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  1. #1
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    Default Re: Nys Denial: Possible Mishandling/Conflict of Interest

    Quote Quoting adjusterjack
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    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.

  2. #2
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    Default 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

  3. #3
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    Default 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.

  4. #4
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    Default 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.

  5. #5
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    Default Re: Nys Denial: Possible Mishandling/Conflict of Interest

    Quote Quoting hyperphoncs
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    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.

  6. #6
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    Default 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!

  7. #7
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    Default 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.

  8. #8
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    Default 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.

  9. #9
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    Mar 2015
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    Default 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?

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