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Tina, Lawyer
Category: Employment Law
Satisfied Customers: 8184
Experience:  JD, BBA, recognized by ABA for excellence.
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I work for Sprouts farmers market I had right knee surgery

Customer Question

I work for Sprouts farmers market I had right knee surgery on October 22 2015 torn meniscus torn acl osteo arthritis returned to work january12 th 2016 while at work I slipped and fell in chicken blood a fellow associate working next to me was prepping chickens and left blood in the floor and I didn't see it I fell aggravated my knee and I landed on my buttocks a contusion I didn't fill out an accident report and when I did they said it was to late so my doctor puts me off work because I am experiencing lower back pain burning down the calves of my legs and my right knee is very painful the doctor tries to do ortho visc shits on my knee as a last resort because knee replacement is the next surgery my husbands insurance that I am on will pay for the shot but not the medication that goes in the shot they want to go a cheaper route so my doctor says we will just replace the knee it is in really bad shape I worked as a deli manager 23 years for Tom Thumb that is how my knees have come to be in such poor shape so the doctor says it will take 6 to 8 weeks to construct the knee I went out of work February 19 th my surgery didn't happen until May 13 th while thus is all going on I hire a lawyer to try to fight the Workmans comp because long story short I was told the case was being evaluated from my job and the case was closed and denied do back doctors and knee doctors at the same time the knee is finally ready I have my surgery may 13th my return date to work suppose to be sept 12 th well my knee had a problem with the scar tissue gathering to fast and the extension and the ending were both struggling so the doctor ordered s manipulation on my knee I had to go to the hospital be put under and the had to break all the scar tissue it was very painful I did it 2 weeks ago Friday I have short term insurance at work through Liberty Mutual and sept is the 1st month if what would be considered long term I was told by my case manager that long term disability was denied because of a pre existing condition I pay for long term insurance extra out of my check every week what am I paying for if I cannot use it I asked and she never really answered my question? This is my question to you why do they offer this extra insurance that will pay 60% of your pay and bonus if you do not qualify they took the money out of my check every week ? Do I have any rights do they get off Scott free and take my money too ???
Submitted: 10 months ago.
Category: Employment Law
Expert:  Law Educator, Esq. replied 10 months ago.
Thank you for your question. I look forward to working with you to provide you the information you are seeking for educational purposes only.
Have you obtained a copy of your long term insurance policy, they have to give it to you? Before you can know if you have a case the policy needs to be read to see if it does contain an exclusion for pre-existing injury or not.
Also, you said workers compensation closed the case, did your attorney file a suit in workers compensation to fight the claim, because that is where it sounds like these benefits should be coming from based on what you said above?
Customer: replied 10 months ago.
They said I
Issued the dead line on the Workmans comp claim by 2 days so the were not considered liable the doctor had extended my return date to I see him in 6 weeks and upon that visit then he will clear me to return to work I do a lot of bending stooping and heavy lifting so he was airing on the side of caution and would not release me just yet that is why I would need lots g term which would only be one month I will try to find out the policy for using my long term insurance I am just baffled that I have payed into it for over a year and I am not eligible ? I just do not understand what I am paying for is this a stupid question ?That was why I payed for it just I. Case something happened thinking ahead trying to look out for me
Expert:  Law Educator, Esq. replied 10 months ago.
Thank you for your reply.
I understand you paid into the long term policy, but you have to also comply with their terms. Most policies do exclude pre existing conditions that existed prior to you buying the policy, so you have to get the policy and read those terms before you know what the coverage would be.
The reason they exclude pre existing conditions is it stops people from getting injured first and then buying the policy to get coverage. But again you have to get the policy to read the terms in order to know your legal rights.

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