Name | EID # | Assignment | Type of Injury | Name of Adjustor at Sedgwick | Name of MLU Advocate/Contact | Time “Wasted” Because of Delay (number of days) | Issue(s) of Workers Compensation Treatment | Member’s Registered Email Address | Entry creation date |
---|---|---|---|---|---|---|---|---|---|
Karina Youssef | 12345 | Testing | Testing | Testing | Testing | 1 |
Testing |
admin@velarium.com | January 27, 2025 at 7:16 am |
Leonard Allen | 381812 | 3b | Eye | Robert Montes | Kevin Davis | 54 |
I have seen multiple Doctor’s and Specialist including those referred to by workers comp regarding my eye. All of which state i need surgery. Once Sedgwick was informed surgery was required, my claim ws delayed. I took initiative in finding surgeons and had surgery scheduled as early as December for an injury that occurred in November. I have tried to contact Sedgwick several times however my calls nor emails are being returned. I could have returned to work in January had i been allowed to move forward with surgeries. |
January 28, 2025 at 10:08 am | |
mike spears | 32572 | 23b | Right shoulder. Also, back | Erika Guevara | Anyone who answers the phone | 30 |
Erika seams ok, but doesn’t always respond. For example, I’ve requested 5 different shoulder doctors who are on the city approved list. She doesn’t reach out to inform me that they are not taking work comp patients anymore or at this time. Btw, how is that possible…. All 5 doctors I requested? |
January 28, 2025 at 11:27 am | |
Clinton Cadena | 69651 | Drill Tower 81 | Left knee injury | Barbara Palser | Capt Crossen | 6 |
Claim was denied from 8/22/24-9/2/24. Then was approved for surgery. My 6 SK days were not converted to ID. Claim number 4076130 |
January 28, 2025 at 12:30 pm | |
Shawn Lenske | 72412 | QIS-S | Respiratory COVID | Meguel Mendoza | Dont have one | 60 |
Still they are not paying for my doctors appointments. I have paid for them out of pocket for 8 months Payroll Deduction Issue |
January 28, 2025 at 2:43 pm | |
Cade Gaspar | 315748 | 23C | Basal Cell Skin Cancer | Bryan Veloz | None | 150 |
I filled out the Workers’ Compensation Form DWC-1 on March 29, 2024 for the need for Mohs surgery for skin cancer on my head. I had this surgery done in the past without any issues when the City was using AIMS. After waiting for months and going back and forth with Sedgwick, they denied my claim. Which is something I didn’t think would ever happen since cancer is presumptive and my other skin cancer claim was approved through AIMS. I was told that Segewick sent an appeal to the workmans comp appeals board and would have to wait for them to create a panel. That was on 07/23/2024. After waiting another month without hearing anything about the appeal, I decided to get the surgery done on my own on 08/29/2024, not wanting the cancer to grow any more. As of today, I have still not heard anything from Sedgwick since 07/23/2024. I had to use 96 hours of SK time and spend $770.63 out of my pocket for this surgery. |
January 28, 2025 at 8:03 pm | |
ARMANDO CARRANZA | 51073 | 114 B | Heart | Barbara Palser | Broessel, Dane | 180 |
City denied 2023 and 2024 heart claim. Hired lawyer, claim approved summer of 2024. City refuses to pay benefits. Trail set with 35% penalty requested. No city employee is getting benefit’s converted, alleged Workday issue. |
February 1, 2025 at 4:12 pm | |
Raymond Rodriguez | 381885 | 48B | Covid | No body contacted me | Kevin Davis | 6 |
This happened back in 2022 I got Covid at work and took a pcr test that was provided by the union. I was too sick to drive to an urgent care and my family isolated from me because of their health issues. I was off QZ MLU approved my QZ time but 4 months later workers comp denied my claim and took 140 hrs of sick time away from me and never returned my QZ time. |
February 2, 2025 at 8:17 pm | |
Michael Cunningham | 105864 | Hru | Back | Multiple. Changed throughout | Captain changed. Throughout | 320 |
Horrible process. Dept was no help. Adjuster was horrible. Lawyering up was the only thing that helped the process, which is still unresolved. |
February 2, 2025 at 8:17 pm | |
Thomas Andrews | 374454 | DT81 | Cubical Tunnel Syndrome/ torn tendons in elbow | Unknown | Captain Crossen | 340 |
Surgery was denied countless times due to work comp needing a ‘peer review’ (face to face) with the surgeon requesting the operation. I’d receive notices after each request saying they were unable to get ahold of the surgeon for the peer review, therefore treatment was denied. Follow up visits were every 5 weeks. The surgeon assured me peer to peer reviews are simple, that he does them all the time, but was frustrated on my behalf because he was never contacted by their team. He looked up the physician denying the surgery and found that they held a general license in 5 different states, no specialty in orthopedics. He wrote a formal request and reached out, stating he needed to speak with a surgeon @ his level or higher, as he was confident someone with his training would see this as an absolute necessity. I went through 6 different adjusters, was doing ALL of the leg work. I was sending emails daily and getting replies from work comp stating I was going out of my chain of command and needed to leave certain requests and communication to my adjuster. I contacted my front office @ the time for advice. Pain every day, weakness and atrophy down my arm and no luck with treatment. I was getting acupuncture weekly out of pocket off the record. I was going to cancel the claim and burn my own time to get it handled. I was beyond fed up. Captain Crossen had me come to MLU to straighten it all out. He emailed a gentleman named Tyrone Spears who oversees all workers’ compensation programs for all city departments. From what I understand, he can override denials. Captain Crossen told me it is extremely rare for them to reach out to Mr. Spears, but they’d give it a shot. Surgery was approved within a week. Post surgery, I received a letter stating PT was denied because Sedgwick did not approve the operation. It took far too long to get PT because of this. I then received packets stating financial coverage was in question because of this operation that Sedgwick did not approve. All has been worked out, but it has left a terrible taste in my mouth. Unless I have no option (unconscious at work transported with life threatened emergencies) I will be handling all injuries on my own. Unfortunately, using my own time and finances is more efficient than going through any process affiliated with the City. |
February 2, 2025 at 9:14 pm | |
Adrian Puga | 510284 | 35C currently in light duty | Torn meniscus | Jose Banuelos Hernández | Capt Faulkner | 60 |
First month of waiting to get an MRI because Concentra would not approve it. There has been delays on getting referrals to my chosen doctor now that I have been seen by him we are waiting for the approval for schedule surgery. |
February 4, 2025 at 7:46 pm | |
Adrian Puga | 510284 | 35C currently in light duty | Torn meniscus | Jose Banuelos Hernández | Capt Faulkner | 60 |
First month of waiting to get an MRI because Concentra would not approve it. There has been delays on getting referrals to my chosen doctor now that I have been seen by him we are waiting for the approval for schedule surgery. |
February 5, 2025 at 5:59 am |