2009
    Posts
    11

    Default Re: W/C Claim

    Just wondering if SAIF has been known to pull the plug in mid stream, So far the adjuster has been very helpful to my needs (meds, payments etc.) according to the IME yes my job was a contributing factor and so far SAIF has not had any problems with paying the hospital bills (about $50,000 to date) But the bypass will be around twice that amount I have read a few horror stories about SAIF not wanting to pay when the bills get BIG! I`m sure the size of the debt has nothing to do with it just speaking metaphoricly. I`m just at the point where the credit card Company`s are squawking and the mortgage is late etc. and anymore disappointment could be catastrophic if you know what I mean.

  4. #4
    Join Date
    Jan 2009
    Posts
    11

    Default Re: W/C Claim

    Went to SSD Drs appt. and was told that there are three levels of disability and He will be reporting back to SSD that I am level 3. Can anyone tell me what level 3 means?

  5. #5
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    17,943

    Default Re: W/C Claim

    was told that there are three levels of disability and He will be reporting back to SSD that I am level 3.
    Don't know where your doctor got that ....(?)
    You are either ''totally disabled'' under SSA rules... or you are not.
    You only reveive SSDI benefits if you are determined 100% totally disabled... there are no 'levels' of disability.

    There are 5 steps to determine IF you are disabed under SSA rules...
    4 & 5 are here...http://www.ssa.gov/disability/step4and5.htm#Q5_1, with access to the others...

  6. #6
    Join Date
    Oct 1971
    Posts
    5,048

    Default Re: W/C Claim

    Actually there is three levels of total disability when you qualify for SSD
    * possible recovery , review within 2 years
    * possible recovery, review withing 4 years
    * no chance for recovery. (review in five years)
    Don't quote me on the years, it's been awhile since I reviewed them, but they're close.
    Tony
    Last edited by tony; 04-08-2009 at 01:33 PM.
    Moderator Responses are based on my personal bias, experience and research - They do not represent the views of the admin nor may be accepted in the legal community, always consult an attorney.

  7. #7
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    17,943

    Default Re: W/C Claim

    The review levels/time periods are not the determination of the evaluating doctor...only the SSA/SSDI administration, and/or the ALJ awarding the benefits.
    Even at that... (a judge issuing the order/award), my first evaluation was ordered in the award notification...did not happen. And there was no review until the 3rd year.

    Under SSA rules, you are either classified as 'disabled' or not disabled under their qualifying rules....you can't be 'partially disabled'...which a 'level of disability' would imply.

  8. #8
    Join Date
    Oct 1971
    Posts
    5,048

    Default Re: W/C Claim

    True, people get this confused though.
    Moderator Responses are based on my personal bias, experience and research - They do not represent the views of the admin nor may be accepted in the legal community, always consult an attorney.

  9. #9
    Join Date
    Mar 2009
    Posts
    289

    Default Re: W/C Claim

    BvIA and Tony are both right. You must be totally disabled and levels are right, I take it from what your saying is: Your doctor thinks your totally disabled with a level 3. Good luck and take care

  10. #10
    Join Date
    Jan 2009
    Posts
    11

    Default Re: W/C Claim

    OK I see, now it makes sense. Now I have another ? Will Ore.w/c follow suit along with SSD and offer a settlement for my being perm/disabled?

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