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Help, Help TPD checks runaround (GA)
#1
No I do not have a lawyer maybe I should. I receive TPD checks. I returned to work after a injury to wrist. I am at MMI and received loss of use at 16%. I know longer can work over time and am on light duty.My injury was a year ago. I asked claims adjuster why I am not getting my checks weekly? This was her answer. Temporary partial is due at least every 13 weeks. Temporary total is weekly. I have not received my checks for three weeks I was told on Tues. I would get three this time. I know it is not true that I could have to wait for 13 weeks. No way do I believe that. What should I do? Another quick question should I allow Comp Nurse in when I go for my next appointment or should I see Dr. alone first. I had allowed it before now I regret it.
 
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#2
If you aren't repped, you can talk directly with the insurance company. If your state has an ombudsman, he/she can also help with your questions.

To learn is power. On this site, go to home page and click on State info. I found this rule on the Georgia site in less than 30 seconds.

Also, regarding the Nurse Case Manager. She is employed by the Insurance Company. Some are good advocates for the worker, getting them treatment. Most, IMO, are only there to keep expenses as low as possible and even talk the doctor out of treatment and push for release back to work. It is up to you. I've dealt with a wicked witch, and had her barred from my case. She was before I had an attorney. Then my 2nd NCM was an angel. She was unique. OK, simply said, you can't refuse a NCM. You do have a right to privately seeing your doctor, but they have the right to talking to your doctor after the appt. without you there. It's your decision.

Rule 262. Computing Temporary Partial Disability.
(a) The average weekly wage the employee is able to earn after the injury may be determined according to the method of computation in O.C.G.A § 34-9-260(1).
(1) An employer/insurer using this method may recompute the average weekly wage after payment of benefits begin under O.C.G.A. § 34-9-262 and at 13-week intervals thereafter.
(2) In lieu of calculating an average weekly wage after injury based on 13-week intervals, the employer/insurer may elect to calculate benefits due each week by multiplying two-thirds times the difference between the average weekly wage on the date of injury and the actual weekly wage the employee earned each week thereafter.
(b) For the purposes of calculating temporary partial benefits as contemplated
by O.C.G.A. § 34-9-104(a)(2), see method of calculation set forth in
O.C.G.A. § 34-9- 104(a)(3).
© When paying weekly temporary partial disability income benefits based on
an actual return to work, file a Form WC-262 with the Board at 13 week intervals or when such benefits are suspended, whichever comes first. When filing the Form WC-262 with the Board, send a copy to the employee and the employee’s counsel, if represented.
Let Go, and Let God......
 
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#3
(04-18-2013, 10:25 PM)chrischris Wrote: If you aren't repped, you can talk directly with the insurance company. If your state has an ombudsman, he/she can also help with your questions.

To learn is power. On this site, go to home page and click on State info. I found this rule on the Georgia site in less than 30 seconds.

Also, regarding the Nurse Case Manager. She is employed by the Insurance Company. Some are good advocates for the worker, getting them treatment. Most, IMO, are only there to keep expenses as low as possible and even talk the doctor out of treatment and push for release back to work. It is up to you. I've dealt with a wicked witch, and had her barred from my case. She was before I had an attorney. Then my 2nd NCM was an angel. She was unique. OK, simply said, you can't refuse a NCM. You do have a right to privately seeing your doctor, but they have the right to talking to your doctor after the appt. without you there. It's your decision.

Rule 262. Computing Temporary Partial Disability.
(a) The average weekly wage the employee is able to earn after the injury may be determined according to the method of computation in O.C.G.A § 34-9-260(1).
(1) An employer/insurer using this method may recompute the average weekly wage after payment of benefits begin under O.C.G.A. § 34-9-262 and at 13-week intervals thereafter.
(2) In lieu of calculating an average weekly wage after injury based on 13-week intervals, the employer/insurer may elect to calculate benefits due each week by multiplying two-thirds times the difference between the average weekly wage on the date of injury and the actual weekly wage the employee earned each week thereafter.
(b) For the purposes of calculating temporary partial benefits as contemplated
by O.C.G.A. § 34-9-104(a)(2), see method of calculation set forth in
O.C.G.A. § 34-9- 104(a)(3).
© When paying weekly temporary partial disability income benefits based on
an actual return to work, file a Form WC-262 with the Board at 13 week intervals or when such benefits are suspended, whichever comes first. When filing the Form WC-262 with the Board, send a copy to the employee and the employee’s counsel, if represented.


(04-18-2013, 10:25 PM)chrischris Wrote: If you aren't repped, you can talk directly with the insurance company. If your state has an ombudsman, he/she can also help with your questions.

To learn is power. On this site, go to home page and click on State info. I found this rule on the Georgia site in less than 30 seconds.

Also, regarding the Nurse Case Manager. She is employed by the Insurance Company. Some are good advocates for the worker, getting them treatment. Most, IMO, are only there to keep expenses as low as possible and even talk the doctor out of treatment and push for release back to work. It is up to you. I've dealt with a wicked witch, and had her barred from my case. She was before I had an attorney. Then my 2nd NCM was an angel. She was unique. OK, simply said, you can't refuse a NCM. You do have a right to privately seeing your doctor, but they have the right to talking to your doctor after the appt. without you there. It's your decision.

Rule 262. Computing Temporary Partial Disability.
(a) The average weekly wage the employee is able to earn after the injury may be determined according to the method of computation in O.C.G.A § 34-9-260(1).
(1) An employer/insurer using this method may recompute the average weekly wage after payment of benefits begin under O.C.G.A. § 34-9-262 and at 13-week intervals thereafter.
(2) In lieu of calculating an average weekly wage after injury based on 13-week intervals, the employer/insurer may elect to calculate benefits due each week by multiplying two-thirds times the difference between the average weekly wage on the date of injury and the actual weekly wage the employee earned each week thereafter.
(b) For the purposes of calculating temporary partial benefits as contemplated
by O.C.G.A. § 34-9-104(a)(2), see method of calculation set forth in
O.C.G.A. § 34-9- 104(a)(3).
© When paying weekly temporary partial disability income benefits based on
an actual return to work, file a Form WC-262 with the Board at 13 week intervals or when such benefits are suspended, whichever comes first. When filing the Form WC-262 with the Board, send a copy to the employee and the employee’s counsel, if represented.


Sorry, but I guess I am blank. They went by my checks that I made 13 weeks before I had my accident. I contacted the State Board and they told me I was suppose to receive my checks each week or right over a week and that if I did not I could reguest and a 15% interest charge would be added on for late checks. They said no way was I suppose to wait 13 weeks for a check as she said it could be. I send a copy of my check each week but am waiting almost four weeks and then I get three at one time.
 
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#4
send in written request to the carrier for your overdue payments and request a penalty.
keep a copy.
you can contact the state board for help
http://sbwc.georgia.gov/file-claim
Reminder :
........Each state has their own comp system; POST YOUR STATE to get accurate information. Use the search feature to find information from similar questions.
THANKS FOR POSTING.
 
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#5
I hate so much thinking about doing all this. I am thinking..... I would be fired by my employer. I have been there 19 years but I messed their safety record up. As if I fell in the floor on purpose. I know I can wait on those checks but it seems like no body wants to be fair.
 
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#6
I hate so much thinking about doing all this. I am thinking..... I would be fired by my employer. I have been there 19 years but I messed their safety record up. As if I fell in the floor on purpose. I know I can wait on those checks but it seems like no body wants to be fair.
 
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#7


if you have a good relationship with the employer, they could intervene with the carrier directly and maybe get your payments caught up.


Reminder :
........Each state has their own comp system; POST YOUR STATE to get accurate information. Use the search feature to find information from similar questions.
THANKS FOR POSTING.
 
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#8
As I said, I am worried about being fired. What use to be good is not anymore. After all these years it is like I threw myself on to the floor on purpose.The carrier told me that when you are on Temporary total your money is due weekly. Since mine is Temporary partial it is due at least every 13 weeks. Just can not figure out where she gets that. Does that mean if she wants to I could be made to wait 13 weeks for my check. She said she was trying to do mine every two weeks but sometimes it was running to three. Have not got the three yet so come Monday it would really be time for my fourth check.
 
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#9
As I said, I am worried about being fired. What use to be good is not anymore. After all these years it is like I threw myself on to the floor on purpose.The carrier told me that when you are on Temporary total your money is due weekly. Since mine is Temporary partial it is due at least every 13 weeks. Just can not figure out where she gets that. Does that mean if she wants to I could be made to wait 13 weeks for my check. She said she was trying to do mine every two weeks but sometimes it was running to three. Have not got the three yet so come Monday it would really be time for my fourth check.
 
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