Sustained multiple spinal fractures during fall during seizure. STD approved, but employer laid off after learning ETA to return. Supplementary accident/hospital coverage denied my claim, stating they only payout benefits for injuries sustained during a surprise incident, not from a med condition.
Inside of my all-tile bathroom taking a shower before work, I had a seizure and sustained a burst fracture to my L1, and compression fracture to my L2. There were other injuries, but these were the most notable because the burst fracture was compromising the safety of my spinal cord. Emergency spinal fusion surgery was required, and my T11 – L1 were fused together with hardware. I spent 14 days in ICU, 7 in regular, and another 2 weeks in inpatient rehab. Here are a few pieces of information:
From the first day of the job, to the last day I worked, equals just a bit over 180 days, which means no FMLA protections. After learning that my neurosurgeon forbids me from working, not even allowed to remotely work from home, for a bare minimum of 3 months, my employer told me that they couldn't hold my spot open. My short-term disability claim had been approved prior to the neurosurgeon giving instructions that restrict me from working for the next 3 months. Would my STD benefits just end when (not if) my employer decides to pull the plug on my employee ID numbers? How does that work? Since my health and supplementary insurance premiums were deducted via payroll, how long do I have before each policy/coverage is canceled? My short-term disability claim has been approved, which begs the question: how am I to receive short-term disability AND be laid off at the same time? Is this seriously a thing? How? Without FMLA protection, what's to stop my employer from choosing to end my disability benefits themselves and just let me go? Do my STD benefits just stop once they do that? Is there a way I can actually find out any of this information? Are the injuries I've sustained "worthy enough" to qualify for SSDI from the federal government? I need help with basic tasks and am really struggling. I'm hoping this whole ordeal gets better with time. Ontop of the regular medical insurance, I was also enrolled and paying for supplementary Accident and Hospital insurance with post-tax dollars. I've submitted claims to both. The Accident policy denies my claim, under the notion that because my injuries resulted from a medical condition, that any and all items that were administered, from transportation, to surgery, to tests, etc, are ineligible for the policy. She tells me to refer to the policy terms and agreement. As I had it up in front of me, I want to point out two clauses under the "Definitions" section:
Covered Accident means an accident causing Injury which:
Occurs after the policy Effective Date;
Occurs while this policy is in force, and;
Is not excluded by name or specific description in this Policy
Now, take a good look at the last line in that definition of a Covered Accident. This is the definition of an Injury:
means an accidental bodily injury which resulted from a Covered Accident. It does not include sickness, disease, or bodily infirmity. Overuse syndromes, typically due to repetitive or recurrent activities, such as osteoarthritis, Carpal Tunnel Syndrome, or tendonitis, are considered to be a sickness and not an injury for the purposes of this policy.
Not only does the definition of an Injury make it look like as if a policyholder tried to claim one of those syndromes as their accident, none of the "specifically listed exclusions" are even closely relatable to suffering from a fall during a seizure.
The Hospital policy denies my claim, without any explanation, reasoning, letter, etc. Their hours are M – F 8am to 5pm and I've been calling right at 8am, only to wait on hold until 5:01pm (I wish I was joking) when a representative picks up the phone. I calmly explain my question and problem, and that I would like to know why it was denied: maybe it was missing something? The representative tells me "Oh, you'll need to speak to the Claims department. Unfortunately, you just missed them, and they're gone for the day. I can give you their phone number so you can give them a call in the morning, if you'd like". I tell her I had been on hold for 8 hours, and even used my fiance's phone to dial in case my phone was just messing up or something. She apologizes, and I let her give me their number: it's the same number I had been dialing. She says she only works basically reception and doesn't have access to any claim information. I thank her and hang up. I try again the next day, and the same exact thing happens. There has to be somebody I can report this to? Some type of agency? I at least deserve a reason as to why my claim had been rejected. I understand the Hospoital policy may or may not pay for my injuries, but it says right in the policy book that they pay for each day an insured is in the hospitall! On their website, it says all email inquiries will be handled within 1-2 business days, and it's been a week. I even used Outlook to verify receipt of my message and not blocked by a spam filter of some sort. I used a plain font, no signature, no HTML, and not connected via VPN just in case this would matter (it wouldnt't)
Other information about me that may be pertient:
I am 38 years old, single, 0 dependents, living in North Florida. I work(ed) for local county government in Northern Florida. From the first day on the job, to the last day I clocked in/out, I had been employed for just over 180 days, which doesn't cut it to earn FMLA protections. I rent an apartment, do not own any real estate, and I do not have a vehicle. At this current moment, I have rent for July paid, but have very little in my bank accounts; probably less than 1k across the board in liquid cash. I wasn't making an extremely large amount or anything, but between my credit card debt settlement agreements – who may now proceed to sue me for the entirety of the debt because I'd obviously choose to pay rent over keeping the agreement – I technically have enough in my Brokerage account to pay them all in full. But the money in that account also acted as my safety net / emergency fund that I'll very likely need to sell my positions for to live. I've got roughly $35,000 in credit card debt between 8 creditors, but no student loan debt, no tax debt and pay taxes on time every year. I have credit card debt settlement arrangements formed with all 8 creditors, that will reduce the amount I pay by a collective total of 72%. Some creditors took my initial offer to pay them only 20% of the actual balance owed, some wouldn't budge beyond 30%, and some played wanted 45-50% after playing hardball by literally pressing charges. It's a great deal and opportunity to save some money, and I could actually afford to if either of my 2 supplementary insurance policies would communicate with me and/or provide some sort of payout. I have a little bit of money invested with a Roth IRA, Traditional IRA, two 401k accounts, and a brokerage account. My understanding is that my brokerage account could be levied/garnished – and for the full amount owed, too. Are there some kind of protections for people with my situation or with a disability? I'm fully expecting I'll be forced to sell off my positions in my brokerage account in order to get by, especially if STD is cut and my supplementary policies don't pay anything for the injuries incurred on the day of the incident. I tested negative across the board during a urinalysis drug test, if that even matters. I have a strong feeling that when I do recover, my life will likely never be the same, considering the very nature of what fusion surgery accomplishes. I have questions around this topic – but does my experience count as a disability? Who, or what, determines what is and isn't a disability? Who is, or isn't disabled? Am I eligible to withdraw from my IRA without the penalty if they/whoever decide I'm disabled? Does disability status last forever? What if I am deemed to be disabled, withdraw from my IRA, then find a remote gig 6 months later within the same calendar year and earn some income because I don't want to just sit and wither away at the age of 38? Pardon my frustration… Tips/advice/info/knowledge/what to be careful regarding the recovery of my spinal fusion surgery is much appreciated… thank you….
Any help, info, advice is greatly appreciated… thank you…
Please do not DM me asking me anything about my employer. You will not receive a single piece of information. This thread is not about them. I will not click your link.
submitted by /u/kaiser1025
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