Denied my sick time pay

[Belair747]

Hi, I have 30 dedicated years with my company. I pay about $30 a month for short term disability insurance . I have about 60 days of unused certified sick time banked. My MS symptom's , crippling fatigue and terrible muscle pain has gotten so bad some days I cant move. I was sick about 10 days and my 2 doctors agreed I need a 4 day work week with intermittent days off for medical appointments and signed all the forms required. I applied for short term disability insurance to cover my sick days. It was denied and my appeal denied. They told me I had to use unpaid FLMA. FLMA only lasts 12 weeks and 12 weeks is now up. I am in fear of losing my job after 30 dedicated years. Not to mention I now cant keep up with bills due to unpaid sick days. They had me drowning in paper work just for the unpaid FLMA, I have been using up all my vacation to cover my needed sick days. I am to exhausted to fight any more. I give up. Have become depressed,no longer see my family or friends, stopped going to my doctors. Thanks for listening!:rose

[MSW1963]

How long has your STD insurance coverage been in force? What was stated reason your claim for STD benefits was denied? Do you have LTD coverage?

If you fear your job of 30yrs is in jeopardy due to your absences and/or poor job performance appraisal, you need to discuss these issues with your MS and/or PCP docs. Based on your post, I would consider it urgent and would have the conversation ASAP.

It may be a matter of how your docs phrased the initial request for 'leave of absence/reduced work schedule' that resulted in the STD claim being denied.

It may be necessary for your docs to re-phrase the request to meet your company's demands and to comply with the policy description of disability for your Short Term Disability claim to be approved.

The terms of most STD policies prohibit claims to be paid on an intermitten basis. STD policies require that you must be disabled full time for what is expected to be a short term duration. If you can't work one day or week but can resume working the next day or week, that would not meet the defination of disability for most STD policies.

I hope this helps. Best of luck and take care.

[Belair747]

Denied sick time

Hi,
Thanks for your input. I have always had and paid for STD . Fees may have changed over the past 30 years. My company provides FTD. According to my STD manual STD claims can be filled out if you have 7 consecutive sick days for more and it is for 26 weeks after , and if approved will cover intermittent or reduced week schedule sick days due to illness there after up to 26weeks. The insurance company denied it they said MS is not preventing me from preforming my job. This is not true, I have crippling fatigue and terrible spine (back) (neck) (eye) pain . My doctors stated this on the paperwork, yet the insurance company's doctor (whom I have never meet) said this does not prevent me from working full time. I thank your for listening to my story. kind regards

[MSW1963]

Interesting that your STD policy covers intermitant leave, although insurers develope many nuances in their policies to meet new market demand, it's not a complete surprise, although I haven't heard of it before.

Have you discussed the STD benefits denial with your docs? Your docs will be essential in helping you appeal your denied claim, and hopefully getting the denied claim reversed and approval of your claim.

Have you considered talking with an attorney? Most local chapters of the NMSS maintain a list of disability attorney's in your area. An attorney who specializes in insurance disability may have advice about perfecting your claim and getting it approved for your specific type of STD policy, and info about complying with the policy terms.

Best of luck.

[Belair747]

Hi,

I didn't know I needed to hire an attorney to appeal. I already appealed myself and my appeal was denied. I called 2 different attorneys, they told me I should have called them to help with the appeal. Now its denied. How was I to know I had to hire an attorney to get my own Banked Certified Unused Sick Time pay and my STD insurance protection (which I pay for in good faith). So now I am being told I have no FLMA or STD or no pay if I am sick. Being monitored now if I call in sick. Now taking loans from my retirement 401 to cover bills. I feel like this INS Company is a fraud and lied about their coverage. Also my Company who didn't make it clear that banked sick time could NOT be used in case of illness ( unless this INS CO approved STD first) I am scared, feel taken , exhausted, in pain, ready to quit. Thanks for listening, you don't have to reply. Just wanted this out there.

PS I did send copies of all my paperwork to the department of labor and my states Insurance regulations department (consumer protection).

Kind regards to all !

Thank you

[MSW1963]

Have you past the final date to appeal the most recent denial for STD? Have you exhausted all your appeals and have been issued a final decision?

There is typically a statute of limitations, standard for insurance contracts is 1 year from the final denial, in order for you to hire a lawyer and file a civil lawsuit. You and the insurance co are involved a contract disupte. You don't agree with their final denial of your STD claim, you file a civil case in a court of law.

Most lawyers are on retainer with big insurance companies, or would give a major organ of the body to represent one of the big insurance co's. That's where the really big money is in insurance litigation.

Most attorneys listed in your local phone directory/google, represent the insurance co's or wish they did, they're not interested in biting the hand that feeds them, so to speak. Once an attorney represents an insured individual, they usually get 'black listed' by insurance companes.

Contacting an attorney who specializes in representing insured individuals may require a referral from organizations like the NMSS.

I'm not familiar with Banked Certified Unused Sick Time pay or what the requirements are for approval to actually use the accumulated sick days. Is there a limit on the number of consecutive days that can be used at one time?

Do you need your doc's determination that your are ill to use banked sick leave? If so, that sounds pretty close to or no different from FMLA and close to STD requirements, so what is the distinction, or is there one, other than it being paid?

Otherwise you have accumulated sick leave that you could have otherwise used without all the stupulations applied by banking the days?

Why don't you qualify for FMLA?

I'm clearly not familiar with the concept of banked sick leave. Hopefully someone who is will come along with advice for you.

You need to talk to an attorney who represents insured individuals who specializes in Disability claims.

[Belair747]

Denied sick pay & short term disability

Good Day,

Yes my appeal was denied and final. My approved Unpaid FLMA which was 12 weeks is now all used. My company told me I don't have enough hours worked to apply for it again.
I am a fighter, but almost at the end of my rope. I need your opinion. I am going to file a claim in conciliation court for lost wages due to denial of STD.

Should I file it against A B or C below?
A. The doctor who I have never meet, who stated MS does not prevent full time work.
B . The Claims management company who denied my short term disability and denied my appeal.

C. My company (a major airline)

Also I am going to file a complaint against this unethical Doctor to the State Medical Board in which he practices.

Thank you & Kind regards,

[MSW1963]

I would consider filing a compliant with EEOC and The Department of Labor over the banked sick leave you were denied. Being denied access to your banked sick leave seems to be an employer/HR dispute, seperte from the STD claim denial.

If there's a 3rd party administrator involved in administering banked sick leave, a 3rd party administator would fall under EEOC and DOL jurisdiction, as agents acting on behalf/approval of your employer.

STD is an insurance matter. Contact the Department of Insurance in your state, file a compliant against the STD insurer.

In addition to the Department of Insurance in your state, you should contact your local chapter of the NMSS for a list of attorneys to represent you, who specialize in STD/LTD insurance litigation. You need legal representation. The insurance company probably has lawyers on staff full time, and other private firms on retainer. You deserve nothing less than legal representation too.

With 30yrs of employment with your company, I think it would be a case of interest to all the agencies, DOL, EEOC, Dept. of Insurance, private attorney.

Airlines have aquired a poor reputation over the years, to both their customers and their employees, their reputation is not the best.

You can probably file an EEOC and DOL complaint online, at their website, www.EEOC.gov. EEOC and DOL work jointly, when you file with EEOC, they will also file your complaint with DOL, on your behalf if DOL issues are involved in your compliant.

Best of luck to you and let us know how things are progressing.

[MSer102]

Poster MSW1963 has given you some good advice. It sounds like you need legal advice and help from some government agencies to deal with some complicated issues.

I don't know what certified banked sick time pay is but it sounds like it's something that the Department of Labor can help you with. There are no laws that say that an employer has to offer sick time pay but it appears that there are laws that say when they do they have to abide by their own published policies. And a labor attorney might be able to help you here too.

The unspoken thing between the lines of MSW's post is that small claims court is probably not the best venue for your claims.

You can't sue the doctor who works for your SDI insurer for breach of contract because you don't have a contract with him. You can't sue him for malpractice because you aren't his patient and he wasn't giving you medical care.

You can complain to the medical board(s) where that doctor is licensed but those boards deal with licensing and medical competence in the giving of medical care to patients. They don't handle the giving of medical opinions as a consultant or employee when not involved in giving care to patients. You aren't his patient and he isn't your doctor and you didn't incur any medical harm based on the care he gave you because he didn't give you any care, so the board(s) isn't going to do anything for you or against the doctor. Making a decision that you don't agree with doesn't prove that the doctor is unethical. But filing a complaint about it might make you look unreasonable and not believable.

I have to agree with MSW that your best bets may be a private labor attorney and government agencies. Small claims court against an insurance company and an airline that pay their attorneys more in a year than you'll make in a lifetime - not so much.

[Belair747]

Denied Sick time, STD and FMLA is used up

Reading through my Employee Benefits handbook.

Certified Time , STD and LTD all run together.

My certified sick time is the days I have accrued over the years from never being sick. It cannot be used until the Claims Management Company approves your illness or disability, this is when your Certified Sick Time pays, when that is exhausted, STD starts and runs 26weeks, once the 26 weeks of STD are exhausted, then LTD is used.
Since I was denied STD I cannot get paid for my certified sick time. Or apply for LTD. They all run together.

The attorney I called wasn't to interested because they make their money on LTD denials, Which would never occur if needed since my STD has been denied.

I thank you for your advise and taking the time to reply.

I am going to my doctor tomorrow, as I have fallen into a deep depression. Only my fellow MS friends understand, and I kindly thank you for listening.

Best regards to all!