Wednesday, May 6, 2009

The FMLA, It's Rules, and Why It's Impartial

Everyone is familiar with the Family Medical Leave Act (FMLA), but what parts are missing in the rules of it? How many are shoved under the rug because of it’s gaps?

The FMLA came into effect in February 5, 1993 as an attempt to give individuals a secure position of employment in the event of illness, injury, or childbirth. Unfortunately, the act was created with some loop holes to help protect the smaller businesses that could not afford to hold a position for an 'injured' employee for up to 12 weeks. For instance, if the business has less than 50 employees, they do not have to honor the FMLA guidelines; even if they state the intention to do so in the company handbook. This is where my personal experience comes into play, and this is my story.

I have lived my life in a man's occupation, going at it full-bore. Naturally, this can cause some complications physically. In September of 2007 I took a job for a small city municipality as an equipment operator and truck driver. I began to have problems with my knees and neck, as well as some other health issues that directly affected my work. In June of 2008, with my company insurance in tow, I went to the doctor for help. He set up an appointment for an MRI on both my neck and my knee.

The MRI of my knee showed something that was explained to me as a ligament that was slowly crushing my kneecap. But the one of my neck was a bit more complicated. It showed allot of arthritis, degenerative disc disease, a herniated disc, and the one below it was bulging. I was sent home with an order for physical therapy, steroids, and muscle relaxers.

Although my knee showed progress with the therapy, my neck didn't; in fact, it continued to get worse. The muscle spasms began to intensify and radiated to other parts of my body; like the back of my head and my shoulders. My physical abilities were deteriorating quickly and I had gotten to the point where I had to back out of a lot of duties on the job, as well as home. For example, I could lift the trailer ramps once or twice a day, and then would have to call someone to do it for me. I knew my time was limited and before long I would be forced out of my work completely by my physical impairments.

That day came on December 31, 2008. The day before I had supervised a group of community service workers on a project shoveling rock. Not being one to sit and watch, I joined in. Within an hour or two, I had a headache, my neck was hurting, and I was getting sick. At that point I 'whimped out' and watched their progress. On the 31st, I was home with sick kids when I sat up in bed and something popped in my neck, and instantly knew the disc had ruptured again. Within 30 minutes I was in excruciating pain.

I naturally had the next day off for New Year, but still put in a phone call to my boss explaining what had happened and that I would be going to the doctor on Friday instead of coming to work. This time however, the doctor referred me on to a pain specialists and a neurosurgeon and was sent home with a two week off work notice and allot of medication. Two weeks later, I had another MRI ordered from the surgeon and a note for another week off of work. This is where it starts to get really complicated.

At this point the insurance had already denied the first MRI due to false reports of an automobile accident in 2007. The interesting part is that there was never an accident, and I couldn't get any written proof from anyone on the claim. On the day before the second MRI, the insurance denies the preauthorization claiming that it is a new injury and they can't authorize until I had been under the surgeons care for eight weeks without improvement. Even with a report from the doctor saying it was the same herniation previously diagnosed and that I had been under constant treatment for it, they still denied the coverage.

He sent me home with a doctor's note for six weeks of very light office duty only in an attempt for me to get the situation resolved. The note was faxed in to my employer and I immediately received a phone call from the office manager. She informed me that she did not have a position for me and I would have to sit it out at home without pay. I was also told that they would be contacting their attorney due to the fact that they were paying for my insurance and not getting anything in return from me. It was a bad situation for the city and made them look bad. I guess compassion is a dying virtue.

At this point, I had made countless phone calls to the insurance, doctors, attorneys, you name it and I called them all. My days where spent on the phone and computer trying to sort out the mess. I was informed that the cities attorney had notified them that they had to keep my insurance, but that didn't stop them. I had requested medical leave forms in which I was denied. Attorneys would not call me back when they learned of my case, or they would refuse my calls.

On Thursday, January 28 I received a phone call from the insurance company. The very lady that hated me for harassing her for six months asked me if I had any idea what my employer was trying to do to me. When I told her I had no idea, I was informed that they had requested cancellation of my insurance policy as of January 30, 2009. It cancelled on midnight of that day. I didn't receive the letter from the city until the following Monday, too late to do anything about it. The reason given for cancellation of the policy was that I had not put in any hours in the month of January to support full-time benefits as required in the handbook. I guess it's ok to refuse an employee hours and then terminate their position because they didn't have any.

The law supposedly states that an individual's insurance cannot be cancelled for a condition that a patient has been consistently treated for. In trying to push this issue, the insurance made it's own loop hole by claiming that the doctor had stated in his report that my condition was directly exasperated by the heavy physical labor that I do at my employment; thus pushing it off as a workers' comp issue. This left me no choice but to file for a workers' comp claim. The city tried to refuse me the claim papers, until I told them they could not legally deny me the application; especially since it was their insurance company making the claim.

What a mess! I ended up going back to my family practitioner who supplied me with a doctor's note stating that I was off work indefinitely; and in all honestly, I can't work. Currently I cannot get insurance and have no income. With three kids to support, it is a little stressful. I know there are legal issues that would more than defend my situation, but they don't do any good without an attorney that is willing to help.

As far as the FMLA goes, it was issued and approved by the government to help people in my situation. It is my personal opinion that if the government is going to pass laws and acts like the FMLA to help it's tax-paying citizens, the government offices (no matter their size) should have to honor it's guidelines. Many small business would go under if they had to follow guidelines such as these very often, but the government offices get federal grants and funding no matter their size. As it stands, the city has only around 18 employees, give or take a couple, leaving me just plain out of luck.

Any information or input on this situation would be greatly appreciated. This blog is solely intended to inform others so that they may be aware in similar situations, but I am still fighting this and am looking for anything that may help me to win this battle.