Did you really expect a different outcome? On Tuesday, The Pony got a letter from the U.S. Department of Labor saying that his workman's compensation claim has been DENIED!
As his shop steward said when he contacted her: "What in the actual EFF???"
After all the hoops he's jumped though (with a broken ankle, mind you) to goad three postal service employees to fix what they'd neglected, or done wrong, with his paperwork... now the U.S. Department of Labor has a few more paces to put The Pony through.
Even though they've already paid him one week of his Continuation of Pay, now this claim is denied, and The Pony will have to pay back the money he's been given (oh, so much! that one week!) unless the claim is adjudicated in his favor. That's not a problem, the money is sitting in his bank account. He's not like the poor gal who needed that money to live on while she's injured. I hope her claim went through okay.
The denial letter says they didn't get sufficient medical evidence to support his claim that the injury was caused by the work incident. Supposedly they don't have any documentation from the podiatrist, who says the forms were sent in. Also, the Department of Labor says the doctor's signature was unreadable. So they got SOMETHING. They'd already mentioned that the urgent care forms were only signed by a nurse practitioner.
Now The Pony has to file a reconsideration, and supply supporting evidence not already received, and have his case reviewed by a different committee than the one who made this determination.
SWEET GUMMI MARY! WHAT IN THE NOT-HEAVEN?
The Pony went by the podiatrist's office on Wednesday, and was told by office staff that the paperwork had been sent. Also, that the podiatrist was in another town that day, to come back on Thursday. The Pony said he WOULD, since he has a follow-up appointment that day. So they said they'd have the paperwork ready to give him a copy of everything.
As The Pony pointed out, the podiatrist's signature was a stamp. As Farmer H pointed out, ALL doctors have unreadable signatures! Anyhoo... I told him to specifically request that they also print the name under the signature. And not to leave until he's satisfied that EVERY detail mentioned in that denial letter is remedied.
Then he has to mail it in himself. He has 1 calendar year from the date of determination on September 2 in order to file for reconsideration. Once he does so, they TRY to get a new decision within 90 days.
Looks like that podiatrist's office was right when they said nobody else around here will deal with workman's compensation, because they try to deny everybody. And also that Farmer H's brother knew the score when he said he'd had 4 claims, and 3 of them needed a lawyer to get his rightful compensation.
It must be a big business. There are many billboards along the highway with lawyers touting their services for workman's compensation claims.
Oy! What a stuff up! I hope everything gets righted, but their 90 day consideration period put them smack in the middle of Christmas/New Year or close enough to it that 'they' might all be on holiday or some other sort of break from work. I'll keep my fingers crossed for somebody with an ounce of sense zipping that reclaim through with the speed of a hummingbird's wings.
ReplyDeleteRiver,
ReplyDeleteAt least The Pony is not hurting financially. It's a royal pain in the rumpus, but at least his injury wasn't disabling, he still has a job, and though terribly incompetent in some ways, his superiors are treating him in a friendly manner.
Thanks for the crossed fingers. If you get injured during well-wishing, this blog will not pay your medical bills!
Insurance is big business, make no mistake! They have people with no other job but to seek out errors to delay or totally avoid pay-outs! Probably the least careful "insurance" is Medicaid. They will push anything through with little or no proof involved. After all, that is just tax payer money!!
ReplyDeleteKathy,
ReplyDeleteI agree! They hope people will give up after so much hassle. This was a perfect storm of incompetency between the USPS and the Department of Labor. One held up The Pony's initial appointment for TWO WEEKS, and the other didn't notify him that his claim was lacking these items UNTIL THE DENIAL. Also, he trusted the podiatrist's office that they had actually sent in the correct info from the form he left them.
Many of my students used the ER for their primary care, since Medicaid paid. Need a doctor's excuse for an absence? Go to the ER!