Workers' Compensation Discussion Forums

Let me 1st start off by thanking all the people here who has helped me out by answer my questions in the last 3 weeks... As many of u guys already know, I live in the Hesperia/Victorville area in California. For those of you who have seen this place, it is in the middle of a vast desert. There are barely any workers compensation lawyers out here and the few out here(like my lawyer) deal almost exclusively with Spanish speaking clients. My lawyer is Mexican-American, but only moved to this country like 10 years ago, so English is not his first language. Most of the time I just can't understand what he says so I really appreciate the help you guys are giving me here.

On to my question....
Recently my lawyer informed me that my IC accepted my case. I was very happy because originally they were doubting the severity of my injury. I work in the non-profit sector, trying to help drug addicted and homeless. To make a long story short, one of the homeless people got angry and threw a punch at me that caught me in the face. I fell in an awkward position which tore my acl, and allowed the side of my face to bounce off the concrete. My manager witnessed it and told me to "stop being a baby" and get up. I thought I was okay, just with a few bumps and bruises, so I eventually got up and got back to work. My manager claimed that being attacked by our clients was a part of my normal work, and that I was not allowed to report this to the authorities. He also claimed that the punch didn't land, and that I fell over myself and hurt myself. I got legal representation. They still denied the case, but after a month the IC accepted the case. I was very happy when they accepted the case. But, recently they IC has gone back to saying "The punch did not make contact. The injuries occurred outside the workplace". They are still paying my doctors bills, but are refusing to give me a settlement. So...can an IC initially accept the case and then suddenly drop it?? I find that really odd.

Well, if they actually denied the claim, then you should have received a denial notice that explained the reason.

If they are still paying medical bills, then they likely didnt deny it. Are you claiming injuries like psych or something? Often that will get denied, barring something obvious.

Did you have any bruises from the punch? Tends to be hard to fake that. Also, it would mot be unreasomable to argue that even if the punch didnt land, you could have injured yourself avoiding it.

if they have new information that will support a denial then yes they can deny benefits at any time.
it is not odd in workers comp to correct a mistake or change a decision when new information in available.
your atty should get you an expedited hearing to restart benefits.
it depends on what you mean by a "settlement"; the terms can be confusing.
the carrier cannot deny impairment benefits or medical care ordered and approved by the comp court.
that is generally the only thing that might be considered a settlement in workers comp.

for more information review the PD fact sheet(D):
http://www.dir.ca.gov/dwc/iwguides.html

They did deny me originally after the manager's eye witness testimony, but eventually they accepted the claim. The thing was that at the msh, instead of trying to settle out of court, they went back to that old argument they used to deny my claim...and that argument was that the punch didn't land and I tore my acl outside of work. They also argued that if I was severely injured, I would have not been able to complete my shift. No new information came up to support the denial, they just reused their previous argument. I haven't gotten a denial letter, so I assume my claim is still accepted. I guess from what I hear, they don't need a valid reason to change their decision.

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(10-07-2011 12:23 AM)Woodlawn Wrote: [ -> ]Well, if they actually denied the claim, then you should have received a denial notice that explained the reason.

If they are still paying medical bills, then they likely didnt deny it. Are you claiming injuries like psych or something? Often that will get denied, barring something obvious.

Did you have any bruises from the punch? Tends to be hard to fake that. Also, it would mot be unreasomable to argue that even if the punch didnt land, you could have injured yourself avoiding it.

I did have bruises, but apparently bruises don't qualify as an injury in the workers comp system. And they have been using a ton of stupid arguments to discredit my claim...example=the policy at most social service agencies is that we aren't supposed to call the police when aggressive situations occur during an intervention. Yet, the defense attorneys have used an argument that there is no evidence that the incident occurred because I didn't call the police. Then after my manager actually testified that the incident did occur, they changed the argument to "no punch landed. She got hurt outside of work".
Currently, right now my head feels like exploding!!

(10-07-2011 01:19 AM)LornaMc Wrote: [ -> ]They did deny me originally after the manager's eye witness testimony, but eventually they accepted the claim. The thing was that at the msh, instead of trying to settle out of court, they went back to that old argument they used to deny my claim...and that argument was that the punch didn't land and I tore my acl outside of work. They also argued that if I was severely injured, I would have not been able to complete my shift. No new information came up to support the denial, they just reused their previous argument. I haven't gotten a denial letter, so I assume my claim is still accepted. I guess from what I hear, they don't need a valid reason to change their decision. .

so it was just an argument used during negotiations and not a denial of benefits.
as i stated previously they are NOT required to agree to a settlement.
however you are entitled to court ordered periodic payments for any permanent disability.
the laws and strategies can be complicated; best leave the negotiations to your atty.