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How to Determine if an Unemployment Claim Was Mishandled

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  • 04-21-2015, 11:31 AM
    hyperphoncs
    Re: Nys Denial: Possible Mishandling/Conflict of Interest
    Hey all, I'm back! Sorry this response is so late. I'll catch up on any replies since I left but first, the update I promised. I did get a call from someone at the DOL who cleared up the confusion after getting my letter requesting clarification on where my claim stands so I knew how to proceed.

    They said they made the decision to deny back in December but right after that, they saw the remaining documents that came in so they withdrew that decision and continued reviewing my claim. So the person who said in January that my claim was on hold pending review and that it would take another month or so was correct. I was just never informed that there was a denial before that happened (either because the letter wasn't sent or it was sent and I never got it).

    At the end of that period, after reviewing all of the documents, they made the decision to deny again, but the person who said my claim was denied back in December didn't know there was activity on my claim after that. Even another person from the DOL I spoke to for clarification gave me the wrong information and said that no one looked at my claim after the December date.

    So they confirmed that people weren't on the same page with what was actually happening with my claim and they allowed me to request a hearing. With that settled, I focused on the determination and asked if they could give me more information about why I was denied. The copy of the original letter said I didn't provide compelling evidence but since that was based on them having incomplete documentation, I wanted to know what the reason for denial was after reviewing everything.

    They said there were two reasons. The first is that I need a signed letter from my doctor stating that he told me to quit and they asked if I can get that. The second is that in his opinion, I quit without talking to my employer about the problem first. I'll post again in a minute to talk about that and answer the replies I got.

    - - - Updated - - -

    I'm aware that unemployment insurance isn't needs based. That's a non-issue. In spite of attempting to have the confusion cleared up, I did read through the unemployment insurance law cited to better gauge how they may have determined I "quit without good cause" after I was told that was the determination. I also went through sample case judgments to bookmark any that seemed relevant to my claim.

    I don't have experience going through the system or working for it, but it doesn't mean I can't understand the language of the law that should be driving their decision and what points to consider or that I'm not taking into account the fact that I don't know what kind of people or system I'm dealing with. The fact that I don't know is why I'm posting here. To get feedback and guidance from people who've seen these claims and hearings play out.

    I also looked over the sections regarding voluntary quitting prior to submitting my claim, so it was important to know why they made the decision they made. Otherwise, I'd just be guessing at which specific aspects of "good cause" I'd have to address at a hearing that apparently weren't adequately addressed in my claim. Logical is the only way I can approach something like this because getting emotional about it is pointless. If the state cared how I feel, I wouldn't be in this mess to begin with lol

    The issue with getting a doctor's note is that I didn't quit because the doctor told me to (even though he did tell me I shouldn't be there if I was reacting that badly). I quit because I was too sick to stay and my employer wasn't addressing the issue. When I was diagnosed, I wasn't anticipating quitting yet because I still thought they might fix the problem or offer other solutions, so I had no reason to ask the doctor to write a letter telling me to or to even be thinking about it. I was just concerned about my health. Lesson learned.

    The issue with getting a letter from him now is that he wouldn't remember me at this point. He's not my primary care physician. He's the doctor I saw when I left work during my most severe respiratory attack because he runs an emergency care center I was able to get to in less time than it would have taken to get to the nearest hospital. Once the examination and testing was done, my history was taken, questions were asked, and he gave me the diagnosis and prescriptions and his recommendation to remove myself from the environment causing the reaction, that was it. I never saw him again.

    I submitted all of the related medical records when I filed the claim, but if a letter is what they want, I likely won't have that. So I'll be looking through prior cases as well as the law again to get an idea of how to best make the case of the apparent medical need to leave without requiring an implicit direction documented by letter. Any ideas on that are appreciated!

    - - - Updated - - -

    On the opinion that I quit without talking to my employer, that one may or may not be tricky because the only proof I have that I continued to follow-up in spite of my employer already indicating they weren't going to do anything about it are the emails I sent through my state email (which no longer exists) and the internal calls I made from my state line (which aren't stored) up until the time I gave up and resigned. The only things I can back up on paper were already submitted.

    I said I left out a lot in my original post, but I was very detailed in outlining what happened in my claim, when the complaints were made, what my employer's response was, the union involvement, my employer's response to that, and the remaining leave I took for additional recovery time before resigning. To them, it didn't meet their requirements. Maybe to the appeal judge, it will. I don't know.

    What I want to go back and highlight in sample cases and the law is any mention of the length of time considered appropriate between the employer's failure to resolve the issue and you quitting because it might help me understand how on Earth they could think all of what happened (which was an ongoing battle lasting a year) amounted to me not talking to my employer before I quit.

    - - - Updated - - -

    Quote:

    Quoting comment/ator
    View Post
    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?

    I don't want to post so much information here that I'd be even more identifiable but I'll try to answer. Transferring to another location was discussed but wasn't possible for my job and the way I outlined that part in the claim, I felt it met the requirements regarding when a transfer isn't considered a reasonable solution by the DOL, but I'll look over it again.

    There were other employees (in-house and visiting) affected by the issues. No one in-house was affected to the same degree that I was. The air quality issues cited (aside from the mold concern) were always present and had been an ongoing complaint by other employees. No one ever took it seriously enough to get the union involved, but some did make enough of a stink about it that the ones in charge of our agency's property affairs decided to have the carpet steamed in case that helped (that was a year or so prior to all of this).

    When I got the union involved for my issue (which was primarily the suspected mold), said employees submitted testimony to the problems and how long they've been going on in addition to individual surveys the union requested done by all employees frequenting/housed in the location that confirmed a number were having issues. At the time, I couldn't have the surveys/statements because they were private information to be submitted without influence, but I plan to contact my union to request copies.

    An interesting thing (to me) is that aside from finding the air quality conditions were poor, several issues were actually cited to be in violation of state regulation and building codes. The report with that detailed info was already submitted with my original claim. Some of the issues were also cited by the state inspector when he did his annual inspections.

    There were no accommodations that could be made. Transfer wasn't an option and due to the security of what I worked with, telecommuting from home was also not an option. The only option short of me working in a plastic bubble was for the air quality issue to be fixed and while some in the agency felt it should just be done to get it over with, others just didn't want to spend any money doing it and chose to argue instead that nothing was wrong or ignore the issue all together.

    The only recommendation made by the union was to try purchasing an air purifier, which I had already done (and which obviously couldn't address an air quality issue present in an entire open office building).

    Most of these points were touched on in the original claim but I know that I'll have to go back over everything and tighten it up/add what might make the case stronger. Here's my question about the hearing: Is the point for the appeal judge to make their own decision independent of the decision the DOL made or is the point for them to decide if they agree with the DOL's decision according to the reasons they made it?

    For example, if the appeal judge doesn't agree with the DOL's determination on the points they made, but decides I should be denied for an entirely different reason the DOL didn't think was a problem, I'd still get denied, right? Or would they not be looking at anything other than what the DOL found relevant?
  • 04-21-2015, 03:20 PM
    chyvan
    Re: Nys Denial: Possible Mishandling/Conflict of Interest
    Quote:

    Quoting hyperphoncs
    View Post
    For example, if the appeal judge doesn't agree with the DOL's determination on the points they made, but decides I should be denied for an entirely different reason the DOL didn't think was a problem, I'd still get denied, right? Or would they not be looking at anything other than what the DOL found relevant?

    The hearing is a complete do-over. To play it safe, just assume the judge will have seen none of your other paperwork, that it won't even be there so you need to bring it, read anything about your case, and just go in there like that person is hearing everything for the first time.

    You can use your earlier denials as a jumping off point, but you really have to know what you have to prove. The other thing is that with medical, a claimant might get denied initially because there were questions as to whether the claimant was sick enough to quit. Then at the hearing the claimant will really focus on that part because of the earlier denial, and then the next decision will be, "you had good cause to quit," and then immediately followed up with "effective on the day after you quit, you are not able and available," and in essenses, you're still not eligible because you proved that you were too sick to do any job and not just the job that you left.

    Just know that this hearing is the MOST part of the entire process, and you have to have it all together because the likelihood of getting a second chance is very near zero.
  • 04-22-2015, 10:22 AM
    hyperphoncs
    Re: Nys Denial: Possible Mishandling/Conflict of Interest
    Thank you! That will be the other hard part. Finding a way for them to understand that I was too sick to work there because I was being made that sick by working there but that illness wouldn't have prevented me from working in general, which is what the law requires as far as I know. So I wouldn't have been able to take a job as a bike messenger, for example, until after I fully recovered, but I was perfectly able right out of the gate to continue doing the type of work I was doing or any other type of work that wouldn't require above average respiratory exertion.

    That's the main reason I left when I did. Reaching a point where I was too sick to do anything at all, even sit up at a computer or stand behind a counter, was inevitable if I stayed and it did reach that point when I requested to go on sick leave for recovery. Thankfully, I was able to recover while on leave in spite of the condition returning when I returned to work again, but no one, including a doctor, can guarantee that the damage being done to my lungs wouldn't eventually be irreparable. Having chronic respiratory issues for the rest of my life wasn't a risk I was willing to take. Certainly not for a job.

    I just don't know how to prove that I was sick enough to warrant leaving, especially since what I provided wasn't enough. I considered that short of the doctor's letter, I might present credible documented medical evidence that my diagnosed condition is guaranteed to evolve into a more permanent and/or fatal condition if you don't eliminate the cause (which in this case was my place of work), but I don't know if that would be out of place for something like an unemployment hearing.
  • 04-22-2015, 11:13 AM
    chyvan
    Re: Nys Denial: Possible Mishandling/Conflict of Interest
    Quote:

    Quoting hyperphoncs
    View Post
    I don't know if that would be out of place for something like an unemployment hearing.

    The hearing is the place. If you have a diagnosis from a doctor, you can submit it. If you had tests or cultures done, you can submit the results. You can submit copies of your prescription labels. You can submit printouts from the internet for the type of condition for which the drug would be prescribed. You can submit photos from work showing water damage. If there was visible mold, you can show that too. You can use emails between you and your employer. You can printout phone records to show that you made a call to your employer on a certain date and time. Even though it won't prove the contents of a call, it will stop an employer from being able to say, "she never called me." You can also testify as to what you did; however, it always best if you can back it up. You can bring witnesses, but in practice, it's rare that they ever show up no matter how much they tell you beforehand that they have your back. If there was some a ticket/violation/report issued and it's available as part of a public record online, you can submit that.

    As the quitter, the burden is on you. These cases can be lost because of just one tiny thing a claimant could have done differently, and this is pretty much your only chance to do it right.

    Quote:

    Quoting hyperphoncs
    View Post
    especially since what I provided wasn't enough.

    You don't really know that. I had the same judge doing my board of review by himself and then part of a three judge panel. It was the SAME record that was being reviewed. In the first decision when he probably thought he could get away with it he says, "the claimant quit her job with the Employer because the Employer ceased to provide health insurance benefits. While certain fringe benefits may be considered wages, we (he really meant I) that health insurance paid by an Employer is specifically excluded."

    Then with his peers, he says in a dissenting opinion, "I am in complete agreement with the majority on most of the decision. However, the majority is basing its decision on information contained within a more than 40 year-old UIPL (not true because it was reissued and strengthed in 1998 and was only 12 years-old at the time of my quit). Therefore, I would remand this matter to the Department on both issues." Which means instead of outright denying me like in his first decision, I'd have at least gotten to start all over again which wouldn't have been a total loss.

    It's because of stuff like this, that I don't hold the UI people in high regard. Depending on who you get, the day of the week, if it's near lunch time, or who might be looking over their shoulder, you can get very different decisions with the exact same FACTS.
  • 04-22-2015, 12:42 PM
    hyperphoncs
    Re: Nys Denial: Possible Mishandling/Conflict of Interest
    Quote:

    Quoting chyvan
    View Post
    It's because of stuff like this, that I don't hold the UI people in high regard. Depending on who you get, the day of the week, if it's near lunch time, or who might be looking over their shoulder, you can get very different decisions with the exact same FACTS.

    I hear you there! Thanks for the input. I'm trying to put on my "lawyer hat". Updating you, I just got a letter from the DOL saying that my request for a hearing was received and sent to adjudication. It was mentioned that this process takes weeks. From what the letter says, if they don't change the determination, it'll be forwarded for a hearing to be scheduled, but if they change it, I'll be notified.

    Have you (or anyone else here/thanks to commentator for the detailed post btw) heard it happen often that the adjudicator overturns the determination and your benefits get approved? More importantly, will they have any contact with me? When I googled the adjudication process, I found some people referring to interviews and questions being asked during the process, but it wasn't clear if they meant during the claim process in general or if the adjudicator's office itself contacts you with questions.
  • 04-22-2015, 12:53 PM
    eerelations
    Re: Nys Denial: Possible Mishandling/Conflict of Interest
    comment/ator is your best advisor here because she works (and has been working for a very long time) as a senior UI official.
  • 04-22-2015, 01:02 PM
    chyvan
    Re: Nys Denial: Possible Mishandling/Conflict of Interest
    Quote:

    Quoting hyperphoncs
    View Post
    Have you (or anyone else here/thanks to commentator for the detailed post btw) heard it happen often that the adjudicator overturns the determination and your benefits get approved? More importantly, will they have any contact with me?

    Anecdotally, I've never seen an initial determination changed in the sense that if it was a denial it stayed a denial. The rational may have changed which can help you at the appeal hearing if you skipped something, but just plan a hearing. However, it makes sense. These websites attract the problem children. If you were to get your denial fixed, you wouldn't be posting here or you'd just stop with any follow up.
  • 04-26-2015, 06:46 AM
    hyperphoncs
    Re: Nys Denial: Possible Mishandling/Conflict of Interest
    Quote:

    Quoting eerelations
    View Post
    comment/ator is your best advisor here because she works (and has been working for a very long time) as a senior UI official

    Thanks so much!

    Quote:

    Quoting chyvan
    View Post
    Anecdotally, I've never seen an initial determination changed in the sense that if it was a denial it stayed a denial. The rational may have changed which can help you at the appeal hearing if you skipped something, but just plan a hearing. However, it makes sense. These websites attract the problem children. If you were to get your denial fixed, you wouldn't be posting here or you'd just stop with any follow up.

    Makes sense! I contacted my union to see if they could send me copies of the statements and surveys that were submitted by other employees attesting to the fact that they were also having issues and how long they individually were trying to get the problem resolved since the person from the DOL asked me to name names (some names, I don't have and others only agreed to be honest if they were allowed to remain anonymous). The union said their policy didn't permit releasing that to me. They said that's why they included a section summarizing the statements and responses in their report.

    Meanwhile, the DOL contact who called me to ask questions again finally irritated me. Not because he kept saying I just quit out of nowhere instead of addressing my employer about the issues before I left even though I was actually following up and documenting the problems related to the air quality and mold/leakage via email on a weekly basis up until I left (which only my employer can prove at this point so why bother).

    Not because he kept saying I didn't give my employer a chance to find a solution in spite of all the times I sent emails and left messages saying hey, so what other solutions are there, what else can we do (which again, only my employer can prove)?

    Not because he felt I should have relocated to the moon or otherwise blindly turned my life upside down for the sake of hanging on to an employer who didn't care what happened to me as long as they didn't have to spend any money. Not because he kept making it sound as if I'm a stubborn person who'd refuse transfer/relocation just because I don't feel like commuting farther to work in spite of the fact that I just relocated there.

    Not even because he thinks so highly of the state that he kept commenting on how wonderful it is working for them, how they'd practically move mountains to accommodate you as if that's true for every single state agency and every single person working in them. I was laughing in my head at the notion that an employer who wouldn't even move air for me would move mountains. I'm sure he's seen other agencies do it, other people really try to do what was best for their employee. Where I worked, dream on.

    None of that bothered me because I figure he's just doing his job or playing devil's advocate. What irritated me was him telling me how things were at my job as if he knew what they did and didn't do and how our office handled matters better than me when I'm the one who actually worked there.

    Imagine being at home and your neighbor stops by, smashes your television, and tells you they won't pay for it. Then imagine recounting that to someone miles away and them saying, "Sorry, but I'm sure your neighbor didn't smash your television." Great! How cool that a person who wasn't there is *sure* that what you stood there and watched happen didn't. Very impartial.

    I don't blame him for his comments. He might be going out of his way to help me for all I know. This entire thing is just a source of unwanted stress. I won't mention details, but what makes this worse is the fact that the people handling/involved in this were awful. The organization had poison from the top down. I've had a lot of jobs, been the lowly grunt and the bigwig, and I've never worked somewhere with people that deceitful, volatile, vindictive, and in it for themselves nor an organization that dysfunctional. Want to hear a joke? How long does it take the state to change a light bulb? Well, if you're talking about the agency I worked for, a year and only if it's in the budget.

    In the time I worked there, the number of things said and done by coworkers, supervisors, even people in HR were nasty at best and illegal at worst. Which is funny because I would have guessed that working for a state agency would be better. But I figured, the job market is tough, for the first time I have good benefits, retirement. As long as I keep my head down and don't rock the boat so I don't end up one of the targets, I'll be fine. And when I reach out for a new job, I won't have to worry about them sandbagging me out of spite like they would others.

    I endured a lot in the interest of protecting my job without making enemies. When I developed the respiratory condition, there was a part of me that was glad because I knew I would have stayed there as long as I had to just to keep a roof over my head in spite of what it was like there. Still, I tried to do what I thought was the right thing, not just for me but for everyone there, and ask my employer to fix the problem. Asked for meetings, asked for advice, asked for help. Banged my head against a wall while they dragged the wall out month after month after month with empty promises, vague answers, or no answers.

    I knew what kind of people they were. What their agendas were, what their priorities were. I knew they'd never help me. Not really. They'd just make it seem like they would to cover their butts. I still thought I should give them the chance. To know that they didn't do the right thing and the fact that they're the only ones who have the means and records to prove it is almost comedic.

    That agency was a dark mark on my life that I (and my lungs) were so glad to finally be rid of yet thanks to this unemployment stuff, it's like living with their misery over my head every day all over again. Every time he calls, it's like my employer is standing there smirking at me. To be told after everything I went through that I didn't try, to know that those people will more than likely have the hearing ruled in their favor no matter what I say or do, makes me feel like it's not worth it. All of my energy is going into staying on my feet right now. If only for that, this is something I may just let go.

    The guy from the DOL seems to think I was stupid for leaving and maybe I was. Maybe there were other options I didn't know about (and certainly wasn't getting any help with). Maybe I shouldn't have been afraid of being blacklisted and instead sued or kept escalating it until all of their dirty laundry was out in the open, forcing them to act. If I'm stupid, fine. I'm stupid.

    But unlike a year ago, I'm a stupid person who can walk up the stairs into my home without having to hold onto the railing for dear life. I'm a stupid person who can hop on my bike and ride a block without having to get off and lie on the ground because it feels like my lungs are collapsing. I'm a stupid person who doesn't have to be on disability and doesn't have to say, "I can't physically do the job you're asking me to because of my condition."

    So the DOL, the appeal board, they can decide that I didn't do the right thing according to the unemployment insurance law, but they'll never convince me I did the wrong thing in general. If I don't get the benefits, so be it. As the saying goes, at least I've got my health.

    - - - Updated - - -

    So weird. I checked the mail from Saturday and I got a reversal? It sounds like something changed and now I don't need a hearing (unless my employer appeals). I'll follow up on that to verify what I'm looking at. Thank you again to everyone for all of your input. Even if this flips over again, I've had an attorney reach out to me to help just in case. If threads can be marked as closed, please do. Thanks!
  • 04-26-2015, 08:43 AM
    comment/ator
    Re: Nys Denial: Possible Mishandling/Conflict of Interest
    So now, has this person been filling out weekly certifications so he can be backpaid, or is he to start drawing benefits right now? In either case, there's 26 weeks of weekly benefits, after all this terrible major major soul destroying mess is resolved, either to be backpaid or to be paid out now. I'm sure dealing with this claimant has been a real pleasure for all concerned.
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