WCB claim after more than one year


#1

I have pinched nerve on my L-4 and since October 15 2016 I am on LTD. Before that I was 6 months on STD ( since Apr. 15 to October 15.2016). During the STD period I had to work 4 hours per day. Manulife Insurance wanted me to work 5 and 6 hours, although my physician recommended 4 hours. After results of MRI test Manulife figure out that I have to stop working full time. After almost an one year and half period on STD and LTD I claimed my disability as work related injury. WCB did not accept the claim not for reason of late claim, but for reason that this injury is not being work related. Mostly in the Refusal Statement they are mentioning that I did not have traumatized my back, although I have many injuries on my back in the passed 6-7 years. Also WCB professional for this Statement did not use all the information that I have provided to them and many of the informations he missed and misinterpreted.
Any suggestion how to appeal this refusal?


#2

What is the WBC appeal process for your province?
Did the WCB denial letter say how to appeal?


#3

Hello Jammer,I appreciate your response. The answer on your first question is- Appealing period is 12 months from the day of the denial letter ( in my case from December 28 2017). Also is possible to get copy of all documents of the file. ( I requested to get copy yesterday- Jan. 4.2018)The answer on your second question is- Yes: It says this: " Please note, you have the option of requesting a formal decision review through our dispute resolution and decision review process within 12 months of any decision made. We have information on our website about this process or I ( the case manager- adjudicator) can explain the process at any time, if you prefer." That’s all that I understood your questions and I have answered them. If you need more information I could attach the whole letter to the e-mail.Thank you again, Kiro On Thursday, January 4, 2018, 8:21:28 PM MST, jammer resolutelegal@discoursemail.com wrote:

jammer
January 5 |

marvik:
Any suggestion how to appeal this refusal?

What is the WBC appeal process for your province?
Did the WCB denial letter say how to appeal?

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#4

I would suggest if the “dispute resolution and decision review process” is not clear, phone the case manager - adjudicator.

Why do you even have to make a claim with WCB?
Maybe apply for CPP-D if you can’t do any job any more (could you do a job where you sit all day though?).


#5

Thanks for responding on my question.
A little bit more explanation about the dispute resolution and decision review process… I have reviewed the decision and all paperwork and medical reports , including the medical consultant who suggested in his report my case to be rejected. I expected that, but I found out that many of the facts of the medical reports from my physicians, from MRI reports, and from my employer informations he is swinging, or ignore. Many informations are interpreted wrong, or in different meaning and makes the readier to think that I don’t know what am I talking and asking. It’s incredible how he made his report only in favor of WCB! For your information, in the first letter of rejection they did not included the MRI report, although they requested that MRI test on Dec. 19.2017. Later, on Jan. 26.2018 I received a new letter of rejection including the new MRI test. Same decision was made.
After all this discovery recently ( on March 8.2018) I have called the manager of the case and asked for providing the offered legal help about appeal, but until today I have no answer from her ( manager).I wanted to see what kind of help they provide and if that legal consultation will guide me in right direction for appeal.
About my ability for sedentary job, I have talked to my surgeon doctor who I visited on March 7.2018. He recommended that kind of work after one more therapy with two more injections for my pinched nerve. He expects more improvement with this therapy, because he found out that there is a big improvement comparing the previous MRI pictures.He strictly said that I can only do some work with sitting, even with modified hours of work.He said that will send a letters to my employer and WCB too.
Also I have applied for CPPD and just yesterday I talked to CPP and the representative told me that decision is made on March 14.2018 and I will receive it within 10 days trough mail. I need some guide about this option if it’s possible to do any job with sitting and how will affect the CPPD benefit with insurance, which will take all my money if I am approved by CPPD? Are they eligible for taking the CPPD until they cover all money they paid me in the past year and a half. They don’t talk too much about that and don’t explain what is my right and what I have to do if they stop paying my, or decrease the payments until I am out of work? I asked them for the their policy they made with my company, but the case manager don’t provided it to me, although he promised me if I request to receive the Policy he will send it to me. And I have requested it since Dec.19.2017. No answer until today.
I have explained my case with WCB and Manulife too because they are both side which impact my situation and make a mixture of feelings that confuse me more than help me. If you have any suggestion in this situation I would appreciate it.
Sincerely, Kiro Seremetkoski


#6

If you will be able to do a full-time job sitting then I would think your CPP-D will be denied. :frowning:
If you are approved for CPP-D then the insurance company deducts the monthly CPP-D for all the months they paid you LTD. They also deduct the CPP-D monthly amount from your LTD monthly amount, you get the same amount but it might affect your taxes.
The insurance company is only entitled to the amount of CPP-D that is paid each month.


#7

Thank you for the answer.
I wasn’t clear with my question. Now I’ll try.
How long can the insurer take money from CPPD? Is the insurer eligible to take money from CPPD even if they stop to pay me any money? I would probably work some part-time sedentary job in the future until I retire. If I qualify for CPPD, but Manulife stop pay me monthly LTD amount, can they take my CPPD monthly amount?
Greets, Kiro


#8

The insurer can only deduct CPP-D from LTD that they are paying you.
If the insurer stops paying you then they can’t deduct CPP-D.
One nice thing is (I think it is common) is that CPP-D increases every year (only consumer price index which was 1.5% in 2018) and the insurer likely only deducts the CPP-D amount when a person first gets it.
You can still work and receive CPP-D, if you make less than about $15k then it is considered your disability prevents you from earning a (just forgot the word) income.
If you are denied and your doctor supports you then you can appeal it.
Read: https://resolutelegal.ca/cpp-disability-benefits/appealing-cpp-denial/
If you want a legal opinion then get the free consult: https://resolutelegal.ca/free-consultation/