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  1. #1
    Join Date
    Jul 2012

    Default Approved for Surgery but Denied TTD


    This claim in NY

    I was put out of work in April 2011, originally was on my jobs disability Ic, until diagnosed with work related injuries.
    WC Ic quickly denied claim, and my job put me back on disability Ic for payments, with my job, wether its occupational or non occupation, you get your check for up to six months as long as claim is active , disability or workmans comp. right after our hearing in Sept 2011, I was notified by my jobs disability Ic that this was work related and that WC Ic would be paying me, this did not happen, they were still stalling, saying controverted evidence , no money, I went for about 7 weeks no payments till depos in October, we won in December, everything established, treatment to all sites all the WC jargon, we went to court again for compensation in February , and got maximum pay, all won, workmans comp Ic paid back my job all money and I got the difference between disability and workmans compensation pay through my job, ALL IS GOOD, the decision read that up until October 2011 all paid, after this date everything will be held in abeyance, since then I had an IME that stated diagnoses, the Docter said I had marked disability light duty, but I needed an ACDF SURGERY because I was getting no relief, I stated this to IME Docter and gave him my docters notes information to go with IME report, he amended his report to recommend that I needed this surgery, and it was reasonable. My Doctor put in for the surgery and was approved quickley for surgery and bone stimulater, I had surgery on June 1 2012. Now we are going back to court soon to collect back workmans comp payments up till now which will be paid back to my company's disability Ic, because since they stopped payments to me from last September, I have signed a subrogation agreement through them, so they can continue monthly checks. I have filed for SSDI, whether or not I pursue this SSDI is a question mark because I do want to get back to work sometime, the ACDF will take time to heal. What i want to know is that when I do have this hearing and settle up monies up to now can we compel Sedgwick to start paying me directly so I can get off of the subrogation agreement through the disability Ic ?, I am paying tax on this money and I have to declare all money to govt. and if I am denied SSDI can my company's Ic stop my payments even though they know this is a subrogation agreement against workmans compensation. I know my company's disabilitys criteria of being disabled is one or more parts that keep you from doing your job about 20 percent or more
    I have talked to my attorney already, I would like the forum to weigh in thank you!

    Sorry for the long book

  2. #2
    Join Date
    Jun 2012

    Default Re: Why is Workmans Compensation Ic Not Paying Ttd, but is Paying for Acdf Surgery

    my work accident and injury happend dec 5 2011 i filed for comp january, finally got a hearing june then july 2nd hearing i proved my case and letter says medicaltreatment and care authorized.(after me paying for my prescriptions and copays for last 7 months totaling about 3 thousand$) so i to have been out of pay for while , it will be 9 months by time next hearing in sept. they want me to see IME first to see how serious it is, i had my doctor fill out MMI which i faxxed to my lawyer so hopfully ill see atleast my back pak ($12k or so)

    As for ssd that takes longer then comp takes to win a ssd case i filed for that in may. i went to their ime exam got deneyed even tho doctor said i was messed up and disabled. i hired binder and binder llc lawfirm for social ecurity case , they are very good and very helpful.

    should also do as i have if i have not yet, contact DSS and see what you can get, currently i have mediciad with a very good HIP health plan thru medicaid ( 0 copays for anything incl hospital stays and 1$ generic 3$ brand name drugs) this si good for when you settle comp and have no medical.

    goodluck to you and remember we are all going/went thru this BS we know how u feel.


  3. #3
    Join Date
    Apr 2012

    Default Re: Why is Workmans Compensation Ic Not Paying Ttd, but is Paying for Acdf Surgery

    My subagratory agreements has limits, yours might also. My sympathies to you having to deal with Sedgwick.

  4. #4
    Join Date
    Feb 2007
    Charlotte, NC

    Default Re: Why is Workmans Compensation Ic Not Paying Ttd, but is Paying for Acdf Surgery

    Dirk, you have a complicated situation and you need to sort this out with your lawyer.
    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

  5. #5
    Join Date
    Jul 2012

    Default Re: Why is Workmans Compensation Ic Not Paying Ttd, but is Paying for Acdf Surgery

    Thank you it's already in the pike, I am still on my jobs disability Ic policy, so I am receiving money, but all this has to be counted at tax time, Sedgwick , since the inception of this , first denying claim, then paying the first six months back to me and my job, has not paid me a dime, as a result of this hence subrogation agreement. My lawyers filed awhile back for court date, they said it would take time for hearing, I figure summer court dates are few, since, I do have income , it's not an ASAP situation like a lot of people on this, I just wanted to get off my employers disability Ic , and on sedgwicks, I figure when it comes tax time I will attach court decisions to my tax returns, because I'm not supposed to pay any tax on this money, let Sedgwick deal with the IRS , I'm paying minimal fed and state taxes. It's like I'm still working

    - - - Updated - - -

    Thank you for your post, I heard binder and binder is good for ssd , my lawyer has already filed for ssd

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