Insurance, Workers Comp and 52 weeks?

[undies]

Incoming wall of text:

I had a workers compensation injury back in 2011, I was out of work for a little over a year. Returned in 2012 and worked until this past 6/2015 when the same injury flared up. As of 10/3 I was sent the whole insurance being dropped and having to file for cobra letter, I am in the western region carve out. After WEEKS of calling the various outlets to see why I was dropped my local HR told me that I only get covered for 52 weeks for a workers comp injury. I had been getting contributions paid since I was off in 6/2015 with no issues, I was told it was a mistake and they shouldn't have even been paying that in the first place. I've spoken with my BA and was advised to file a grievance as he has never heard of such a situation, I did and now waiting for that avenue to resolve. In the meantime we have had to sign up for my wife's health insurance to avoid any penalties from obamacare due to the lapse in coverage.

Does my time off 4 years ago count towards this insurance limit if I go off again with the same injury?

 

[bottomups]

Did you file a new injury report in 6/2015? If you did you should have gotten a new claim number and reset the 52 week clock.

 

[undies]

Did you file a new injury report in 6/2015? If you did you should have gotten a new claim number and reset the 52 week clock.

No, they said it wasn't a new injury since it's the same body part being hurt again...

 

[bottomups]

I don't know the workers compensation laws in your state. In Wisconsin, you are considered healed when returned to work. If you then injure the same body part it is considered a new injury.
Is Liberty Mutual paying you TTD benefits? If so, are they paying at the weekly rate you were receiving in 2011?

 

[undies]

I don't know the workers compensation laws in your state. In Wisconsin, you are considered healed when returned to work. If you then injure the same body part it is considered a new injury.
Is Liberty Mutual paying you TTD benefits? If so, are they paying at the weekly rate you were receiving in 2011?

LM is not paying me, I'm getting paid from state disability. I'm in California. I did litigate the original injury and was declared something like 95% disabled, not sure if that makes a difference.

 

[Bubblehead]

LM is not paying me, I'm getting paid from state disability. I'm in California. I did litigate the original injury and was declared something like 95% disabled, not sure if that makes a difference.

Call your lawyer then?
Surely you have contacted your (a) lawyer during the past 5 months of this process?

 

[Whatbrownwontdoforyou]

I may vary by area.....where I am if 2 years passes it's considered case closed on original injury

 

[bottomups]

It does vary by by area and state workers compensation laws. In Wisconsin a case stays open for 12 1/2 years from date of last payment. Once returned to work and healing plateau has been reached the injury is deemed healed. Any new trauma to same area is then considered a new injury.
I have been out now for 50 weeks with a ruptured rotator cuff. Fifth surgery on this shoulder and all have been new claims.

 

[barnyard]

You are going to have to read through your state's worker's comp laws. That is really the only way to know.

 

[undies]

According to the state workers comp people I spoke to, California has no laws requiring employers to maintain health coverage when an employee goes out on disability.

In order to make it a new claim, I'll have to file for new and further benefits stating that my condition has worsened. But by doing that, I risk getting my disability rated lower and possibly not even being able to even return to my job! Scary . I know my back won't last the 18 years I need to retire, so I'll have to take a wait and see approach...