Jane, a young-at-heart, spunky, and punctual nurse at a local hospital recently fell and injured her knee, requiring surgery, while working. Fortunately, Jane was a planner and had opted into her employer’s short and long-term disability plans. She contacted us with some questions. Her questions and our response may help you understand some intricacies if you have to coordinate workers’ compensation and short- or long-term disability.
Jane’s First Question
“I slipped and fell while at work injuring my knee. I need surgery, which is scheduled soon. My employer’s workers’ compensation insurance is saying I don’t have a claim. I do have short-term and long-term disability through my work. I don’t really know what to do and a friend suggested I contact you, so I wanted to reach out. I am wondering which one I should make a claim against…”
“Jane, we are very sorry to hear about your unfortunate situation. First, a little disclaimer - We cannot make any specific recommendation to you at this time since we do not know all of the facts and we are not representing you yet. With that said, it is not uncommon for competing insurance companies to make you think you have to make a choice against who to file a claim against. In general, we would encourage anyone to file a claim against any insurance company who obligated themselves to cover such a claim – whether that is workers’ compensation, short-term disability, long-term disability or otherwise.”
Jane’s Next Question
“Well, I think my short-term disability is going to pay me, so I don’t really have a reason to claim on workers’ compensation, right?
“Again, this is just general information but, in our experience, STD/LTD and workers’ compensation covers and pays for different things, and likely has different offsets and policy requirements. For example, most STD/LTD policies will only pay for a certain percentage of your pre-disability wages for the period you are disabled under the policy and will not cover any additional medical expenses you incur, but workers’ compensation will cover medical expenses related to the injury. Another example is that most STD/LTD policies will have a provision that requires you to apply for any other benefits that may be available (such as workers’ compensation, SSDI, or others) and will offset from your STD/LTD benefit the amount you receive or an estimated amount if you do not apply. So, again, your policy may be different, and we encourage you to read them, but you may and likely do have significant reason to file a claim against both.”
“Wow. They made it seem like I had a choice and both would cover the same thing. I never thought about those things.”
“Jane, it is a good thing you called us and did not just rely on the information from the insurance company representative. Unfortunately, stories like yours are common, and we see good, hard-working people just like you who make what they think is a good decision based on information (often faulty) from an insurance company representative that later comes back to bite them hard, and often in unexpected ways. We would be happy to handle both of these matters for you so that both insurance companies know they are dealing with someone who has the knowledge and experience to call them on their misinformation.”
Be like Jane
Jane took some initiative to question exactly what was going on in her case. She did not just rely on what two separate insurance companies were telling her. We have seen over and over insurance company representatives misrepresent (either intentionally – let’s hope not, or negligently – because they did not have all the information) information to injured and disabled workers.
Coordinating claims can be complicated and must be done correctly to adequately protect your rights! Give our team here at Louisiana Disability Law a call if you are in this type of situation. Don’t rely on the insurance company to look out for your best interest.