Oh, and it's because the KGB (Sedgewich) is dragging their feet on approving the case.

I would not hesitate at al to call your state's labor and industries folks and report 'the harassment' that you are receiving as a result of your on the job injury/illness.  It's one thing to suffer the initial trauma, it's a whole other thing to suffer the verbal abuse due to the slow response of a 'third party adminstrator, Sedgwick.  Sedgwick also has a new partner in crime, Genex, who serves as their health service coordinator  (it was Intracorp)... approving any treatment that you receive. (this includes prescription drugs, appliances as crutches, canes, braces and physical therapy)  These folks are located in California and have a hard time reading the entire file or understanding devastating injuries, even the IME doc's notes and recommendations.  fyi..... worker comp time loss is counted as family medical leave time.  This could pose a problem if a family member needs your assistance within the next year, God forbid.  You may not get access to the time you need to care for them. 

 

File the grievances if Sedgwick is dragging their feet on approving treatment that is needed within a certain time frame.  They may have 60 days to approve procedures, but if you only have a small window of opportunity to get the surgery needed to prevent life long disability, start screaming loudly, fast track the grievance and call your state's labor and industries.  If you live in Washington State, call Project Help for assistance.  (206-281-8901 and ask for Vicki Smith).  For Sedgwick and Genex it's all about the bottom line and removing cost from the equation.  Your 1st line manager has little if any influence with these two organizations, however he/she can use their head and realize that you are hurt on the job and should be working with and for you to remove the work place hazard, get you the appropriate tools to prevent further injury, and find work that you can do, if possible, while you're healing and work hardening after recovery. 

 

Oh, and it's very important to remember that short term disabiity is approved by QDS and worker comp is approved by Sedgwick.  If you are out for more than 8 calendar days, you will be working and providing both organizations the same type of chart notes, paper work, phone calls.  They don't talk with one another.  The release forms that you sign have no effect when they should be sharing info between themselves.  Because this causes your doctor's office additional labor expenses, suggest to your doctor that they bill Sedgwick for the 2nd set of records that are needed by QDS as a result of the on the job injury.  The 3rd set that Genex needs also could be billed for.  These costs are often socialized to other patients that are being seen in that doc's office, raising costs for all of us.  So make sure that you make the calls to your supervisor, Sedgwick, QDS and Genex after your appointments if time loss is involved.  Keep a journal of all your activities, conversations, correspondence, etc. 

 

Take good care.

Very good information, Pnb.   I sure didn't know that about this being under the family medical leave umbrella.   This poses a huge problem for me, since I care for my elderly father by myself.............hmmmmmm.   At least now I know, and can deal with that one if it becomes an "issue" later.  Thanks for the info. 

 

As I have discovered,  you also suffer an "occurrence" each time you run out of FMLA time.  I had FMLA to take care of my disabled spouse, and suffered an OTJ occupational disease.  As previous FMLA hours fell off and were again available, I was under the FMLA umbrella.  The minute I ran out of FMLA hours, I suffered an occurrence.  And this continued in a constant cycle, until eventually I could not be in "SATISFACTORY" status for over two years.  And I worked in a call center that had a permanent injunction against attendance issues for people with disabilities (originally issued for someone who suffered migraines)!!  Of course, the center was required to notify all current and future employees of this fact, but they never did ... and now they are closed.

Beware of GENEX ... I have to file suit under ERISA for termination of LTD benefits.  I was scheduled to attend an IME with a psychologist who presented me with a "release" I could not possibly sign.  Had language in it that I was giving up more than the usual "rights to privacy."  It's bad enough having your mental health records all over the country, and after my providers, QDS, Genex and the IME provider having the records, now they wanted to send them to yet another party for review.  I was not advised of this prior to the appointment.  My benefits were terminated for "non-compliance" ... despite the fact that medical documentation was submitted indicating my continued permanent total disability.

Tertle have you contacted a labor attorney?  If not, you need to.  You should fall under the ADA Americans with Disabilities Act. 

   I would look at filing a complaint.  

As far as those occurences are concerned, it's ridiculous........the way it is going I will be suspended or fired for attendance, before that KGB Sedgwich ever approves my L&I claim.  That's why I AM getting an attorney.

I would suggest that in each of our states that we find a legislator to champion this issue, the one where worker comp time is counted on your FMLA calendar.  If you are hurt on the job, you should not be penalized by having to use FMLA hours to recover.  You could be denied access to the time necessary to care for a seriously ill or injured family member.  By the way, if you have established a benefit case, a reoccurance is just that, depending the amount of time that has transpired, the absences do not count as another occurance, it's part of the 1st one, so as with any benefit case, 1 occurance, 1 day. 

 

The non-compliance could be the company's insistence that we file for Social Security Disability benefits at the end of 6 months of absence. SSA will not discuss SSDI unless you have been or anticipate being absence for 1 year.  If you are capable of being a greeter at Wal Mart, you will not get SSDI.  The company will find themselves in a world of hurt soon as the SSA has recently started filing suit in district federal courts around the country against companies that do what Qwest is doing to it's employees on benefits.

 

Later!