Filing For Extended Work Absence / Disability: How to maximize approval chance?

My company goes through Sedgewick (https://www.sedgwick.com/). If I get approved, I can get up to 4 or 5 months off (with partial pay). I'm currently planning on going to Birkholtz in South Africa, who asks for 4 months for distraction phase to hit 8cm (.75mm a day).

How would you word this sort of request in the claim for time off? Or what details would you include / exclude when requesting? It's a serious surgery, but it's cosmetic, but it's also fixing a mental issue.

Thanks a ton, team.

If you're in the US, start with your company's HR department and apply for FMLA. They should not ask you what your medical leave is for (and are not allowed to). At that point, they should let you know what your options are with the amount of leave you are requesting. You will need a doctor's note saying how long you will be out. Again, the reason does not have to be on the note. At quick glance, Sedgwick seems to be a claims company, not a benefits manager, so they should have no say on the leave approval itself, or in how much of your pay the leave qualifies for and when that kicks in. That should be spelled out in the benefits/disability package you chose either when you started or during open enrollment. In summary, talk with HR ASAP.

Just be prepared that anything can happen and your 4 month stay could get extended.

It all goes by the codes your doctor writes.
When I removed nails at HSS they gave me a month paid under “hardware removal”. Even if the initial was cosmetic, I said it was causing me pain to get insurance to cover, which was true one of the screws was annoying.
For tibias, my leave was submitted under an orthopedic correction, which is true because I had bowed tibias, although I am correcting this and lengthening. If there is no initial medical reason, there is not really a valid code to submit a claim under. Unless your doctor is willing to lie of course. Also when you get approved long term, they usually ask for progress reports once a month, at least mine does but it’s not sedgewick.

If you’re just taking an unpaid LOA it might be easier, but getting approved for short term disability for cosmetic is a long shot if your doctors honest, and you will need to grant access to medical records. They don’t really care about the cosmetic part if there is an initial medical reason for the surgery, like for example if you have breathing problems and get a nose surgery to correct this but on top of correcting your septum they alter your cosmetic nose shape for example. Or if you had a root canal but on top of this you want a veneer on top of it. Try to see if you have any possible rotational deformity or knock knee/bow legs, or maybe a discrepancy above the norm

So basically you want advice on scamming the system to get an elective surgery that you frivolously want and don't actually need. Sorry but that just really pisses me off. Why is everyone so eagerly throwing out advice?

There's people out there that legitimately get hurt on the job through no fault of their own that actually need paid off time and some disability benefits just for them and their family to eat from day to day. And are probably still making heavy sacrifices because said disability is not quite enough to live comfortably.

You're theoretically taking money they need and/or making the process for them more difficult. While probably living extremely comfortable already just so you can go break your legs and suffer for months if not years to grow a few inches when you're already within the realm or a normal height.

It's just...none of this sits right with me at all. Think of the poor guy who paints for a living and maybe had a ladder break while 20 ft up in the air because his boss was ignored the condition of the ladder and was too cheap to buy a new one for the company. He now has two broken legs and every day is misery. The only thing he can rely on in this some supplemental help to survive.

That's what those funds are designed for! You want a personal procedure? That's fine; save up your own funds and figure out a way to take off work. Don't scam a system designed to help those in extreme need, please.

@bid133: okay, so HR is the big hurdle. This is really good to know. I already told my manager about this, which might have been a mistake. He was supportive, however-- in fact, he was the one who directed me to the medical leave / partial pay process. I am far more concerned with getting the time off than the pay, so if HR can label this a medical LOA rather than just some sabbatical, that would be fantastic. I would not be able to get some plain sabbatical until 2026, probably.

@Activatedxx: I had a consult with Paley and he said there were no deformities I can try another consult with another doctor and see what they say. What's the sign of a rotational deformity? Like walking with toes pointed out?

@darksol64: These claims / health insurance companies are insanely rich and definitely not the paragon of virtue or fairness. They are not some community friendly, non-profit charities. They are lucrative businesses. As such, I feel zero guilt over stretching the truth to get compensated by them. Also, yes, where I live (coastal US), I feel short and this has bugged me my whole life, so I am solving it.

I talked with my manager and said I was having a medical procedure.  That was that.  I didn't have enough PTO saved up to be paid full time for 3 months off, so we stretched it to basically pay for half the time. 

For PTO do you mean accrued Sick Leave PTO or Holiday PTO? And I'm guessing this was just between you and your manager and HR / director level-- so you didn't have to tap into some "extended leave" request?

Quote from: Activatedxx on December 04, 2024, 07:40:05 AMIf you’re just taking an unpaid LOA it might be easier, but getting approved for short term disability for cosmetic is a long shot if your doctors honest, and you will need to grant access to medical records.

When you say "short term disability" being a long shot for cosmetic, are you also including unpaid medical leave?

It looks like I'm allowed to apply for both paid and unpaid short term disability leave, with LOA being a different thing (mental, grievance, etc).

Quote from: badgerbrocktree on December 04, 2024, 10:00:57 PMWhen you say "short term disability" being a long shot for cosmetic, are you also including unpaid medical leave?

It looks like I'm allowed to apply for both paid and unpaid short term disability leave, with LOA being a different thing (mental, grievance, etc).

Initially I didn’t know if anything would pan out, so I enrolled in school to finish my masters online while doing LL. If nothing else worked, I would’ve just taken an educational unpaid LOA.

For just an unpaid LOA, I don’t think you need medical documents. I think your manager just has to approve it. For paid LOA/disability your doctor has to fill out films and they ask for the codes your surgery was under.