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NEED HELP ASAP (hopefully someone that is familiar with CA state WC law )
#1
Hello I have been on workers comp before and have been screwed over (I was even told that my boss made a mistake on my L.O.A so I would have to wait 3 weeks to get paid) this case was closed awhile ago and I did nothing about it at dealt with the violations. Unfortunately my girlfriend is now on WC and was given strict restrictions. She injured her knee at work and she is a general manager of a fast casual restaurant. She injured herself over a week ago, but tried to power through it a day because she did not realize how serious it was and has a strong work ethic and it just made it worse so she reported it to her DM amd filed the necessary paperwork and now has been put on WC. Now she waited til after the first weekend and went to the E.R. the a W.C. dr like she was told to do and was informed that she needed to get a hold of her adjuster which had been changed to a "special" senior adjuster who she has called every business day around 4 times and left voicemails because the dr wants to do an emergency MRI of her knee...she cannot stand on it whatsoever the swelling was horrible that for awhile they thought she had deep vein thrombosis. The thinks she ruptured her miniscus and need the adjuster to apporve the MRI to do so since they cannot get a hold of the adjuster they are making her wait on pain pills and she has been paying for them do to an update and no adjuster approval. Now she was told by her DM who she can barely get a hold of even though she is used to speaking and seeing him regularly (well it has been an abnormal amnt of time since their last meeting which is supposed to be weekly but he blowing her off) that they want her back at only 100 percent then she told him when her next app (she has been texting him constantly since he now barely answers his phone). Now after her next appt she got new restrictions that she SHOULD SIT 100 PERCENT OF THE TIME and since she does not have an office only a "standing desk" in the kitchen (fyi she has crutches and a cane) she cannot do any work til someone comes in two days to set up her work software on her laptop. Anyways now they are saying after the fact her restrictions became more intense that she MUST come back and sit at work on the booths all day and sit on a stool and cashier which the cashiers have to stand to make milkshakes and her manager duties she cannot do because she would have to go the kitchen with her crutches or cane which violates her restrictions in multiple ways and goes against company policy due to high risk of an accident occuring. She has a shitty low sales store they just put her in to help bring up sales and is brand new like only gm of THAT store for a week or so (she has been a GM for over a year) so she has very little manager coverage because before she went a bunch of ppl including the GM quit so it makes it difficult and not likely that her sales and labor cost work with that many managers on a shift for x amnt of hrs extra with her there none the less they have days they cannot work and are not trained to work on inventory at all so she will end up having to run a shift as usual by herself a few days out of a week and some of her 12 hr shifts for multiple reasons thus making it so she has to WALK and squat to open the safe and do other manager duties tmrw she is expected to have inventory counted and she asked for help from her DM and he said it is HER STORE NOW and hef problem to fix then hung up. She cannot call HR until mon and does not understand how her knee will heal properly she is supposed to be elevating and icing it regularly and it swells a lot even from short car rides. There is no way she can properly do her job also she drives a standard therefore she has to use a clutch and the dr put down she cannot use a company and they told her the cannot anything about her personal car but she should not because of an accident risk, especially since they told her she should take heavy narcotics. I am driving her tmrw it is a 34 mile drive in HEAVY TRAFFIC and luckily I am free tmrw but I  not on my school days and I go 5 days a week. I asked my family and they said they would take her , but, was told that she needs to not drive so is workers comp going to pay for her drive? Because the busses and pu lic trasportation is poor in SoCal and she cannot front that much money for an uber or taxi what she should she do? Is it a viable reason to call HR? Can her boss fire her for not performing her duties well if she cannot and has to quick train unqualified people? Her boss mostly does not want to find coverage for her because it is a small district and he is well known dick who lies to succeed and pressure them to also. If her knee worsens before her next visit does she go in early to the drs before her appt (days early)? Overall how should she handle the situation? Call hr? Call a lawyer? Fyi she has to put in sick days for her few days of missed work...any and I mean ANY advice will be greatly appreciated! I do not want my gf to get fucked over more than I did. Thanks!
 
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#2
Excuse the typos I am exceptionally sleep deprived and my phone kept freezing mid writing
 
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#3
I,m not sure I want to read that much; it seems to include too much that is not about the injury.
You don,t have to show fault or blame to get benefits.

Here,s some General information
http://www.dir.ca.gov/dwc/iwguides.html
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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#4
(09-25-2016, 03:43 AM)Fallingfromtrees Wrote: Hello I have been on workers comp before and have been screwed over (I was even told that my boss made a mistake on my L.O.A so I would have to wait 3 weeks to get paid) this case was closed awhile ago and I did nothing about it at dealt with the violations. Unfortunately my girlfriend is now on WC and was given strict restrictions. She injured her knee at work and she is a general manager of a fast casual restaurant. She injured herself over a week ago, but tried to power through it a day because she did not realize how serious it was and has a strong work ethic and it just made it worse so she reported it to her DM amd filed the necessary paperwork and now has been put on WC. Now she waited til after the first weekend and went to the E.R. the a W.C. dr like she was told to do and was informed that she needed to get a hold of her adjuster which had been changed to a "special" senior adjuster who she has called every business day around 4 times and left voicemails because the dr wants to do an emergency MRI of her knee...she cannot stand on it whatsoever the swelling was horrible that for awhile they thought she had deep vein thrombosis. The thinks she ruptured her miniscus and need the adjuster to apporve the MRI to do so since they cannot get a hold of the adjuster they are making her wait on pain pills and she has been paying for them do to an update and no adjuster approval. Now she was told by her DM who she can barely get a hold of even though she is used to speaking and seeing him regularly (well it has been an abnormal amnt of time since their last meeting which is supposed to be weekly but he blowing her off) that they want her back at only 100 percent then she told him when her next app (she has been texting him constantly since he now barely answers his phone). Now after her next appt she got new restrictions that she SHOULD SIT 100 PERCENT OF THE TIME and since she does not have an office only a "standing desk" in the kitchen (fyi she has crutches and a cane) she cannot do any work til someone comes in two days to set up her work software on her laptop. Anyways now they are saying after the fact her restrictions became more intense that she MUST come back and sit at work on the booths all day and sit on a stool and cashier which the cashiers have to stand to make milkshakes and her manager duties she cannot do because she would have to go the kitchen with her crutches or cane which violates her restrictions in multiple ways and goes against company policy due to high risk of an accident occuring. She has a shitty low sales store they just put her in to help bring up sales and is brand new like only gm of THAT store for a week or so (she has been a GM for over a year) so she has very little manager coverage because before she went a bunch of ppl including the GM quit so it makes it difficult and not likely that her sales and labor cost work with that many managers on a shift for x amnt of hrs extra with her there none the less they have days they cannot work and are not trained to work on inventory at all so she will end up having to run a shift as usual by herself a few days out of a week and some of her 12 hr shifts for multiple reasons thus making it so she has to WALK and squat to open the safe and do other manager duties tmrw she is expected to have inventory counted and she asked for help from her DM and he said it is HER STORE NOW and hef problem to fix then hung up. She cannot call HR until mon and does not understand how her knee will heal properly she is supposed to be elevating and icing it regularly and it swells a lot even from short car rides. There is no way she can properly do her job also she drives a standard therefore she has to use a clutch and the dr put down she cannot use a company and they told her the cannot anything about her personal car but she should not because of an accident risk, especially since they told her she should take heavy narcotics. I am driving her tmrw it is a 34 mile drive in HEAVY TRAFFIC and luckily I am free tmrw but I  not on my school days and I go 5 days a week. I asked my family and they said they would take her , but, was told that she needs to not drive so is workers comp going to pay for her drive? Because the busses and pu lic trasportation is poor in SoCal and she cannot front that much money for an uber or taxi what she should she do? Is it a viable reason to call HR? Can her boss fire her for not performing her duties well if she cannot and has to quick train unqualified people? Her boss mostly does not want to find coverage for her because it is a small district and he is well known dick who lies to succeed and pressure them to also. If her knee worsens before her next visit does she go in early to the drs before her appt (days early)? Overall how should she handle the situation? Call hr? Call a lawyer? Fyi she has to put in sick days for her few days of missed work...any and I mean ANY advice will be greatly appreciated! I do not want my gf to get fucked over more than I did. Thanks!
What type of doctor is she being treated at? Most (not all) employers have a medical provider network for work comp injuries. Was she provided with a link to a list of doctors to go to or was she told she can see any doctor who takes work comp?

The procedures in California work comp are very complicated. To get approval for an MRI her doctor needs to send a request in writing on a form called an RFA. You cannot just call to get approval (sometimes you can but usually not). If her doctor wrote it up as an expedited request it should take 3 days for an answer. If he wrote it up as a regular request it can take between 5 business days to 14 days for an RFA to be approved. If she is being seen by a doctor who has no clue about work comp he probably did not send it the request correctly. If your girlfriend was sent to an industrial clinic this is not a good place to be either. You will know if she was sent to one of these as they are only work comp and they have her come in every week and do not take her out of work. After 30 days she can switch to another doctor in the MPN (medical provider network).

It is not the employers responsibility to make arrangements for her because she cannot drive a stick. I do think it is a little odd the doctor did not take her off work and gave her narcotics. She should go back to the doctor and state her employer will not abide by the restrictions (only if she attempted to work and employer did not abide by them) and ask to be taken off work and placed on TTD. TTD will provide work comp payments. If she is at one of the employers industrial clinics they may not take her off of work. She should attempt top see if she can work (if she has not done so already). Did her doctor state work comp will provide her with transportation to and from work? If so she should call her adjuster and if her adjuster fails to call back in 3 days I would call back and get the main number and ask for the adjusters supervisor (this will piss off the adjuster but I would do it).

She can call an information and assistance officer and talk to them about what is going on and ask for advice.
http://www.dir.ca.gov/dwc/ianda.html

Tell her not to quit her job as she may not qualify for benefits such as wage replacement. Her employer can state she has to be 100% to return top work but in the meantime they will need to provide her with TTD payments which is similar to what she earned after taxes. if she quits she will not be eligible.

If her employers are getting nasty you can hire an attorney, but make sure you google his reviews. There are some shady work comp attorney's out there.

This is where you can get information about work comp in California.
http://www.dir.ca.gov/InjuredWorkerGuide...ebook.html
I am not an attorney.Anything I write should not be considered legal advice.I am writing from my own personal experiences,which is not from any sort of legal background. You should consult with an attorney over legal issues. In California, if you cannot get an attorney you can consult with an I&A officer.
 
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#5
No her dr did not because her dr changed and she got someone random who was not as good and said they cannot do anything about her personal form of transportation, but her workers comp adjuster must help her, which she called the adjusters supervisor who was pissed and said he would talk to the adjuster which was like 4 days ago and she still has not called back. She was not provided with list because her DM would not cooperate and no one knew where the list was and she just called the insurance company who gave her a dr, an industrial dr who seemed pretty young and new, but claimed she expedited a MRI...that was almost 7 days ago by late tonight it will be exactly a week. Also her job requires her to park in an employee parking lot and walk about a quarter mile around a mall, but her DM keeps saying figure it out and apparently implied to another gm that he wants to catch her fuckimg up at work while injured...we do not think corporate even saw her new restrictions because her DM claimed he emailed it and said they did not care and that she must cashier and figure out how she can do management stuff from her stool outside her kitchen with unqualified people doing her job, which is against corp policies so can he legally write her up for a job she cannot perform if her unqualified and untrained employees do incorrectly? And thank you for all of the info I will look up TTD because they want her to put in sick time for her 5 days off. I really appreciate the info sorry for the long posts I just felt the need to well illustrate the situation and I am so stressed and worried for her.
 
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#6
If she wants an atty
Caaa.org
Workers cmp insurance is not going to make the supervisor/manager be a better employer.
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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#7
(09-25-2016, 03:58 PM)Fallingfromtrees Wrote: No her dr did not because her dr changed and she got someone random who was not as good and said they cannot do anything about her personal form of transportation, but her workers comp adjuster must help her, which she called the adjusters supervisor who was pissed and said he would talk to the adjuster which was like 4 days ago and she still has not called back. She was not provided with list because her DM would not cooperate and no one knew where the list was and she just called the insurance company who gave her a dr, an industrial dr who seemed pretty young and new, but claimed she expedited a MRI...that was almost 7 days ago by late tonight it will be exactly a week. Also her job requires her to park in an employee parking lot and walk about a quarter mile around a mall, but her DM keeps saying figure it out and apparently implied to another gm that he wants to catch her fuckimg up at work while injured...we do not think corporate even saw her new restrictions because her DM claimed he emailed it and said they did not care and that she must cashier and figure out how she can do management stuff from her stool outside her kitchen with unqualified people doing her job, which is against corp policies so can he legally write her up for a job she cannot perform if her unqualified and untrained employees do incorrectly? And thank you for all of the info I will look up TTD because they want her to put in sick time for her 5 days off. I really appreciate the info sorry for the long posts I just felt the need to well illustrate the situation and I am so stressed and worried for her.

Does her employer have a human resource department? She can request a link to the medical provider network from her employer or claims adjuster. She should really not be at a doctor her employer or claims adjuster picks...because those doctors usually do what is in the best interest of the employer. Do you know if she is at an industrial clinic...they have names like Concentra and US Healthworks (I will delete after you read)? These are the types of clinics that injured workers get sent to by employer after an injury. They usually want to see the injured worker almost weekly or every two weeks.

I am not sure if the adjuster has to provide transportation to and from work...1171 have you read this before? Doctors do not always know the rules, but what he could have done was request the transportation in writing and send in a RFA form to the adjuster. This is usually how it is done, the doctor request transportation help and if she wants transportation to and from her doctor the doctor needs to request it and also state why. I have read they have to provide transportation to and from doctors appointments if she cannot drive due to her injury, but I am not sure about to and from work.

I recommend asking her doctor to write a note about employee parking situation and state why she needs accommodation from parking lot. She needs something in writing from her doctor. I do not know why her boss is being so horrible. Does her restrictions say anything about how far she can walk? If so I recommend her state to her employer that she cannot physically walk that far and can she park in the closer parking lot/customer until she is more healed (especially if she is in crutches). She needs to speak up and state she needs to park closer because her doctor stated it.

She should give her employer her restrictions and also anyone she is working under.Again, if they ask her to do things outside of her restrictions she needs to speak up and state she is not allowed because it falls outside of her doctors restrictions (but do this within reason example restrictions state she can only walk 10 feet and asked to walk 12 feet not a big deal, but asked to walk 1/2 mile it is a big deal). With the parking situation I recoemend saying something like my doctor said I cannot walk that far so temporarily can I park in the customer lot (that is figuring it out as her boss stated)? It does sound like her employer is making an effort to accommodate her..so I would try the best she can to work within them without doing something to re injure herself ( do not be unreasonable employee either). If her employer continues then she can make an appointment with her doctor and let him know they will not follow her restrictions and ask if can he place her on TTD. This is what I recommend but as you can see from what I wrote beneath this post I am not an expert, just another injured worker. To get opinion from an expert see attorney or information and assistance officer.

Additional info about timeline for requested treatment and testings:
Again as I wrote above they have 5 business days to make a regular request but forgot to mention the first day sent does not count (then they either mail you a response or approve it and do not send to UR so they are not late yet because mail takes a few days). If the adjuster needs more information a request can take 14 days, however expedited requests should take less time. They may have approved it and notified the doctors office. This happens all the time, so you can check back with them. The claims adjuster can approve a request or send to a utilization review department. Sometimes doctors do not write their reports the day the patient is seen and some take up to 20 days just to send in the request. The only way to find out when the MRI was requested is to go to the doctors office and ask for a copy of his report and copy of the RFA form and a copy of the fax or mail confirmation page to see when it was sent, or call and ask the doctors office if they received an approval yet from the adjuster as you will not get anything sent to you if adjuster approved it and did not send to UR utilization review). If it was mailed they add 5 extra business days before they have to respond. If the doctor did not send in the request on a RFA form it may be ignored.

CA work comp does not always move fast and is not like private insurance. This is actually a nightmare for many to get proper medical treatment as her doctors requests can be denied,. if so she should be able to use her private insurance.

They may require her to use sick days in lieu of TTD first (unknown). Most adjusters do not work weekends. Unbelievable the adjuster did not call back. I recommend calling the supervisor on Monday (start writing this stuff down who you talked to and what days you called and what was said. You can go above the supervisor, but I do not recommend it unless the supervisor does not return calls several times. Just know these people work for the insurance company or employer so they will be looking out for their best interest. It is not like dealing with private insurance. You can also call and I&A officer as I gave you the number above Monday through Friday. They should be able to help you and may call the adjuster as well (unknown). Give people a few business days to return your call.

Try not to worry about what the employer is trying to do, but definitely write everything down, the dates who said what just in case she is fired. I also recommend for her not to discuss her injury or other things about this with other regular employees as gossip usually makes things worse. Working within her restrictions has a lot to do with her and her speaking up for herself if something they ask will cause her injury. Again it does sound like her employer is making an effort to accommodate her, which is a good thing. If they don't she should receive TTD, so try not to worry. Make sure she is within her medical restrictions at work and elsewhere. They do send private investigators out to take pictures of people sometimes so if she claims she cannot drive to her doctors appointments make sure she is then not driving on her own time (just an example).

Review the links I provided and you will have a better idea of how things work with CA work comp.
I am not an attorney.Anything I write should not be considered legal advice.I am writing from my own personal experiences,which is not from any sort of legal background. You should consult with an attorney over legal issues. In California, if you cannot get an attorney you can consult with an I&A officer.
 
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#8
Transportation to and from work is not covered; mileage/ transportation for treatment only as its a " medical" benefit
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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#9
Thanks 1171.

One more question 1171. If part of her job description is parking far away and if she has restrictions on walking (I am assuming here since she is on crutches) then doesn't her employer have to allow her to park closer as accommodation and if they will not she would be TTD?

Her boss told her to "figure it out" when she told him parking 1/4 mile away in employee parking lot would be difficult. He could have replied and allowed her to park in customer lot until she is out of crutches would have been the right thing to do. Treatment like this is why employees get stressed out hire attorney's.
I am not an attorney.Anything I write should not be considered legal advice.I am writing from my own personal experiences,which is not from any sort of legal background. You should consult with an attorney over legal issues. In California, if you cannot get an attorney you can consult with an I&A officer.
 
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#10
not necessarily.
there maybe other ways the employer can provide modifications; maybe a shuttle of some kind or carpooling or someone to drop her off and then park etc.
if the employer cannot accommodate walking restrictions including required parking, then she would be eligible for TD payments.
she may have basis for an ADA complaint.
of course, Aholes can be found anywhere. most lead pretty miserable and petty lives with only few acquaintences who are willing to put up with it.
but generally they were created by a very mean spirited and hyper critical or abusive childhood environment.
not everyone can overcome such terrible role modeling, no one taught them the correct way to live and treat others.
I tend to feel sorry for them rather then anger. they are doomed to unhappiness.
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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