Weeks 26 - 42: The Worker's Comp Leave

I was injured on January 24th, and saw the Maverick-chosen doctor on January 26th. After an MRI, he referred to a neurosurgeon for consultation for a herniated disk. The neurosurgeon was also chosen by Maverick, and my appointment was not scheduled until April 3rd. On February 22nd, I received a letter from Maverick Human Resources stating that I MUST apply for Medical Leave – and Medical leave could not exceed 90 days – failure to apply would result in termination of employment and worker comp benefits. That would mean my 90-day leave would run out only 3 weeks after seeing the neurosurgeon.

I requested that I be placed on a waiting list in hopes the neurosurgeon would have an appointment cancellation. Fortunately, there was a cancellation with a different surgeon in the same practice, and I was able to see him on March 6th and had surgery on March 15th, followed by 8 weeks of physical therapy – 4 hours, 3 times a week.
In The Recap, I mentioned that I was treated like a second-class citizen – I was. Fortunately, I had Ollie’s Gal to help sort things out, and fight my battles. I’m sure there are other injured drivers that just either give up or go along with what they are told. She took the time to learn the rules and regs, and held everyone to their responsibilities.

The people involved were more than you would imagine. During the 4 month period, we dealt with 6 different companies and 11 different people:

• Maverick:
  
  • Rachelle was my designated contact for my WC claim. I placed 12 phone calls to her, 3 were returned; also sent 9 emails/faxes, she responded to none.
    
  • Tami became the person I dealt with for Health Insurance payments and COBRA. We called her 6 times, and she returned every call. We also sent 4 emails/faxes. Again she responded to all.
    
  • Lisa called 3 times in response to emails/faxes that were sent to Rachelle. Each time she told us that Rachelle was out and she was filling in – as a “fill-in” she did a much better job than Rachelle.
    
  • Tina was my DM. I left her 4 messages directly after my injury. I did not hear back from her until Feb 19th, when she called to tell me that they would need to “recover” my truck. They did not actually recover the truck until March 21st, when I finally sent an email to Derric, the Fleet Manager.
    
  • Letha is the VP of Human Resources. We only contacted her twice that will be discussed below.
  
  
  
• WC Insurance Carrier: The Insurance Adjuster was Carol, who was very responsive. We called her 5 times, and each time she did return the phone calls.
  
  
• Case Manager: Cathy was the Case Worker assigned by the Insurance Carrier. I was in her schedule to call each Friday, so there were times I would leave her a message, and no matter the importance, I did not hear from her until Friday. And, there were times that she talked to Rachelle, rather than me, which evidently took up her allotted Friday time, so it would be the next Friday before I would hear from her. Example: Called her on 4/5 to advise her that hip pain was returning. I did not hear back from her until 4/12. In all there were 25 phone calls exchanged with her and 10 e-mails.
  
  
• The Neurosurgeon: I dealt with the neurosurgeon’s nurse, Glenna. I called her 27 times trying to arrange appointments. She returned 5 calls. I did not find out until the end that she could not return my calls directly. She had to get approval from the Case Manager, who had to get approval from the Insurance Adjuster before she could schedule a visit.
  
  
• Physical Therapy: I had 24 Physical Therapy Visits, and at the end of therapy, a Functional Capacity Evaluation. This was required before the Neurosurgeon could release me to Full Duty. The therapists were terrific, but the support personnel were difficult to deal with. When I requested copies of the reports they were submitting to the insurance company, I was told I would have to pay for them. I paid for them and waited weeks. I was told that I really didn’t have a right to those reports, and I told them they might want to look up something called HIPAA, (Paragraph 5b.5 Notification of or access to records). Then I was told I could have my attorney request. I told them I didn’t have an attorney – I was making the request, and had a right to copies of my records.
  
  
• Long-Term Disability Insurance: The problems associated with this will be discussed further below. Basically, had Maverick responded appropriately, we would not have been dealing with the insurance provider at all. As it was, we placed 9 phone calls to the provider, and had 2 calls returned. The first call returned was basically to tell us to go away and call Maverick, who should be dealing with this. The second call returned was after leaving a message for the supervisor. She did return the call, and after hearing the problems with Maverick, she agreed to resolve our problems.

The request for records was finally resolved, but it was apparent that everyone involved – doctor, case manager, therapists - believed they were working for the Employer and Insurance Carrier, and I had no rights. There were other miscellaneous phone calls and faxes not listed above. In all during the 4 month period, there were 151 phone calls and 50 miscellaneous faxes, emails and letters. All could have been simplified if phone calls were returned.

Maverick was one of the worst offenders. I was required to make a weekly check-in to a recorded voice mail. Penalties for failing to do so could also result in termination or loss of WC benefits, but my phone calls and correspondence were ignored. I only had 3 conversations with Rachelle. She never returned phone calls, and never answered emails. I talked with her when the claim was filed, and again when I was ready to take the Fitness for Duty test. Any other information I received came through the Case Worker. Several times the Case Worker told me she had talked to Rachelle about one of my messages or emails, but Rachelle never talked to me directly.

The Doctor and Case Worker were another problem. Numerous calls to the doctor's office went unanswered. The Case Worker only performed her duties after she was challenged in an email, regarding a Monthly Report that showed several phone calls with me that NEVER happened. It was only after the Functional Capacity Evaluation (FCE) was completed and I was attempting to contact the doctor yet again, that I found out the doctor's office could only make appointments through the Case Manager - which explained all the unreturned phone calls - they were waiting to hear back from her.

There had been several emails between the Case Worker and Ollie’s Gal about the limit of 12 visits with the therapist, when the doctor had called for a minimum of 18, and a maximum of 30. The confusion was because the Case Worker was using Tennessee regulations, when the claim was filed in North Carolina – a mistake that Ollie’s Gal had to point out to her. Finally in an email dated 4/2, she advised Ollie’s Gal that she had talked with the insurance adjuster who agreed with Ollie’s Gal’s assessment of NC rules, and had approved additional visits. However, when I reported for therapy on the 12th visit, I was told that my 12 approved visits had run out, and I would need permission before continuing. We called the insurance adjuster only to find that insurance adjuster had NEVER heard from Case Worker. The insurance adjuster sent fax immediately approving all remaining visits for therapy.

The major issues surrounding the numerous phone calls and correspondence were:

• MANDATORY 90-DAY MEDICAL LEAVE: Received letter 2/22/07 (dated 2/16/07 - and 3 weeks after injury) that I was REQUIRED to request Medical Leave. Failure to do so could result in termination or loss of WC benefits. AND, the Medical Leave could be no longer than 90 days. At that time, I was waiting for an appointment to a neurosurgeon, because the MRI indicated a herniated disk. It made no difference that the injury was caused by Maverick's FAULTY TRAILER. I was told there would be no exceptions. But I tried anyway.
  
  By the end of April, when my Mandatory Medical Leave was about to run out, the surgeon released me to Light Duty. Maverick would only allow Light Duty to be performed in Little Rock, but my surgeon wouldn’t release me to drive to Little Rock, as he believed the drive would be too much at that time, and performing Light Duty there would interfere with my physical therapy. Now, Maverick does have an office in Knoxville, so I requested that if Maverick wouldn’t extended the 90-day Leave, at least let me perform Light Duty in Knoxville.
  After several phone calls, emails and faxes to Rachelle requesting extension of Medical Leave (that ran out 4/29) or Light Duty in Knoxville, I finally received a phone call from Lisa on 4/17, who indicated she was filling in for Rachelle (The return call was actually about Long-Term Disability - more on that later - but since I actually had someone on the phone, I took advantage of the situation.)
  
  I asked that Lisa talk with Ollie’s Gal, who questioned why no exceptions could be made. Lisa would only state that there could only be exceptions made for a matter of days - not weeks. Ollie’s Gal asked about taking Personal Leave, as the policy manual also has a provision for 30-days of Personal Leave a year. Lisa said there could only be one leave taken – either Medical or Personal, but not both. Ollie’s Gal pointed out that there is nothing stating only one or the other. Finally Lisa (very upset), stated - "he can't just take Personal Leave because he is DISABLED". When Ollie’s Gal asked why they considered me disabled, Lisa backtracked and stated "just because his medical leave is up". Ollie’s Gal then went back to why exceptions couldn't be made, because it would seem the cost of replacing a driver would be more than simply extending his medical leave. Lisa then said there were "insurance considerations". There is a strong possibility she was actually referring to the liability of letting an injured driver return, but Ollie’s Gal simply stated that we would be willing to pay the health insurance. At that, Lisa said she would talk with Letha, the VP of HR, and call back the next week. The call never came.
  
  Finally on 4/23, we sent a letter via overnight mail to Letha with a formal request to extend the Medical Leave until 5/30/07. Again we received a call from Lisa telling us that Letha was out of the office and wouldn't return until the 30th (coincidence that it was the day after Medical Leave expired).
  
  Immediately after that phone call, we sent a request by fax for copies of the OSHA 300 and 300A logs. An employer is required to supply these by the end of the next business day or face steep penalties. Amazingly enough, Letha was available to send a letter than included copies of the logs and a statement that Maverick would extend Medical Leave until the 25th (my FCE was scheduled for 21st).
  
  A point to make here is that after the problems I had encountered with Maverick to-date, and the ordeal of Worker's Comp, I really had no desire to return to work for Maverick, but I did not want my record to reflect that I was unable to return because of a Worker Comp claim. I preferred to leave Maverick on my own terms.
  
  
• HEALTH INSURANCE: With the Request for Medical Leave (letter dated 2/16 referred to above) was an election to pay to keep insurance in force. I chose the election and mailed back to Maverick on February 28th. Since the letter stated there was a 30-grace period for making payment, we started automatic weekly payments through on-line banking. We included an explanation of how those payments would be coming at the bottom of the form for insurance election.
  
  On March 7th, while traveling with Ollie’s Gal on a business trip, I received a phone call from Tami at Maverick advising me that my health insurance would expire the next day if payment wasn’t received. We asked about the 30-day grace period (letter dated 2/16, this was 3/7). Tami advised us that the 30-day grace period was only for payment, but was actually due for all weeks since the last paycheck of 2/3. It would have been nice if that was spelled out in the letter, rather than just stating there was a 30-day grace period. We checked with the bank to find that 3 checks had been issued but not cashed. We called Tami back with the information, and at the same time, arranged an overnight letter to cover payments. On the way to the FedEx office, Tami called back to say that the checks had been located, but we sent overnight anyway to make sure there would be no future problems – but of course that was asking too much. Two months later we received a letter from Tami, with 3 of the bank-issued checks included – because now I was overpaid. The bank would not deposit the checks directly to our account without Maverick’s endorsement, and all we could do at that point was to wait until the checks were stale, and the bank would return the funds to our account – almost $175.
  
  On 5/13, I received a letter stating I was required to start COBRA payments as of 5/1 and, not being sure how FCE would go, we sent payment for both May and June. When I returned to work on 5/31, we stopped the COBRA payments. Then, on 7/6 (after being back to work over a month) I received a letter from Tami with an application for health insurance enclosed, stating that since my insurance had terminated, I was required to reapply. When we called, Tami stated that the letter was only sent as “a favor”, that actually it is the Driver’s responsibility to request reenrollment when the insurance has terminated. We told her that to our way of thinking, since we had made COBRA payments, the insurance had NOT terminated. But Tami explained that it is a termination of the group policy – and that typically the DM makes sure the employee fills out the reenrollment on return to duty – but this is an unusual case, since we actually kept up the insurance during the 90 days, and rolled over to COBRA. Tami said she would discuss with Letha and call back. She did call back the same day to say that she and Letha had both talked with United Health Care, who informed them that since I had been on COBRA, I now had to wait the 60-days that any new employee needs to wait. Just when did I become an ex-employee?
  
  
• LONG TERM DISABILITY: The final problem was with the Long Term Disability (LTD) insurance. Not that I hoped to need it, but the policy is written in stone: LTD claims must be made within the first 90-days of any LTD. And, since there is a minimum $100 per month payout, and I have contributed to it, we believed the payout could help offset the cost of COBRA, if necessary. All documentation we could find indicated that filing for LTD is typically done through the Short-Term Disability (STD) that rolls over to LTD – with one exception – Work Related Injuries: they can only be filed on LTD. Now here is the conundrum – how does a person file within the 90 days, for something he isn’t sure will be a permanent LTD, especially when STD does not apply? We made several inquiries, and since Maverick did not respond, we finally went directly to the LTD insurance company - both emails and phone calls. The Insurance Company advised us that they could do nothing, because any LTD claim must come directly from Maverick. Returning to the 4/17 phone call with Lisa:
  
  Lisa insisted that the claim must be filed over the phone – directly with the Insurance Company. We told her that they said the phone applications were only for STD, which I didn’t qualify for since it was a work-related injury. Lisa insisted the Insurance Company had advised wrong. So, the next day we called the Insurance Company and filed the claim over the phone. When the documentation arrived in the mail, it was for STD – not LTD. That started another go-round. We finally reached a supervisor at the Insurance Company, who agreed to prepare the LTD claim and forward it to Maverick for signature – but advised us that the reverse should happen.

Fortunately, I was able to return to work and LTD was not necessary. And you would think that the troubles were behind me, but on 6/26 I received a VIOLATION SUMMARY LETTER from the Safety Department – dinging me 2 points for logs that weren’t submitted between 5/1 and 5/23 – I was still on Extended Medical Leave during that time. The Safety Department agreed to remove the points when a log sheet covering all days was received. But, at the same time advised I had been also been dinged 3 points for getting hurt in the first place. I was told I needed to talk to the Safety Manager, Brett, about those points.

I did talk with Brett and explained that I was not being careless – it was Maverick’s faulty equipment that caused my injury. He said he could recommend removal of the points, but it wasn’t his final decision – does anyone at Maverick have the authority to make a decision – or are they just in the habit of laying responsibility at everyone’s feet but their own? I never did hear back from Brett about the decision, but did find out the points had been removed, when I finally got so fed-up I went to Dave C., the Director of Operations for the Specialized Division, with my complaints.

After my conversation with Dave C., I promised to send him a list of the problems, and some of my experiences, which I emailed on July 31st. I never heard anything back from him. I only had one reply from Brett to several emails I sent with photos attached – only to say that he had received and had forwarded to the “appropriate people”. If the Safety Manager is not the appropriate person, who is? I have to wonder how serious they are about upholding Maverick’s reputation in the industry.

We finally hired an attorney to handle closing the case. That is still being negotiated, and we will follow-up with any new developments when they happen.