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CA Can ins ask for another DEU 100?
#1
I have already seen a QME doctor in 2007 and received a rating. Now the insurance carrier has asked me to submit another DEU 100 can they legally do this? Im in CA
 
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#2
yes. there is no law against asking.
sounds like you got a physician's impairment rating but what about a permanent disability rating?
your input will help the state produce a more accurate calculation of your PD benefits.
why would you not want some input before this is done?
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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#3
They're (insurance co) telling me my PD rating was miscalculated. My orig injury date was 2004 went back to work in 2005 and I was re-injured (same exact injury) in 2006 my PD was calculated using 2004 and should have been 2005 (less $). I got my settlement in 2009. They contacted me two weeks ago to discuss future medical and a lump sum. I said that I would entertain the possibility of a lump sum and they sent me a DEU 100 to fill in with a due date. Since my PD was miscalculated (according to them) I need to have it recalculated.
I was asking because I have already gone through the QME process and thought that was it. My adjuster (?) assured me it was not another QME request. I sent it off using the same statement in my original DEU 100 with the questions about doctors and appointment dates x'd out.
 
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#4
if they want to settle you should get a number from them before doing much more.
the figure they have in mind might not be worth your time and trouble.

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
Thanks, They wont give me a number until they recalculate and they say I will probably owe them from any amount because they overpaid me. Can you tell I don't trust them? Thanks again
 
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#6
(08-29-2012, 06:52 PM)ChiliK Wrote: Thanks, They wont give me a number until they recalculate and they say I will probably owe them from any amount because they overpaid me. Can you tell I don't trust them? Thanks again
I think they already recalculated-that's how they caught the error.
it's not that hard for them to do.
yup.
and the only way they can recoup the amount is from a C&R. the law won't let them deduct it from your medical or another claim.
if you do a C&R you are giving them a way to collect the overpayment that they don't have now.
don't just give that to them without getting something in return-like
allowing them credit for only half the amount.
or have them send you an advance on the C&R (before you sign!)
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
(08-29-2012, 09:08 PM)1171 Wrote: and the only way they can recoup the amount is from a C&R. the law won't let them deduct it from your medical or another claim.
if you do a C&R you are giving them a way to collect the overpayment that they don't have now. don't just give that to them without getting something in return-like allowing them credit for only half the amount. or have them send you an advance on the C&R (before you sign!)

I have received all PPD payments according to the amount listed in a WCAB letter. They were bi-weekly and have stopped since 2009. I thought the only thing they "owed" me was future medical. Should I be careful when they mention C&R? Could a C&R allow them to change the definition of "future medical" for purposes of recouping the over payment?
I don't have an attorney and really appreciate your help.

 
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#8
If you already received your award what other settlement is available?
What did you think the lump sum was for?
A compromise & release will buy out all future benefits including medical and the claim will close.
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
It sounds like whoever is working for the IC has no clue.

First of all, no, you don't have to complete that form. If the insurance company wants the report rerated, a halfway decent adjuster should be able to do it. If not, there are private raters all over who can review and give a reliable rating.

Secondly, it sounds like you settled by Stipulated Award, and probably based on the apparently erroneous rating. They never filed a petition to set aside, so this is moot. Further, this whole "you'll have to pay it back" is totally wrong. There is no regulation that requires you to pay back overpaid PPD. Further, unless a judge orders it, there actually is no overpayment.

Lastly, they could try to credit the overpayment of PPD against what they would offer, but don't do it. They need to give you some information, and then counteroffer at least the alleged overpayment amount plus their offer. If their offer is lousy, screw it and don't accept it.
 
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#10
(08-30-2012, 08:42 AM)Woodlawn Wrote: It sounds like whoever is working for the IC has no clue.

First of all, no, you don't have to complete that form. If the insurance company wants the report rerated, a halfway decent adjuster should be able to do it. If not, there are private raters all over who can review and give a reliable rating.

Secondly, it sounds like you settled by Stipulated Award, and probably based on the apparently erroneous rating. They never filed a petition to set aside, so this is moot. Further, this whole "you'll have to pay it back" is totally wrong. There is no regulation that requires you to pay back overpaid PPD. Further, unless a judge orders it, there actually is no overpayment.

Lastly, they could try to credit the overpayment of PPD against what they would offer, but don't do it. They need to give you some information, and then counteroffer at least the alleged overpayment amount plus their offer. If their offer is lousy, screw it and don't accept it.

that's my reading of the situation as well.
Chili holds the high cards and they hope he doesn't realize it and folds.
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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