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QME done, 3% WPI, MMI Status, but, working
#1
I'm in California: Just got the QME, states 3% WPI for pain and MMI permanent and stationary status, with 10% of disability apportioned to non-work related activities. According to the 2005 PDRS I am in a Group 220 Occupation and the QME states I cannot ever return to my profession. Injury is to my thumbs and little finger and report states injury was caused by my work. Pending the QME results, my employer placed me in another job (based on my restrictions) at the same hourly pay which is (boring, but) great. Now that the report is in what happens next? Can my employer fire me/ lay me off if the PD settlement is less $$ than keeping me on as an employee even though I am successfully performing in another capacity? If they hired from the outside, the position I am in now would be at a significantly lower hourly rate, can they reduce my pay? I am 59 years old, how does my age figure in? I'm really confused about how this all works especially the 3% WPI. Because of the excessive demands for production/quota by my employer I became PD and have lost my career of choice but, still want to work. 

What are my options now and how do I know I am being fairly dealt with? Is the State Claims Administrator there for me or the Company? In the end is it advisable to have an attorney review the QME and PD Settlement? Will there be an actual settlement based on the loss of my profession, but does the fact that I'm working in another capacity negate an actual settlement? Do I have recourse if I don't think the settlement is fair? 

Any input would be much appreciated!
 
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#2
an employer is not required to find a permanent position for you. they cannot employ you in contradiction to your medical restrictions; it has nothing to do with the PD $$$.
the law does not require that they maintain your previous pay.
your age can modify you rating upward a small amount.

the comp court reviews all work comp benefits involving permanent impairment.
I've never heard of a State Claims Administrator in califnoria; are they an official with the state of california or someone in your company, or just a licensed adjuster?

Yes you need an atty to handle the QME report and your PD rating. 3% is incompatible with a restriction taking you out of your job. I suspect the rating or the restriction is in error and needs to be challenged.
go here to search for an atty specializing in workers comp:
CAAA.org

no the settlement will not take into account your job loss.
you can work and are still entitled to permanent disability benefits.
you need to learn more about workers comp in california.
start here
http://www.dir.ca.gov/dwc/InjuredWorker.htm
and here
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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#3
Thanks so much for your input. 

So... should I wait to hear what the court says? I wasn't aware it went to court. How long does this take?

Regarding State Claims Administrator... this was probably the Workman's Comp Insurance Company Claims Admin.

I originally met with a WC Attorney who spent a lot of time with me only to tell me he wouldn't take my case ... at that time (didn't charge me). But, if my claim was dismissed or if after the process got to this point (post QME) and I felt I needed assistance he would meet with me again. He is a former WC court judge and was extremely knowledgable. Is now the time to call or should we wait to hear what the court says?

Thanks!
 
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#4
the work load of the judges varies and often depends on the complexity.
you should not wait for the court, you want ambiguities resolved before the court see it.

a claims administrator is paid by the self-insured employer to adjust their claims. they are not necessarily an impartial or neutral point in the process.

talk to the atty now about the discrepancy between the 3% rating and the restriction from your normal duties.
such a minimal pain level rarely requires one to change their occupation. the doctor seems to be trying to please both you and the claims administrator/adjuster with their opinion and is really confusing everyone.

even if the atty still doesn't want to take the case they may be able to better explain how both opinions (on the rating and the loss of job) can be valid at the same time. it is such a low $$ case it's not cost effective for most attys

another option would be to negotiate with the adjuster for a higher rating if you are going to have to change carreers--- but that might be more then you believe you can do.
you could also try discussing the situation with the I&A officer. some may intercede with the claims adjuster on your behalf
http://www.dir.ca.gov/dwc/IandA.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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#5
The claims adjuster is always looking out for the best interest of the insurance company or self insured employer (unknown what you have but I assume your claim is with the states insurance company.

Your employer is doing the right think by allowing you to work another position.

I would contact that attorney ASAP. You can also call or meet with an I&A officer where you case is located and ask for their advice. This link may help answer some of your questions.

http://www.dir.ca.gov/dwc/InjuredWorker.htm
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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#6
Update: Just received paperwork from employer that states, "QME indicates that you have permanent limitations from your injury which we have rated at 8% or $6,960... including any future medical treatment." It also includes, "Pursuant to Labor Code 4650 (b)(2) advance permanent disablity payments are not due if your employer has offered you a position that pays at least 85% of the wages paid to you at the time of injury, or if you have returned to work for another employer that pays you at least 100% of the wages you earned at the time of injury. Any amount due will be paid if/when an award of permanent disability is issued."

OK... so my employer has given me another job that is "at least 85%" of the wages paid to me at the time of injury." Actually, I have been paid 100% of my wages in another job. The paperwork they want me to sign reduces my pay back to the rate I was at prior to the raise (minimal) I received during this process, I'll ask for my current rate before I sign the papers. 

My lingering question is this... when, if ever, do I receive the $6,960? I don't understand the Labor Code "Any amount due will be paid if/when an award of permanent disability is issued." Since we all agree that I have permanent limitations, is our agreement the "award of permanent disability?" Or, is the "award" the $6,960? Assuming "award" means the $6,960, if I continue to work does the "award of permanent disability" come when I leave the company? The paperwork guarantees the job for 12 months and if I 'voluntarily quit prior to working in this position for 12 months, I may not be entitled to the 'Supplemental Job Displacement Benefit.'" Next question, is the "Supplemental Job Displacement Benefit" the $6,960?

Sign me... So Confused!
 
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#7
The paper work is done only on your comp benefits and is not fixing you current wages. Your benefit rate is fixed for the date of injury wages.
The comp court doesn,t yet agree and has to approve all finalizations. It will issue an award after it's reviewed.
No, the agreement will probably be titled a "stipulation with request for award".
No, permanent disability is paid whether you are working or not.
The award will be for all benefits: temporary disability, medical treatment, and permanent disability.
No, the supplemental benefit is something else.
You really need to read the material on the website links we have posted:
Start with fact sheet D
http://www.dir.ca.gov/dwc/iwguides.html
http://www.dir.ca.gov/dwc/SJDB.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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#8
Thank you so much! Very helpful. Thank you for taking the time to answer my questions. Much appreciated!
 
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