I Can’t Believe They Denied My Industrial Disability / Medical Retirement

Why would CalPERS or the County Retirement Association deny a disability / medical retirement application?

Denials are frequent. The retirement system hire defense doctors, referring to them oftentimes as “Independent Medical Examiners”, even though they are hired, paid for by and used repeatedly by the retirement system. Thus, the label “Independent” is misleading. These defense doctors are used to evaluate its members following their applications for benefits. These doctors are routinely used for the purpose of defending against claims for insurance companies, workers’ compensation carriers, and for retirement systems. Thus, the defense doctors understand that if they can deny benefits for their employers, their referrals will continue.

Therefore, it is very important that once you are evaluated by a doctor on behalf of CalPERS or the County Retirement Systems, that you take steps to get a copy of the doctor’s reporting regarding your evaluation. It will provide you with the information in most cases as to why you were denied.

Although reasons vary, many times the claims are based upon the fact that you are older, obese, or had an injury in your past, that the doctor can claim is the “real” reason you have your current disability from work despite having injuries actually occurring on the job. Other common reasons to deny claims is that your injury is not bad enough to disable you claiming you are exaggerating your injuries or are a malingerer and just want the benefit instead of working. Defense doctors also routinely state that your disability is merely based on your subjective claims of having pain, and that the objective findings cannot substantiate the pain you feel.

To most, a denial is shocking and frightening. Most employees have already been through a lengthy workers’ compensation process filled with denials and delays, and now they face more of the same. Most have been off of work for months or years. The employer has already advised them that it cannot accommodate the restrictions developed during the course of the workers’ compensation case. So how can CalPERS or the County Employees Retirement System now come to a completely different result?

Whether it is CalPERS or the County Employees Retirement System employees discover that it is an entity separate from their employer which makes its own determination many times opposite of that which was determined by the employer and the workers’ compensation system.

At the time of the denial a decision must be made whether to return to work or pursue an appeal hearing. It is beneficial for employees with disability / medical retirement rights to consult with an attorney handling such matters at the first time they believe that they will not be able to return to their prior job, but certainly once the retirement system has obtained a medical report against you, it is imperative that you get professional advice.

Jane Oatman, Esq. 
FAUNCE, SINGER & OATMAN
Fighting for the Rights of Disabled Public Employees
http://www.public-pensions.com
1-800-874-2284

Timing is Important

One of the ways the retirement systems “nickel and dime” injured workers, is to make the effective date of the disability retirement as late as possible. Thus, if an injured worker is taken off payroll during a workers’ compensation case and months, or even years, later files for disability retirement, the retirement system will try to ignore those months and years of uncompensated time by making the effective date of the retirement the same as the date it received the disability retirement application.

For county employees, the unfairness of this practice was legislatively corrected by providing for an earlier effective date than the date the application was actually filed. Thus, if an injured worker delays in filing their application beyond the day after the last day of regular compensation, the application is deemed filed on the day after last regular compensation. But, once the injured worker knows that they cannot return to the actual duties they were performing, an effort should be made to get the employer to agree and file for the disability retirement, or the worker will have to file their own application. In any case, once the decision is made that you are disabled, prompt action on a disability retirement application is advisable.

Delay in filing your disability retirement application can be costly. The County Retirement Act provides that the effective date of your disability retirement benefit shall be the date of your application. The effective date may be earlier than the date of your application if you can prove that you delayed filing because of administrative oversight or you were unable to determine that your disability was permanent until a date after you last received regular compensation.

It may be beneficial to you to have your application effective earlier than the date of your application when you have a lengthy period where you received only workers’ compensation benefits or no benefits prior to the date you filed the application. That way you can recover back disability retirement benefits you would have received had you filed at the time you last received compensation from your employer. The earlier date, however, may decrease your monthly benefit so it may be important that an assessment be made whether actually obtaining the earlier date is most advantageous in the long run financially.

It is very important to know when you last will receive regular compensation. For example, you need to know when exactly your sick, vacation, comp time and holiday time will be end so you can time your application. Regular compensation includes contributions to supplement your workers’ compensation benefit from your sick pay, vacation pay and industrial leave compensation if your employer provides such a benefit.

This means that if you are off work and you continue to receive pay in the form of regular compensation from your employer excluding workers’ compensation pay such as temporary or permanent disability payments, and your doctor deems your condition permanent you need to immediately determine whether disability retirement is an option for you and apply. Otherwise you may lose valuable benefits.

Jane Oatman, Esq. 
FAUNCE, SINGER & OATMAN
Fighting for the Rights of Disabled Public Employees
http://www.public-pensions.com
1-800-874-2284

 

 

IMPORTANT TO KNOW YOUR TREATING DOCTOR IS COOPERATIVE

Many public employees are in a dilemma, with no easy fix, because their treating workers’ compensation doctors will not assist them by completing required disability retirement forms. Retirement systems will not accept or process applications without required doctor forms being completed. The disabled employee is subjected to financial hardship simply because of the treating doctor’s lack of cooperation. 

From the date an injured worker is referred for medical treatment, the doctor must determine whether the injured worker is medically unable to perform their usual job duties. In the past, the treating doctor would complete the required forms for applying to get disability retirement. Now, many doctors simply refuse to cooperate.

Public employees be aware, from the onset of your injury, whether you believe that your injury will result in permanent restrictions preventing you from continuing to perform the duties you were last performing on your job. If you suspect that you may be unable to return to those duties, then your treating doctor must be willing to fill out the required disability retirement forms which are outside of the workers’ compensation system. Your employer, and its workers’ compensation carrier, in picking treating doctors has done nothing to insure that their doctors will help you in obtaining disability retirement. Neither will they help you, in most instances, get their doctors cooperation in applying for disability retirement. 

Your disability retirement benefit may be the only benefit you will have available to assist you financially for the long term. You should discuss with your treating doctor immediately upon referral, whether s/he and their office staff will help you in the event your injury results in need to seek disability retirement. 

It may even be prudent to see what steps you need to take to get a new treating doctor that will take care of your additional and future needs.

 

Jane Oatman, Esq.
FAUNCE, SINGER & OATMAN
Fighting for the Rights of Disabled Public Employees
http://www.public-pensions.com
1-800-874-2284

CalPERS Insurance Rate Hike and the Latest Lawsuit

The California Public Employees’ Retirement System (CalPERS) was created to protect public employees after their years of service were completed. However, over the last few years, as the entire state of California has dealt with budgetary concerns, CalPERS has made some sweeping reforms that have led to widespread criticism. Most recently, the organization chose to raise long-term care insurance rates by 85% by the year 2015. The not inconsiderable hike has shaken the public employee community and resulted in a lawsuit.

In a lawsuit filed by multiple long-term insurance policyholders and their California labor law attorneys, CalPERS is being charged with misleading public employees about the fiscal stability of their program. Employment attorneys, and lawyers focused on medical retirement cases, point to CalPERS lack of communication with policyholders regarding just how under-funded the program actually was, and how this lack of funds would eventually trickle down to the policyholders themselves.

While CalPERS has been offering alternative plans to policyholders, and is making an effort to create more financial stability, for many retirees it may prove to be too little, too late.

Jane Oatman
Faunce, Singer & Oatman
Fighting for the Rights of Disabled Public Employees
http://www.public-pensions.com
1-800-874-2284