Question about CA worker's comp

[mst1981]

I was injured back in September. After seeing a doctor for three months, I was allowed to get an MRI which showed that I have a torn labrum. I was referred to an ortho-specialist who advised me to get surgery. The surgery will take me out of work for at least three weeks. I was told by the insurance company that they will only pay for 66% of the first week that I am out and anything after that is my problem even though the doctor will not release me back to work for three. Is that true?
Thanks

[1171]

maybe.
comp laws vary with the state. that's why this site asks that you post your state.
Is CA the name of the insurance carrier, the Claims Adjuster or the state?

if california then the state laws provide temporary disability payments at 2/3 of your gross wages.
there is a 3 day waiting period that is paid after 14 days.
more here
http://www.dir.ca.gov/dwc/FactSheets/FactSheet_c.pdf

[Woodlawn]

(03-05-2012 07:47 PM)mst1981 Wrote:  I was injured back in September. After seeing a doctor for three months, I was allowed to get an MRI which showed that I have a torn labrum. I was referred to an ortho-specialist who advised me to get surgery. The surgery will take me out of work for at least three weeks. I was told by the insurance company that they will only pay for 66% of the first week that I am out and anything after that is my problem even though the doctor will not release me back to work for three. Is that true?
Thanks

In CA, you are paid 66 2/3rds of your average weekly wage for the period you are taken off work entirely, or your employer cannot accommodate the restrictions the doctor placed.

The carrier cannot decide they are unwilling to pay the three weeks, generally speaking. There are exceptions, but those are pretty rare.

[lizdawiz82]

You need to hire a lawyer because it sounds like the insurance company is not playing by the rules.

[mst1981]

UPDATE
The insurance company has been dicking me around. Apparently, they said that I would only get paid for one week because they only want me to take one week off if I get the shoulder surgery. I spoke with my surgeon last week and he said it's more like three weeks. They're just trying get me back to work ASAP even if it's withholding information.

[1171]

(03-08-2012 11:20 PM)mst1981 Wrote:  UPDATE
The insurance company has been dicking me around. Apparently, they said that I would only get paid for one week because they only want me to take one week off if I get the shoulder surgery. I spoke with my surgeon last week and he said it's more like three weeks. They're just trying get me back to work ASAP even if it's withholding information.

if the employer has work within your restrictions, they don't have to pay.
even if it's just sitting in front of a door to hold it open.

[mst1981]

(03-08-2012 11:48 PM)1171 Wrote:  

(03-08-2012 11:20 PM)mst1981 Wrote:  UPDATE
The insurance company has been dicking me around. Apparently, they said that I would only get paid for one week because they only want me to take one week off if I get the shoulder surgery. I spoke with my surgeon last week and he said it's more like three weeks. They're just trying get me back to work ASAP even if it's withholding information.

if the employer has work within your restrictions, they don't have to pay.
even if it's just sitting in front of a door to hold it open.

No, I understand that but my doctor has to release me first. He told me he would not release me the first week because I will be on narcotics. I have no doubt that my supervisor will want me back but my surgeon said it's also up to me and how much pain I will be in and because I will not be able to use my right arm. I haven't even told him that there will be tons of kids around and I'd be scared of one of them running into me.
Basically what I'm trying to say is that my doctor will not release me back to work unless I am not in pain. When he does release me, it will be with more restrictions.

[1171]

we'll have to wait and see how it plays out.