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How to Determine if an Unemployment Claim Was Mishandled

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  • 03-27-2015, 10:20 AM
    hyperphoncs
    How to Determine if an Unemployment Claim Was Mishandled
    My question involves unemployment benefits for the state of: New York

    I was a NYS employee working at a state agency for years. The building had a major water-related incident and continuous water issues thereafter. Following that, employees began experiencing various allergic reactions, which raised concern about air quality problems including mold. I developed severe respiratory issues that went dismissed in spite of complaints until I got the union involved. The union had tests done confirming the air quality issues and wrote up a report of findings including what the employer should do to bring the building and air quality up to code.

    My employer wouldn't pay for remediation due to budget. My condition declined until I couldn't even breathe while in the building, obviously interfering with both my work and my health. I was diagnosed with an allergic respiratory condition and advised to stay out of the place causing it. I went on sick leave until I recovered. Problems returned immediately upon returning to work and worsened again. Employer still had no plans for remediation to improve air quality. I resigned. I left a lot out of that for length.

    I filed an unemployment claim stating I quit for medical reasons. They started sending me questionnaires. I filled them out as they came and indicated on them that I had supporting documents but it would take a while to get all of it together so I'd be sending them in as I received them. I also indicated that I was willing and able to work and actively looking for employment. When I had all of the major documents, I emailed them in using the DOL's secure messaging system.

    About three weeks later, I got a reply saying my documents were received and my claim was under review and to keep certifying my benefits. A few weeks went by and I got nervous because I have no money. I signed into the DOL account and it said my claim was still pending. I emailed asking how long it might take to review my claim. A week or two later, I got a response saying it would take about six weeks if they didn't need any more info from me or my employer.

    I continued certifying benefits and applying for jobs (including at all of the local stores/restaurants). A month later, I checked in again asking if they needed anything else from me and if it was typical for it to take this long or if it was just because I quit for medical reasons? I got a response a week later saying that my claim was denied three months ago for quitting without good cause, they'd send me the determination letter, and that if I don't agree, I can ask for a hearing.

    I said that didn't sound right because I've been in touch with them over the past three months about my claim being ongoing and it even still says it's pending in the system. I didn't hear anything back yet, but I did just get the determination letter from them (with my address handwritten which I thought was odd because everything else I got from them had printed envelopes). It said quit without good cause, didn't show a compelling reason for quitting.

    How do I go about finding out if my file was mishandled, like if someone jumped the gun and put in a denial for me while someone else was still handling the claim? Also, I've been concerned from the beginning that my claim wouldn't be approved regardless because my employer (the state) is basically the same one making the determination. Do you know if state employees have a harder time having unemployment claims approved?

    After I get a response to that, I'll ask the question I was going to ask about the justification of the determination. Thanks!
  • 03-27-2015, 11:03 AM
    adjusterjack
    Re: Nys Denial: Possible Mishandling/Conflict of Interest
    Sorry, but I think you blew it.

    To collect unemployment you have to be able to work and actively looking for work. If you are ill and can't do that you don't qualify.

    Your proper claim should have been under workers compensation for a job related illness.

    I suggest you consult with a workers compensation attorney. You might be able to qualify with the proper legal assistance.
  • 03-27-2015, 11:18 AM
    Mr. Knowitall
    Re: Nys Denial: Possible Mishandling/Conflict of Interest
    Quote:

    Quoting adjusterjack
    View Post
    To collect unemployment you have to be able to work and actively looking for work. If you are ill and can't do that you don't qualify.

    The inability to work in one particular job site due to air quality issues and allergies does not automatically translate into an applicant's being unable to work at the overwhelming majority of alternate work sites should a job become available.

    A delay in the response to an unemployment claim is most often the result of the agency's being backlogged.

    If you want somebody to review the details of the denial, it would be helpful to have some details about the basis for the denial, not just the conclusion.
  • 03-27-2015, 11:34 AM
    hyperphoncs
    Re: Nys Denial: Possible Mishandling/Conflict of Interest
    Thanks everyone! Yes, my illness was solely caused by and tied to exposure to the conditions of that workplace, so I'm both willing and able to work as indicated. Just not at that job. Any thoughts on the questions I asked? I don't want to proceed in acknowledgment of the denial before I know there wasn't a disconnect in handling my claim that resulted in someone saying I was denied months ago while someone else is saying my claim is still being reviewed. I just don't know how to inquire about that.

    Also, how would I get more details about the basis for the denial? Will they actually tell me if I ask? Because the letter doesn't say anything more than Determination: You quit without good cause. Reason: You have not disclosed any compelling reason for quitting your job.

    By the way, to make it clear, I have no money and no resources, so until I land some source of income or receive those benefits, I can barely afford food let alone consulting with attorneys. That's why I'm on the web looking for free advice lol
  • 03-27-2015, 11:52 AM
    Mr. Knowitall
    Re: Nys Denial: Possible Mishandling/Conflict of Interest
    Generally speaking, when you call an agency and ask somebody the status of your case, they punch your name into the system and read you the information that shows up on their screen, no need for a greater conspiracy. We have no reason to suspect that the system showed your case as anything but "pending" through the date that the decision was approved for mailing.

    You may be able to get more information if you appeal.
  • 03-27-2015, 01:15 PM
    hyperphoncs
    Re: Nys Denial: Possible Mishandling/Conflict of Interest
    I'm not sure if I'm explaining myself well, sorry. That's the part I'm waiting to hear back on, which communication was right: This person saying that my claim was denied three months ago or the persons throughout the last three months saying it's open and still being reviewed.

    If they just look in the system to see the status, there would be no reason for anyone I've spoken to in the past three months to tell me my claim is still pending determination if the determination was already made months prior unless it takes months for their system to show that. That's why I'm confused and hope they'll shed some light on where the disconnect is.

    As of now, my claim still says pending in the system and the letter they sent isn't a determination from now, it's the determination this person said they made three months ago (and they dated it three months ago) as if the communications I had with the DOL over the past three months never happened. I want that cleared up first. If they say the people I've been communicating with recently were mistaken and my claim wasn't under review, then I'll address the determination.

    - - - Updated - - -

    Oh, also, I asked about someone jumping the gun because the date they said the determination letter was sent was in the middle of when I was still sending/receiving the questionnaires and documentation. That's why I was wondering if there might have been someone who maybe handled one or two documents received in the mail and made a determination based on it not realizing someone else was still sending and receiving other documents from me via the post as well as online.

    Everything I've received in the mail, via email, and in my account throughout the process stated my claim was pending from beginning to now, so I just want to be sure this denial letter I never got that's only being mentioned and sent now isn't a mistake before I accept it as the intended determination by appealing it.
  • 03-27-2015, 01:20 PM
    chyvan
    Re: Nys Denial: Possible Mishandling/Conflict of Interest
    Quote:

    Quoting hyperphoncs
    View Post
    Determination: You quit without good cause. Reason: You have not disclosed any compelling reason for quitting your job.

    Whether your claim was handled correctly or not, doesn't matter. You have your decision, and you have to live with it as unhelpful as it is. Submit an appeal REQUEST, and get this in front of a hearing officer/ALJ. All you need to say in your request is: "the determination dated mm/dd/yy is wrong. I want an appeal hearing scheduled."

    Thing is, you quit, and so few quitters get UI, the UI workers don't bother. Also, you didn't send all your documents together. They were spaced out, and someone didn't want to wait. I think you have what it takes to win on appeal, but it's really tough to get UI from an overworked UI work when you quit.
  • 03-27-2015, 02:18 PM
    hyperphoncs
    Re: Nys Denial: Possible Mishandling/Conflict of Interest
    Thanks Chyvan. My issue is the chronology. I want to make sure before I proceed that the final decision is that I was denied. Not that it was the initial decision one person made off the cuff and someone else realized they jumped the gun, so it wasn't upheld internally, explaining why I never got a notice of determination, why my claim status never said it was denied or closed (I checked in on it regularly), and why everyone I spoke to said my claim is still being reviewed for determination.

    This person's response is the first I'm hearing of it out of half a dozen responses from the DOL since the date this person is saying the determination was supposedly made. I'm not going to appeal until I'm sure their wires didn't get crossed. Once I hear back, I'll request a hearing (keeping within the time frame allotted to request one).

    Also, my documents were spaced out but coincided with the questionnaires they were sending me. I didn't file a claim, then send paperwork one sheet at a time over the span of three months. I sent the main documents upfront when I first filed, then got everything else the questionnaires indicated I'd need in one go and sent it all together. If someone was premature in their response because of that gap, fine. I just want them to confirm that the currently active determination is that I quit without good cause. I'll update once I get an answer!
  • 03-27-2015, 02:54 PM
    chyvan
    Re: Nys Denial: Possible Mishandling/Conflict of Interest
    The time to submit an appeal is tight. By the time you figure out what's happening, you might end up with a late appeal, and those are almost always losers. This is winnable.

    You're being too logical. I got a horrible decision, and I thought I could call, and talk to someone to redo it. It was a waste of my time, and luckily it didn't make me late on my appeal. Once the decision is issued, if you don't like it, APPEAL. Save the envelope with the postmark, and everything else.

    The sooner you appeal, the sooner you get a hearing date, and get it in front of a hearing officer who is paid to think, the better off you'll be.

    While I'm not in your state, I had the claim experience from hell and learned a lot. Further in the process, I appealed to the board of review, get a decision in July. Appealed to the board of review panel, and got the SAME identical word for word decision again signed by the same lone judge as in July in September. I knew something was wrong because it should have had the signature of three judges, not one. I called then too, and wanted them to submit my appeal to the panel so I could avoid another 8 week wait. It wasn't going to happen. I submitted all the same stuff with minor tweaks again in September, and then waited to November to get the decision that I should have had in September.

    My opinion is that so many new people were hired to handle the case load from the great recession that depending on who you get, you might be getting someone that is dumber than dirt. You have what it takes to appeal, and the path of least resistance, is to follow the process. Trying to deviate because you're trying to speed things along was a failure for me, and I don't want you pulling out your hair trying to reinvent the wheel, or worse, missing a deadline.
  • 03-27-2015, 06:44 PM
    comment/ator
    Re: Nys Denial: Possible Mishandling/Conflict of Interest
    Quote: "Thing is, you quit, and so few quitters get UI, the UI workers don't bother." This is absolutely NOT true. There is a standard procedure that goes on, in every state, in compliance with federal unemployment law, and people in the unemployment system in every state have a set way of dealing with all claims. Whether or not they think this is a valid claim, or whether they are "dumber than dirt." A great many of the claims that are submitted are pitifully, blatantly obviously deniable just at first glance. But each and every one is put through the very same appeals process.

    When you quit a job, you have the burden of proof to show that you had a valid misconduct reason to quit the job. That you had tried to correct the situation and that you have exhausted every reasonable alternative to quitting BEFORE you quit the job. Yes, it is much more difficult to get approved when you have quit than when you have been terminated. Because it was your choice, and it takes a really valid work related reason for that to be approvable, to show that you are out of work "through no fault of your own." The medical issues are not such a big deal in the approval or denial of the claim. If you have any restrictions on the type of work you are able to do, or are unable to work due to your health conditions, that is an ability to work issue, and is separate from the separation issue.

    You file the claim. Information is gathered, and since it is a "voluntary quit" claim, it must be adjudicated. This will always take four to six weeks to do, and in extremely high claims load times, it may take more time. There is a federal quality standard called "late first pays" which pretty much means that they mustn't simply let your claim lie around on someone's desk for months. They have to act upon it within a certain amount of time. They should've told you that returning their requests for information and submitting your forms were time sensitive. You don't have all the time in the world to get back with them, and neither does the employer. This is an internal measurement. But the whole claims taking and adjudication process is built around this timely decision factor. It is entirely possible that you didn't get all your information submitted to them in a timely manner, and while somebody was waiting on you patiently to submit more or to answer them back, someone else, possibly a supervisor, went in and denied, intending to let it be worked on in appeals if you had any more to submit, or told them to get this darn thing off their desk. In either case, when a decision was made, it appears the decision code was not submitted to the system correctly, or you'd have gotten a notice of decision. In letter form. That's what matters, not what they tell you on the phone.

    Unemployment insurance is NOT a needs based program. It is not given to you because you are poor or needy, and no information is required about your income before you file your claim. Therefore, you cannot sue the state for being late in paying you or making a decision on your claim. They don't care if it is just a little extra money to put with your millions, or if you're starving to death. They have a certain amount of time to make what is called the initial decision, either granting benefits or denying them and giving you a short interval in which to appeal and request a hearing. (Usually 15 days from the date of the initial decision.)

    Calling during this process to ask what is going on, if the claim has been heard from, if all the answers have been provided by the employer, etc. is generally futile. The person you reached can only tell you whether or not a decision has been reached based on the code on file in the system and the claim shows up as pending, approved or denied. Pending just means the initial decision code has not yet been entered. Trying to locate and discuss the claim with the particular adjudicator who is making your particular decision is like trying to find the proverbial needle in a haystack. It just doesn't happen, and your adjudicator did not have time to discuss it with you anyhow.

    What you have to do once you file the claim and quickly submit all the evidence they have asked for, quickly respond to any inquiries they make to you, is to sit home, filing the weekly certifications, and wait to receive the initial decision letter, telling you either you are or are not approved for benefits. This letter will be very curt and brief, is a form letter and will probably cite some code as the reason for disapproval if the claim is denied. There will be information about how to appeal and how much time you have to file the appeal.

    If you received this letter, and you did not file the appeal before the date to file the appeal ( "15 days from the date of issue of this determination") then it's over. You cannot appeal anything, and you cannot protest or complain or file suit against them for misconduct.

    Remember when you ask about the state being difficult to get unemployment approval from, that the state has supervision of the department of labor that does unemployment. Their state department of human resources is going to be very knowledgeable about how to terminate or have people quit and not allow them to be in position to be approved for unemployment easily. You can bet they got everything in quickly. And you can bet that if you have a hearing, they will be there with plenty of information relevant to your situation. That's just what the state does. As any employer has the right to do, just as you have the right to appeal a denial.

    Yes, it sounds like something went terribly wrong with your claim process and your initial decision. They found it, long since you should have heard about it, and said your claim was denied three months ago. Realizing no decision letter had been sent, they said you WOULD be receiving a decision letter, like maybe none was sent when it should have been, three months ago, after the decision. And now you've just received the decision letter, right?

    That's good, in a sense, because you will now be able to appeal and will get to review all your information, IF you respond within the appeals window. DO NOT try to do this any way except as chyvan suggests. Submit something RIGHT AWAY, just say, "I want to appeal" and get it in. Forget about giving reasons or documents in this appeal request. This is, of course, if you're still in the window of time to appeal. Otherwise, forget the whole business.

    If you've been making weeky certifications all this time, and your claim is approved in the appeals hearing, you will be back paid for each of the weeks you have filed for. If you stopped filing, call and reopen your claim and request to begin certifying for weeks again while awaiting the hearing and second decision. As I said, you might be approved in the appeal, and you'd be backpaid, but only for weeks for which you certified.

    Things to think about for the hearing, OP, would be, "Did you try to resolve the problem before quitting?" as in did you ask to be transferred to another department or another location? Also, did you have any other employees in your department who were having health issues related to this situation? Did you discuss with your union and your human resources what accommodations might be available for you to help you deal with the mold issue and your subsequent health issues? Were you the only person who was suffering from such terrible problems related to the mold in the walls? And for goodness sake, have all your medical information collected before you go into the hearing. An attorney is not necessary for a hearing, you can probably manage to submit the information you need to get in and speak for yourself.

    But since neither you or chyvan has ever worked within the system, you don't have a clear picture of how things work, and you're only grabbing small pieces of the elephant and drawing your conclusions from them. As it has been said, don't try to reinvent the wheel, don't try to get on the phone and ask to be treated any differently than the thousands of other people who have filed claims with your state agency this year. Everyone is dealt with in a standard manner. Sometimes in this process, the ball is dropped. I believe they were remiss in not submitting your decision into the system quickly enough. It sounds like you didn't get a timely decision letter, though the decision was made a while back. But that ship has now sailed. If you are still within the timeliness markers, get in an appeal in and get a hearing.
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