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Has anyone tried appealing an IME decision? I'm thinking about lawyering up but not sure if it's worth the hassle.
I did! It was a long process, but I won in the end. If you've got a solid case, it might be worth it. Just be prepared for a lot of waiting and paperwork.
Careful with lawyers, some of them are just as bad as the system. Make sure you do your research before hiring anyone!
Hey Aisha! I went through the same thing about 6 months ago and it was super stressful. Here's what I learned: First, call them ASAP to get clarity on your specific situation. Ask for a case manager if possible - they tend to be more helpful than the general customer service reps. Key questions to ask: - What triggered the IME request? (sometimes it's just routine after a certain time period) - Will you get backpay for the time your benefits were suspended? - What's the typical timeline for your area? (mine took about 6 weeks total) - Can you request a specific doctor or do they assign one? Also, start gathering ALL your medical records now - the more documentation you have, the smoother the process goes. And yeah, definitely have some backup funds if possible because it can take a while. Hang in there! It sucks but most people do get through it eventually. Feel free to ask if you have other questions! 💪
This is really helpful, thank you! Quick follow-up question - when you say "case manager," how do I actually ask for one? Do I just say "I want to speak to a case manager" when I call, or is there a specific way to request it? I've never dealt with EDD before so I'm not sure about the proper terminology to use.
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I'm so sorry you're going through this exhausting battle with Kaiser - your story really hits home as someone who's dealt with similar mental health disability issues. The advice you've gotten here about FMLA vs SDI being separate systems is absolutely crucial and something I wish I'd understood earlier in my own journey. One thing that really helped me when I was preparing for appointments was creating a "day in the life" document that outlined exactly what a typical day looked like with my symptoms - things like "woke up at 3am with panic attack, couldn't get back to sleep," "tried to read medical journals but couldn't concentrate past first paragraph," "had to cancel grocery trip because leaving house felt overwhelming." Having these concrete examples really helped providers understand the functional impact beyond just diagnostic labels. Also, since you mentioned working in healthcare with high-stress patient interactions, make sure to emphasize the safety-critical nature of your role. Mental health symptoms that might be manageable in other jobs become genuinely dangerous when you're responsible for patient care decisions. Any provider should understand that returning before you're cognitively and emotionally stable could put vulnerable patients at risk. The fact that your symptoms have worsened during this 14-week period is actually important evidence that you're not ready to return - stress from fighting for benefits often exacerbates underlying mental health conditions, which is sadly common but medically significant. Keep advocating for yourself - you deserve proper support and your future patients deserve you at your best. This community is rooting for you!
The "day in the life" document idea is incredibly helpful - I never thought about documenting my symptoms in such concrete, specific terms but that would definitely paint a clearer picture than just saying "I'm depressed and anxious." Things like sleep disruption, inability to concentrate on medical information, or feeling overwhelmed by basic tasks really show the functional impact in ways that providers can understand and document properly. You're absolutely right about emphasizing the safety-critical nature of healthcare work. I keep trying to minimize how bad things are because I feel guilty about being off work, but the reality is that my current mental state would genuinely endanger patients. When I'm having panic attacks or can't concentrate, I literally cannot safely make the split-second decisions that ICU nursing requires. Framing it as patient safety rather than personal struggles feels much more legitimate somehow. It's validating to hear that symptom worsening during this benefits battle is common and medically significant rather than just me being weak or failing to recover "properly." The stress of fighting Kaiser while trying to heal has definitely made everything worse, but I hadn't realized that deterioration itself was important documentation. Thank you for sharing your experience and for the encouragement - it means so much to know this community understands what this process is like when you're already struggling. Your practical suggestions give me hope that I can present a stronger case to the new psychiatrist!
I'm so glad you found this community and are getting such solid advice! As someone who's been through the mental health disability maze myself, I want to echo what others have said about documentation being absolutely key. One thing that really helped me was keeping a simple daily log on my phone - just a few bullet points about symptoms, sleep, ability to concentrate, any panic episodes, etc. When I finally got in front of a supportive provider, having weeks of concrete data showing the pattern of my limitations was incredibly powerful. It's much harder for review boards to dismiss "patient reports panic attacks 4-5 times per week preventing focus on complex tasks" versus "patient feels anxious." Also, since you mentioned you're in healthcare - I'm wondering if you've considered reaching out to your employee assistance program (EAP) if your employer has one? They sometimes have mental health advocates who understand the specific pressures healthcare workers face and can help navigate these systems. The fact that you're prioritizing patient safety by not returning before you're ready shows incredible professional integrity. Don't let anyone make you feel guilty for that - both you and your future patients deserve you to be mentally and emotionally prepared for the demands of patient care. Sending you strength for your upcoming psychiatrist appointment. You're doing all the right things by advocating for yourself through this broken system!
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I'm going through something very similar right now and it's absolutely maddening! The IME doctor I saw spent literally 12 minutes with me, didn't ask about my job duties at all, and completely ignored the physical therapy notes showing I still have significant range of motion issues. Meanwhile my orthopedist who has been treating me for 4 months says I'm nowhere near ready to return to my warehouse job. What really gets me is that these IME doctors seem to have a quota or something - like they're incentivized to clear as many people as possible. I've heard from multiple people that the same IME doctors consistently clear everyone they see, regardless of the actual medical situation. It feels like such a rigged system. I'm currently waiting to hear back about my appeal, but reading everyone's experiences here at least makes me feel less alone in this mess. The financial stress while waiting for resolution is almost worse than the actual injury sometimes. Stay strong and keep fighting - it sounds like you're taking all the right steps!
I completely understand your frustration - it really does feel like a rigged system sometimes! The fact that these IME doctors spend such little time with patients and don't even consider job-specific requirements is infuriating. You're absolutely right that it seems like they have some kind of quota to meet. I've been reading through all these responses and it's both comforting and depressing to see how common this issue is. The financial stress while waiting for appeals is honestly brutal - I'm already worried about next month's rent if my benefits get cut off. It's like they're betting that people will just give up and go back to work injured rather than fight through their bureaucratic maze. But seeing stories from people who eventually won their appeals gives me hope. We shouldn't have to choose between our health and paying bills! I hope your appeal goes through quickly - please update us when you hear back. It really does help to know we're not going through this alone.
I'm so sorry you're dealing with this - the whole IME system feels completely broken when doctors who barely know your case can override physicians who've been treating you for months. I went through something similar with a shoulder injury last year and the stress was unbelievable. One thing that really helped me was having my doctor include photos of my work site in the supplemental certification to show EDD exactly what my job entailed. Construction work is so physically demanding and variable - it's not like you can just "take it easy" when you're working with heavy materials, climbing scaffolding, or working in awkward positions all day. My treating physician took pictures during my appointment showing my limited range of motion and included those too. It made the case much more visual and concrete rather than just medical jargon. Also, if you have any coworkers who can write letters describing the physical demands of your specific job tasks, that can be powerful supporting evidence. The whole process took about 6 weeks for me but I did get all my back pay. Don't let them bully you into going back before you're truly ready - a re-injury could set you back months and put you in an even worse financial situation. You know your body better than some doctor who spent 15 minutes with you!
That's such a brilliant idea about including photos of the work site and demonstrating the limited range of motion during the appointment! I never would have thought of making it that visual and concrete. You're absolutely right that construction work isn't something where you can just "take it easy" - every task involves heavy lifting, awkward positions, or potentially dangerous situations where a moment of weakness or limited mobility could cause a serious accident. I'm definitely going to ask my doctor if we can document my current limitations with photos during my next appointment, and I'll see if any of my coworkers would be willing to write letters about what our daily tasks actually involve. It's so frustrating that we have to go to these lengths to prove what should be obvious, but if it helps get my case resolved faster, it's worth it. Thank you for sharing your experience and for the reminder that I know my body better than someone who barely examined me - I really needed to hear that right now!
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I had a very similar situation with my disability claim last year! Based on my experience, here's what I'd recommend: Use May 14th as your return-to-work date since that's exactly what your surgeon specified. For the recovery date, you can use the same date unless your surgeon gave you a different one for "full recovery" vs "able to return to work." Make sure to attach a copy of that surgeon's letter to your claim - it's your strongest piece of evidence. When you fill out the forms, be specific and write something like "Return to work date per surgeon's letter dated [insert date]" so it's crystal clear where this date comes from. Also, definitely try to speak with an EDD agent to confirm they received the letter and ask them to make a note in your file. The documentation is key - keep copies of everything you submit. Good luck with your claim! 🤞
This is exactly the kind of detailed advice I was hoping to find! Thank you so much @Marcus Patterson. I really like your suggestion about being specific with the wording - "Return to work date per surgeon's letter dated [insert date]" is perfect. It shows exactly where the information is coming from. I'm definitely going to follow your step-by-step approach. One quick follow-up question - when you spoke with the EDD agent, did you call the main disability line or is there a specific number that worked better for getting through to someone who could actually help with documentation questions?
I've been through this exact situation! For your forms, definitely use May 14th as your return-to-work date since that's what your surgeon specifically stated. For the recovery date, if your surgeon didn't give you a separate date for "full recovery," it's completely fine to use May 14th for both - it just means that's when you'll be recovered enough to safely return to work. Here's what I found most helpful: When you submit your claim, include a note that says something like "Dates based on surgeon's letter dated [insert date of letter]" - this makes it super clear where your information is coming from. Also, upload that surgeon's letter to your EDD portal if you can, and keep the confirmation number they give you. If you need to call them (and I'd recommend doing so just to confirm they received everything), try calling right at 8 AM when they open. Ask the agent to confirm they can see the surgeon's letter in your file and request that they add a note about it. Having that verbal confirmation gives you peace of mind! Keep copies of everything you submit - trust me, you'll want them for your records. The whole process can feel overwhelming, but having that surgeon's letter is really your best asset here. You're on the right track! 👍
This is such comprehensive advice! I'm in a similar boat and have been stressing about whether using the same date for both recovery and return-to-work would cause issues. Your explanation that it just means "recovered enough to safely return to work" makes perfect sense. I especially appreciate the tip about including that note with the date reference - it shows you're not just guessing at dates. Quick question: when you called at 8 AM, did you usually get through on the first try or did it take multiple attempts? I'm trying to set realistic expectations for myself! 😅
Sean Matthews
So glad to hear everything worked out! This is a perfect example of why it's always better to be proactive and report things upfront rather than worry about it later. Your experience will definitely help others in similar situations. It's also encouraging to know that EDD reps can be helpful when you actually manage to reach them - the 8am strategy is gold! Hope your partner's recovery goes smoothly from here.
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Jacob Lewis
•This is such a relief to read! I'm new to this community and have been lurking while trying to figure out my own SDI situation. Your whole thread has been incredibly helpful - I had no idea about calling right at 8am or getting confirmation numbers. Really appreciate everyone sharing their experiences here. Wishing your partner a speedy recovery!
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Laila Prince
Welcome to the community, Jacob! This thread has been really educational for me too as someone who's dealt with SDI before. The 8am calling strategy really is the best kept secret - I wish more people knew about it. It's so refreshing to see a situation like this work out smoothly when you handle it the right way. Genevieve did everything perfectly by being proactive and transparent with EDD. Hope your own SDI situation gets resolved just as easily!
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