Question
When I was hired about 17 months ago I signed up for the short term disability insurance. I fell last month and broke my wrist. My policy states that I will recieve 70% of my weekly wage. There is no where in the policy that states anything different. Now that I have applied I am told I will recieve $1200 a month. I am told I elected the $1200 amount... does the application or the policy take preference?
Some people find fault as if it were buried treasure.
Answer
Need more info to answer your question.
Is this "short term disability" coverage that you purchased yourself or is that part of Occupational Accident?
Answer
I purchased this insurance when I was hired during my orientation. It is in addition to and seperate from worker's comp. It covers accident or illness after the first seven days. Reduced by any benefits payable for the same disability. Minimun Weekly Benefit: The greater of (a) $25.00 and (b) 10% of gross weekly benefit.
Maximum wekly benefit: $3000
Maximum Benefit Period: 26 weeks
Weekly Benefits: 70% of the employee's basic weekly earnings with a minimum of $184.62 and a maximum of $692.31
Some people find fault as if it were buried treasure.
Answer
OK, let me see if I have this right?
The policy specifies a range of payment, but does not specify a flat amount.
You were advised that you had selected a flat amount of $1200 on the application.
Do you have a copy of the application? If not, request one. Read it carefully for any fine print.
You really need to know what you signed for on the application, before you can take this to the next step.
You may have noticed that I've not given you a definitive answer yet. The reason for that is your question may not be an insurance question, but rather a legal one.
But, let's do our preliminary work first and then if it turns out to be a legal issue, you may need to consult with Opie in the Legal Forum.
Answer
The application has a space for earnings that I filled in at $2200. Then there is a space for an election amount that says $1200 but it doesn't look like my writing. I realize that if I left it blank and signed the paper I am stuck.
I do have another question, I am disabled from driving truck until April 19th according to the doctor. The disability Insurance isn't going to pay many bills. I asked Insurance company if I could find a part time job that I could do with one hand, for example a Wal Mart greeter, and they said if I did they would cancel my insurance. My policy states in the definitions... Total disability and Totally disabled. As a result of and Injury or Sickness, you are not able to perform all of the material and substantial duties of your regular job on a full time basis.
Then under Termination of weekly Benefit it states... 9. have current Basic Weekly Earningds which exceed 85% of your Pre-disability Earnings. ( which they can average over three weeks). I don't see anything that says I can't work to supplement tha policy. Thanks Connie
Some people find fault as if it were buried treasure.
Answer
Unfortunately, it appears that you may have a legal situation because of "policy language and interpretation".
I am not an attorney and I recommend you discuss this situation with your attorney. Just something to keep in mind when you contact your attorney, the policy may only apply to total disability, meaning that it may only pay if you are totally disabled. The insurance company may consider a part-time job as voiding the "total" disability clause. Your attorney should be able to find the specifics in the policy to assist you in this area.
While I understand your concerns and would like to be of more assistance, the situation you are decribing needs legal expertise. Before too much time passes, call your attorney for assistance.
I wish you a speedy recovery and the best of luck.
Answer
I thought I should at least ask. I was under a load when I stopped by the house for my 8 hour break. That was when I fell and broke my wrist. It doesn't seem that workers comp would cover it because I was home but then again I would have been somewhere.
Does workers comp cover a driver while he is on the road but on his required break? Just curious. Thanks
Some people find fault as if it were buried treasure.
Answer
Tricky question. Depends on the state laws that are applicable in your case.
I would suggest talking to your employer and ask that he submit a WC claim on your behalf. The WC insurance company will investigate and make a determinaton.
Answer
I went to the Wisconsin WC site and left my question, They got back to me the very next day. Here is the reply FYI.
Thank you for your e-mail concerning compensability under worker's compensation for your injury.
The Wisconsin Worker's Compensation Law is specific in that an employee whose employment requires travel is deemed to be performing service in the course of employment at all times while away on the trip, except when engaged in a deviation for a purely private and personal purpose. This exclusion would not include acts that are reasonably necessary for living, such as eating, sleeping and reasonable recreation while away from home on a work related trip.
After deviating for a personal purpose, the employee is again in the course of employment when he or she regains the normal route of travel. Thus, the situation as you described indicates a non-compensable injury in that 1.) you were not away from home at the time of the injury and 2.) you were in deviation from employment in that you were engaged in a purely personal task.
I hope that this satisfactorily responded to your question.
Some people find fault as if it were buried treasure.
Answer
You did the right thing by going directly to the WC bureau. At least, you have a an expert determination from which you can proceed in pursuing other avenues.
Best of luck.