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Petaluma teacher's lesson in mistrustFall results in years of disability, disputesBy Mary FrickerPress Democrat staff writer
She finished out the school year on crutches and then took a medical leave of absence. After struggling through five casts, she underwent surgery in January 1993. A year later she took early retirement and a drop in income, unable to stand for long periods in the classroom without pain. Today Moller, 59, still has pain and swelling after standing too long. And to this day, she is fighting her workers compensation claim. Moller's story illustrates how a program set up to quickly provide compensation for on-the-job injuries can evolve into a tangle of delays, suspicion and distrust. Moller said that the Redwood Empire Schools Insurance Group, which handles work-injury claims for the county's schools, has repeatedly questioned her claim and, by implication, her integrity. "There's no way I would ever try to get something I don't deserve. That's against everything I believe and stand for," Moller said. "It felt so awful to have them talk as though that was my prime purpose and to be treated so rudely and curtly. It's appalling -- and always with that veiled implication that I'm trying to get something for nothing.'' Joe Myers, Redwood's executive director, said he could not discuss Moller's case because of confidentiality concerns. "In this particular case, there are a lot of issues. It's an unsettled case,'' he said. Myers said Redwood has an exemplary record of handling claims and gets high marks every year from independent auditors. "Our staff certainly is not perfect, but I would have no fear in comparing them, and our record, to any claims administrator in the state,'' Myers said. At first, Moller's claim went smoothly. Redwood paid for her surgery and most of her follow-up medical care, although it contested some bills. It also began paying her a temporary disability benefit of $336 per week. But a year after the surgery, and after paying out about $17,000 to compensate her for the loss of $36,000 in wages, Redwood stopped the temporary disability payments. In some states, workers are entitled to a hearing before insurers can stop payments, but not in California. Moller didn't understand why the checks had stopped, so she said she called Redwood several times in February and March. "I was royally annoyed with them because they wouldn't return my calls,'' Moller said. In late March she wrote them a letter. Still no reply. Moller said she was beginning to think about getting an attorney, but litigation was distasteful to her. On April 20, a month after her letter, Redwood wrote to say that the temporary disability payments had stopped because Moller's doctor had said she was "permanent and stationary,'' meaning that her recovery was as complete as it could be. That meant it was time to find out if Moller had any residual permanent disability. If so, she was due compensation for it. Insurers are supposed to begin permanent disability payments within two weeks of stopping temporary disability checks, unless they doubt the worker is permanently disabled. This is to make sure an injured worker is never without income more than two weeks from her injury to the conclusion of her claim. These payments are advances on the final permanent disability award, which will be set when the extent of permanent disability is known. Redwood did not begin these payments to Moller. Myers said Redwood and other insurers were interpreting the law differently at that time. First, Redwood wanted Moller to see a forensic doctor to evaluate her condition. An appointment was set for July. "It seemed like everything that was done took months,'' Moller said. In mid-August, the doctor issued his report, which went to the state Workers' Compensation Division for a determination of the exact percent of Moller's disability. The holidays came and went. On Feb. 8, 1995, the state disability evaluator reported that, in his view, Moller was 31 percent permanently disabled. If accepted by both sides, that would entitle Moller to permanent disability payments of $148 a week for 133 weeks, or $19,684. This amount is set by law. Moller could look it up in a book. Moller assumed Redwood would soon send a check. Instead, what followed was two years of letter-writing and frustration in which Redwood disagreed on the extent of disability and the amount to be paid and offered $3,731. Moller's distaste for litigation kept her from taking her case to court. In mid-February 1997, Redwood agreed to the $19,684. A month later, Moller got a check for $14,980 -- which was $19,684 minus $4,704 that Redwood claimed it had overpaid her for temporary disability in 1993. This was the money Moller could have begun receiving on a weekly basis three years earlier, in January 1994. In June, Moller got a letter from Redwood saying it might owe her $3,937 in penalties for being late with its payments but it did not owe the disputed $4,704. Moller believed she was owed both. After an unsuccessful meeting with Redwood in November, she said she plans to file for a hearing with a judge at the Santa Rosa Workers' Compensation Appeals Board to resolve the dispute. A woman who exudes the natural authority of everyone's favorite high school English teacher, Moller says she has no beef with the Petaluma School District. She taught there many years and still occasionally does substitute teaching there. She loves teaching. Her problem, she said, is with a workers compensation system that she believes has treated her without compassion. She worries that other teachers will have the same experience. Moller said she always will be sad that after 20 years of dedicated teaching, she had to fight to get help when she needed it. "I've not felt there was any sympathy for me,'' she said.
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