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Self insured employer in CA
#1
I recently filed a claim through an attorney citing cumulative injury. I have severe C-spine spondylosis, foramina stenosis and spondylolithesis with some instability and the same in my lumbar spine. Severe pain and some loss of function in my hands etc. My employer is a small independent hospital (self insured). How does a self insured employer differ from one having an IC? I am receiving treatment for my injuries pending the outcome of my case. After reading the horror stories here I must admit that I fear for my future. My claim is totally valid as the population I work with are often morbidly obese and immobile. I have voiced concerns about patient/staff safety issues over the years. We are chronically understaffed and poorly equipped. For example, we are forced to treat patients on treatment tables not rated for their weight etc. Has anybody had a positive experience with workers comp in CA? 
T
 
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#2
with a self-insured employer the claims costs are all paid by the employer and they can adjust the claims themselves or hire someone to do it for them. a carrier charges premium which is fixed prior to the coverage period and the carrier agrees to pay the claim no matter how many or how expensive any individual claim is.
workers comp is "no fault" so negligence/liability issues are not really relevant to your case; you do not have to show/prove the employer was at fault---just be an employee and be hurt because of your work duties and you are covered.

most of those that post on message boards have problems with their claim. this is a very very small number out of all the work injuries. those that don't have problems rarely if ever come here to say how great the system is. you only hear about the worst cases on message boards.
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
In my opinion self insured employers are all different. Some seem to take more control of the claim than others. Some treat their employees well while others get emotional and upset at employees who file work comp claims. If you are receiving proper medical treatment, I recommend not hiring an attorney and especially if you want to continue to work there. Some employers take this personally. (JMO)
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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#4
I have received a letter of denial and have decided not to appeal. Workers comp seems like a nightmarish situation and my condition is serious. Can my health insurance provider contest my decision not to pursue my WC case?
 
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#5
not really; they have no standing if neither of the primary parties (employer/employee)choose not to litigate.
they may want a copy of your denial from the carrier.
if you think you might be be off work a year file for SSDI asap.
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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#6
(03-24-2016, 04:51 PM)tiona Wrote: I have received a letter of denial and have decided not to appeal. Workers comp seems like a nightmarish situation and my condition is serious. Can my health insurance provider contest my decision not to pursue my WC case?

If you do not appeal you may be giving up benefits such as worker compensation TTD payments if you are not able to work due to your injury up to 104 weeks. I would recommend discussing this with your attorney.
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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#7
(03-24-2016, 04:51 PM)tiona Wrote: I have received a letter of denial and have decided not to appeal. Workers comp seems like a nightmarish situation and my condition is serious. Can my health insurance provider contest my decision not to pursue my WC case?

Can't say I fault you not going through with work comp, after almost 8 years, if I had it to do over I never would have filed a work comp claim knowing what I know now.
 
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#8
you don't have to file. if it's a work injury the doctor and employer are required to file.
it's not a choice.
you can turn down the benefits but it's not your choice to make it comp or not.
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
(03-27-2016, 10:12 PM)1171 Wrote: you don't have to file. if it's a work injury the doctor and employer are required to file.
it's not a choice.
you can turn down the benefits but it's not your choice to make it comp or not.

I never said I would see a doctor outside of work comp, I would have been better off not seeing one, I did say knowing what I know now. Interesting enough, I remember reading a work comp blog where some defense and applicant attorneys would do the same, not report it, and yes I know it would be considered a form of insurance fraud. Rolleyes
 
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#10
neither you nor I posted anything about seeing doctors.

for others that might read this: remaining silent about a work injury would not be fraud.
giving an untrue history of your injury would be.
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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