MidwestTKR
member
United StatesI have a question for those of you that received short term disability pay while you were out of work. I am a nurse and my OS told me he wants his patients to take off 12 weeks after a TKR which for me means I am expected to go back to work on July 13 . I filed all the necessary FMLA paperwork and short term disability paperwork on time. They were both approved, however approx. 2 weeks ago, I called the disability case manager again to make sure nothing else was needed, (to check in) because he eluded earlier that they periodically need to obtain ongoing documentation from the MD, even though my OS had already filled out the disability paperwork, ( that I was charged for by the way for them to complete), declaring that my return to work date should be July 13.
The disability case manager told me when I called him 2 weeks ago, that additional info was needed to document my continued disability and I mentioned that I am still going to PT. He told me he would contact the MD office to obtain copies of the PT notes and that nothing else was needed from me. I called again last Friday to make sure he received everything and the disability case manager told me that he had not received the notes back from the PT that they requested and it appears that they don't have a consent from me to authorize that. (It didn't make sense, because I had already sent that in before and I told him that.) His reply was that he would send in a request for notes again that day. I advised him to make sure it was sent attention to the OS 's medical assistant (MA) and gave him the fax number. I then called the OS office to inform the MA of all of this and to request she call me when she receives the paperwork, to alleviate my mind. She did as requested and said she would send everything back to them on Monday. I also advised her to please make sure she also included that the OS wanted me out of work until July 13.
Today, I got a check in the mail which was more than $200 less than it should have been and the statement mentioned that I was only paid benefits up to June 15. (As it is short term disability pay is only 60% of my salary and I have been the one paying the premiums through my job for 22 years!! I called the case manager back today to inquire about this and was informed they stopped paying me my benefits on June 15 because they did not have the documentation proving that I am still disabled. He verified however he received the notes from the PT this week and they said I had good ROM.. He told me he will submit the documentation to the insurance's medical review for them to make a decision about continuing to pay me!!!!! He said he would call me tomorrow. I will be so upset if the disablity insurance medical review makes a negative decision about me receiving my disability based only on my ROM. I still have intermittent pain, limited stamina, walk with a cane, etc. AND, since when is it based on PT notes that makes a determination if someone is disabled? For all I know, the PT notes don't mention that I walk with a cane still, have intermittent pain, etc, etc.
Has anyone else gone through this? If they should tell me that their medical review thinks I can return to work based on the PT notes, what do I do? I am going to give him an earful if that happens and dispute it, but thought I'd ask all of you first to make sure I say the right things. I think it's terrible that they could possibly go against what my OS said! I want to make sure I am prepared regardless of the outcome and need your advice if you have been through this.
The disability case manager told me when I called him 2 weeks ago, that additional info was needed to document my continued disability and I mentioned that I am still going to PT. He told me he would contact the MD office to obtain copies of the PT notes and that nothing else was needed from me. I called again last Friday to make sure he received everything and the disability case manager told me that he had not received the notes back from the PT that they requested and it appears that they don't have a consent from me to authorize that. (It didn't make sense, because I had already sent that in before and I told him that.) His reply was that he would send in a request for notes again that day. I advised him to make sure it was sent attention to the OS 's medical assistant (MA) and gave him the fax number. I then called the OS office to inform the MA of all of this and to request she call me when she receives the paperwork, to alleviate my mind. She did as requested and said she would send everything back to them on Monday. I also advised her to please make sure she also included that the OS wanted me out of work until July 13.
Today, I got a check in the mail which was more than $200 less than it should have been and the statement mentioned that I was only paid benefits up to June 15. (As it is short term disability pay is only 60% of my salary and I have been the one paying the premiums through my job for 22 years!! I called the case manager back today to inquire about this and was informed they stopped paying me my benefits on June 15 because they did not have the documentation proving that I am still disabled. He verified however he received the notes from the PT this week and they said I had good ROM.. He told me he will submit the documentation to the insurance's medical review for them to make a decision about continuing to pay me!!!!! He said he would call me tomorrow. I will be so upset if the disablity insurance medical review makes a negative decision about me receiving my disability based only on my ROM. I still have intermittent pain, limited stamina, walk with a cane, etc. AND, since when is it based on PT notes that makes a determination if someone is disabled? For all I know, the PT notes don't mention that I walk with a cane still, have intermittent pain, etc, etc.
Has anyone else gone through this? If they should tell me that their medical review thinks I can return to work based on the PT notes, what do I do? I am going to give him an earful if that happens and dispute it, but thought I'd ask all of you first to make sure I say the right things. I think it's terrible that they could possibly go against what my OS said! I want to make sure I am prepared regardless of the outcome and need your advice if you have been through this.
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