[bravo]

hello, first timer here.
I live in california, perhaps this is going to be a complex case to most of you but here it goes..im a private investigator and my specialty is workers comp and undercover work.. so on may 09 i was given an assigment. to work undercover at a factory, so i was hired to work as a regular employee in a company of 1000 employees, no one knew of my operation execpt for the owner and HR Director, anyways through the course of my investigation I injured my self on 6/9 as usual i wrote a report and submited to my case manager from the p.i firm, i didnt think too much of my injury i thought i had just intake some air in my back no big deal...well time went by i didnt pay too much attention to it..on 8/7 a 75 pnd weight fell on my foot, for that i was sent to the doctor and treated, a week later i was fired from my uc operation. *keep in mind no one knew of my operaiton. the HR Director had no say in this, because if she did she would blow my cover. so i was fired.

My main employer the p.i firm althou upset but they understood that the company had no idea who i was, and although they fired me in an illegal way we where bitting the bullet. at this time my back problems where getting worse, so i wrote another report, submitted to my case manager, he kept giving me the run around, so finally i filed for workers comp and got an attorney on 11/4 and the insurance co. ended up denying me 7 months after i filed, ofcourse that was illegal because they only have 90 days to investigate if my claim is valid or not. but i wasnt denied until 7 months after filing, so now its almost two years since I filed, ive been treated havent worked all that time, I have the L4 L5 herniated disc, wrist problem and foot problem.
MRI showed.

Ive been to a MSC mandatory settlement co. and my case was put off the calendar, so i went back to my doctor to be released MMI i did my FCE functional capacity exam and i just saw the doctor for final rating a month ago...

so here are my questions.

1.what happens next?
2.will i get back pay even if i was denied?
3.since i was working for two employers during the time of the accident
does that mean they both take care of me?
4.what happens when i get the docs rating?
5.How long can it take?

any one here also recently done with MMI?

thank u all.

[jayne]

all I can say is Karma dude Karma......dont know if you are serious or not you do not sound like a pro...but if you are 1171 will be the one to go to.. he/she is the Ca expert....

[bravo]

i wrote all of that out of my nokia handheld tablet, I dont understand by what you mean karma? for what?

---

when I mean specialty in workers comp, I was an investigator not an attorney or adjuster, although im familiar with most of the process, i never saw it from an injured workers perspective..

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[1171]

once there is a rating finalization efforts can begin.
generally 3 paths: negotiated buyout of all benefits -Compromise & Release
negotiated disability award with open medical
court ordered benefits with open medical.

I am assuming the claim is against your P.I. employer, you haven't worked for them since the incident and are no longer employed by them.

I don't know the terms of the agreement of your undercover assignment but I doubt the factory could be considered a legitimate employer-- only a false relationship.

you and your atty need need to pursue the court ordered benefits and allow the carrier to try and negotiate something agreeable to you. that way if negotiations falter your still got a court date lined up.

there is no time limit to resolve disputes each case has different needs and different players.

[Bummer Knees]

Welcome to the real world of injured workers.

Many injured workers end up loosing their jobs, home, vehicles, and sometimes family because of the games the insurance companys play.

The injured workers who receive settlements for the most part are the ones who will never be able to work again.

[bravo]

thank you for your prompt response,

See there are many details to this case that are perticularly complicated,
for one the p.i firm is not on the suit,their name is on the paperwork but the undercover company IC is the one taking care of the case. I was getting a check from them too, In other words I was in the pay-roll,

My main concern is the backpay, they owe me 19 mo's of pay,
How would that work?
And finally, Once I get my MMI rating next month do you think it might take long?

From your personal experience.

thank you

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(06-24-2011, 08:37 PM)Bummer Knees Wrote: Welcome to the real world of injured workers.

Many injured workers end up loosing their jobs, home, vehicles, and sometimes family because of the games the insurance companys play.

The injured workers who receive settlements for the most part are the ones who will never be able to work again.

even as a P.I I knew IC were always doing things on bad faith, but you have to remember that there is alot of fraud going on out there,
I see it from a point of view of the injured worker now, and its not pretty at all,

[1171]

are you still employed by the PI firm?

you still have not explained the undercover agreement:
who paid you-- one /both?
who controlled when you quit or when the assignment was completed ?
how it was performed ?
how long you stayed on the assignment?
how the operation was to be conducted?

it appears that you are still undercover posing as an injured employee on comp!!
if not, how can anyone tell the difference?
if you are no longer undercover and posing as an employee, why you are still taking the factory's comp payments?
have you disclosed your undercover relationship to the carrier or the comp court or your atty?



your situation could be similar to a temporary help agency; their employees are not employees of their clients and would not be covered by the client's comp policy.
or similar to a consultant who is hurt while at a clients job site--they are not covered by the client's comp carrier.

if not disclosed, you could be accused of trying to shift liability from your PI employer to their client.
whether you have dual employment or single employment is a fact for the court to decide, not you.

if you are willing to sign any thing the carrier offers, you could be settled in 6 mths -- of course it depends on your employment status.

[bravo]

(06-24-2011, 10:11 PM)1171 Wrote: are you still employed by the PI firm?

you still have not explained the undercover agreement:
who paid you-- one /both?
who controlled when you quit or when the assignment was completed ?
how it was performed ?
how long you stayed on the assignment?
how the operation was to be conducted?

if you are no longer undercover and posing as an employee why you are still taking the factory's comp payments?
have you disclosed your undercover relationship to the carrier or the comp court or your atty?


your situation could be similar to a temporary help agency; their employees are not employees of their clients and would not be covered by the client's comp policy.
or similar to a consultant who is hurt while at a clients job site--they are not covered by the client's comp carrier.

if not disclosed, you could be accused of trying to shift liability from your PI employer to their client.
whether you have dual employment or single employment is a fact for the court to decide, not you.

if you are willing to sign any thing the carrier offers, you could be settled in 6 mths -- of course it depends on your employment status.

Im sorry for the mis-understanding,, No the case was over the moment I was terminated, which was 4 months into the case, When I said I was getting checks from the Undercover job, This is how the pay system worked when you work a(UC) undercover operative, (Let's say I was getting pay $25.00 as an Investigator, But when ever I have a UC case let's say for example I would get pay $8.00 In the UC case, then the P.I firm will off balance my check to $17.00.. So at the end I would be receiving two checks, the P.I firm would pay me $17.00 hr, and the UC would pay me $8.00, Understand?...So I was getting two checks at the time of the injury, the terms of my UC operative was simple, I was to be hired as a regular employee, so my employment was just like anyone else's. I worked just like everyone else, I was investigating fraud, and sexual harrastment. I would work 5 days a week at the end of each day I would do a Daily report to submit to my case manager, always reporting to him, So when I was injured I reported to him, the reson why they fired me was simple,,, a week after my second injury they pulled me into the office and said my job was terminated, the only person who knew of my UC operation was the owner and the HR Director, But when word came down of my termination they could not do anything about it or else they would risk employees finding out about the case, (an owner defending an employee, no bueno)

When you say settle with in 6 months, and all depends on my employment status... What do you mean?

I will not go back to the P.I firm because they gave me the run around, so Pretty much I walked out on them, so u can say I dont have a job.
And the doc, gave me MMI I still dont know the rating But I was told to go back to work with restrictions, extreme restrictions,

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(06-24-2011, 10:11 PM)1171 Wrote: are you still employed by the PI firm?

you still have not explained the undercover agreement:
who paid you-- one /both?
who controlled when you quit or when the assignment was completed ?
how it was performed ?
how long you stayed on the assignment?
how the operation was to be conducted?

it appears that you are still undercover posing as an injured employee on comp!!
if not, how can anyone tell the difference?
if you are no longer undercover and posing as an employee, why you are still taking the factory's comp payments?
have you disclosed your undercover relationship to the carrier or the comp court or your atty?



your situation could be similar to a temporary help agency; their employees are not employees of their clients and would not be covered by the client's comp policy.
or similar to a consultant who is hurt while at a clients job site--they are not covered by the client's comp carrier.

if not disclosed, you could be accused of trying to shift liability from your PI employer to their client.
whether you have dual employment or single employment is a fact for the court to decide, not you.

if you are willing to sign any thing the carrier offers, you could be settled in 6 mths -- of course it depends on your employment status.

BTW Forgot to tell you,,Yes my atty knows I was working UC,the carrier also knows, and Ofcourse the moment I filed Workers comp the UC employer became aware of who I was, So yes everyone knows,

---

Also, One more thing, Since I dont have a job to go back to, AM I still entitled to my back pay?

[AQA]

Just a note.

Forgive me, for I just finished speed reaing the info that was provided. I will reread it in the morning.

You stated that you were released from the dr. and able to go to work with restictions. However; you don't have a job to go back to. I believe that is what I read.

Have you filed for unemployment benifits??? Just a thought.

1171 has been doing the regular great job by providing information and asking specific questions so he/she can give answers.

[bravo]

(06-25-2011, 01:13 AM)AQA Wrote: Just a note.

Forgive me, for I just finished speed reaing the info that was provided. I will reread it in the morning.

You stated that you were released from the dr. and able to go to work with restictions. However; you don't have a job to go back to. I believe that is what I read.

Have you filed for unemployment benifits??? Just a thought.

1171 has been doing the regular great job by providing information and asking specific questions so he/she can give answers.

yes 1171 has been very helpful, and to answer your question,
exactly,the doctor gave me MMI still waiting on my rating,but he said i could return to work, with 25 pnd weight limit sedentary work, although i dont have a job to go back to, im wondering if i can still get my back pay owed for 19 months. is it a positive or a negative that i can go back to work,with out ever receiving benefits from the ic?

thank you for your help.