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How is a WC settlement calculated in California
(02-18-2014, 07:40 PM)Mocabean Wrote: 1171 - I see that you've been an active contributing member for a long time and, I imagine you've been instrumental in helping so many of us (injured workers) just make it through one more day without losing our sanity, which is why I'm wondering why your last post in reply to pleasehelp was so abrasive. There were two excellent links and some sage advice in your last post but that information was hard to find under the steaming pile of criticism and condescension that you also included. FYI, I'm not big on posting to message boards, and I only write reviews when a product or service has been either exceptional or terrible and, even that's not often. I just know what it is to be unfamiliar, frustrated, and agitated with 'the system'. People end up blaming everyone because they don't know where the road block is.

I suggest reviewing the links 1171 supplied. You need to become aware of the UR and IMR rules to get medical treatment. If you are not aware of them, then receiving treatment may become difficult. I placed in search words in the top corner of the dept of industrial relations that 1171 sent you and put in utilization review. This is the link that an help you a lot. Click frequently asked questions link for example in the above. Read a few links a day on that site, and you will gain knowledge.


You can get help from an information and assistance officer at your local work comp board. You can call or go in person. They can help you through this.

Did you receive your file from your former attorney?

You need to make sure you are now copied on your doctor's reports as you are now representing yourself.

I did read back at your string of posts on this link. One stated you had a doctor's appointment three weeks prior and he was going to request physical therapy and you have not heard anything. There is a process that requests have to go through. Some doctors offices don't get reports out for tree weeks to the adjuster. You need to know these things.

1. When was the treatment request faxed or mailed to the adjuster.

2.The adjuster has 5 business days after this to decide to approve or send to UR. If more information is needed then you will be notified of a delay and then UR has 14 days to respond.

3. If the request was denied by utilization review, you and/or your doctor have 20 days to appeal the denial or you can request an IMR (independent medical review). You have 30 days from the UR denial to do this.

4. If UR appeal was also denied you have 30 days to request and IMR.

5. If you fail to request an IMR within 30 days then this denial will stand for a 12 month period unless your condition has changed or evidence was not previously submitted to UR is available.

If you adjuster failed to send the request to UR, then I suggest filing for an expedited hearing. An I&A officer should help you with this. You can also file if your adjuster sent your doctor's request though UR late.

I would continue to look for another attorney. Try not to hire the large mill type of firms, and find a single practicing attorney who is either a work comp specialist or MOST of his practice is work comp.

I the mean time you can get help from I&A officers. They are a great resource that many do not use.

Good luck to you.
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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