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P&S with restrictions but no disability rating. What?
#51
(09-21-2016, 06:03 AM)1 Hurt nurse Wrote: Hi. Doctor did not approve modified work at all. Made me total TD until re-eval. I don't really have an Atty per se. Was speaking with one about my case but my back hurt so bad because of the modified I didn't care anymore and felt like I had to give my notice. QME was very clear with wording on apportionment. Said 100% caused by my employment. Not sure what to do now. If TD not affected by location I think I'll just give my workers comp agency the doctors info and out of country address and see what happens there. Are there laws that say the practitioners have to be licensed in the US? The chiropractor is but not sure if PT or acupuncturist will be. They may be Australian.

You need to be seen every 6 weeks or so and have a continued TTD note by a doctor or you may not be able to receive TTD. It is unknown if you can even receive TTD after quitting your job.

I think it would be very difficult to treat in another country, but contacting an attorney or and information and assistance officer at the work comp board would be your best bet as 1171 wrote above.
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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#52
(09-22-2016, 01:42 PM)California_Help Wrote:
(09-21-2016, 06:03 AM)1 Hurt nurse Wrote: Hi. Doctor did not approve modified work at all. Made me total TD until re-eval. I don't really have an Atty per se. Was speaking with one about my case but my back hurt so bad because of the modified I didn't care anymore and felt like I had to give my notice. QME was very clear with wording on apportionment. Said 100% caused by my employment. Not sure what to do now. If TD not affected by location I think I'll just give my workers comp agency the doctors info and out of country address and see what happens there. Are there laws that say the practitioners have to be licensed in the US? The chiropractor is but not sure if PT or acupuncturist will be. They may be Australian.

You need to be seen every 6 weeks or so and have a continued TTD note by a doctor or you may not be able to receive TTD. It is unknown if you can even receive TTD after quitting your job.

I think it would be very difficult to treat in another country, but contacting an attorney or and information and assistance officer at the work comp board would be your best bet as 1171 wrote above.
 
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#53
Hello everyone, the saga continues and I have a few more questions.
Here is my current situation:
Still living in Bali receiving excellent care from a Licensed American Doctor who is now my Primary Treating Physician.
Lower back is getting slowly better with therapy three times/week. Pilates/rolfing, recommended by QME. Workers comp reimbursing therapy.
Had my re-eval by my QME in November and she made me P&S. 8% for my lower back and an extra 4% for pain. Adjuster still waiting for details of injury to determine if I should receive TD. Resignation does not seem to be a factor at the moment but workers comp just placed a DA on my case so we will see.
Presently however my neck and one spot in my right scapula are not yet making much progress. These spots have been well-documented as problems since my injury but were not claimed on my initial DWC as I didn't realize they were considered separate from my lower back. Same back. So I have now filed to add these to my claim and have another QME appointment to evaluate causation March 1st. My adjuster has denied these additional body parts which I imagine is customary.
So:
1. Should I be worried about a DA assignment and get my own representation or is this normal after a year?
2. How likely is it that my QME will add additional body parts at this time?
3. What transportation costs should be covered by Workers comp?
4. Even though I am not receiving TD at this time it looks like I will eventually be compensated in that way. Unfortunately they are not basing my rate of pay for that on my full-time wages at time of injury. They are basing that on a part-time rate from when I briefly attempted to return to full-duty but couldn't. All the reading I have done says this is incorrect.
5. They are also basing my PD on this part-time rate.
Thanks for any advice!
 
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#54
I assume you want california information as I did not reread all your prior posts.

often times internal carrier guidelines call for atty oversight at certain points or time frames. difficult to tell what triggered atty referral.
QME will review all your medical records. make sure they are complete. if the body parts have been mentioned in prior reports, then it's likely the QME will confirm.

L.C. 4600 C. 6. e. 1.
"(e) (1) When at the request of the employer, the employer’s insurer, the administrative director, the appeals board, or a workers’ compensation administrative law judge, the employee submits to examination by a physician, he or she shall be entitled to receive, in addition to all other benefits herein provided, all reasonable expenses of transportation, meals, and lodging incident to reporting for the examination, together with one day of temporary disability indemnity for each day of wages lost in submitting to the examination."
https://leginfo.legislature.ca.gov/faces...&article=2.

this applies to all authorized medical treatment as well as medical/legal exams.

general legal theory for TD supports an Average Weekly Wage calculation base on the best estimate as to what you would have earned during the period of your disability had you not been injured. you would need to supply such evidence. W-2s should suffice. PD rate can differ and can include wage information based on projected future occupational earnings.
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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#55
(02-10-2017, 08:36 PM)1171 Wrote: I assume you want california information as I did not reread all your prior posts.

often times internal carrier guidelines call for atty oversight at certain points or time frames. difficult to tell what triggered atty referral.
QME will review all your medical records. make sure they are complete. if the body parts have been mentioned in prior reports, then it's likely the QME will confirm.

L.C. 4600 C. 6. e. 1.
"(e) (1) When at the request of the employer, the employer’s insurer, the administrative director, the appeals board, or a workers’ compensation administrative law judge, the employee submits to examination by a physician, he or she shall be entitled to receive, in addition to all other benefits herein provided, all reasonable expenses of transportation, meals, and lodging incident to reporting for the examination, together with one day of temporary disability indemnity for each day of wages lost in submitting to the examination."
https://leginfo.legislature.ca.gov/faces...&article=2.

this applies to all authorized medical treatment as well as medical/legal exams.

general legal theory for TD supports an Average Weekly Wage calculation base on the best estimate as to what you would have earned during the period of your disability had you not been injured. you would need to supply such evidence. W-2s should suffice. PD rate can differ and can include wage information based on projected future occupational earnings.
Would you consider fares from Indonesia reasonable if I am the one requesting the appointment?
Thanks
 
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#56
is it the same QME as november.
if you've moved further away or relocated in the mean time then it could be considered unreasonable. probably should negotiate something before the apt. there maybe closer QMEs or costs can be split. better done before then after, when there are no options.
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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#57
(02-10-2017, 09:01 PM)1171 Wrote: is it the same QME as november.
if you've moved further away or relocated in the mean time then it could be considered unreasonable. probably should negotiate something before the apt. there maybe closer QMEs or costs can be split. better done before then after, when there are no options.

Same QME as November and they paid for that flight from Indonesia but it was a mandatory appointment. I asked for this one so not sure if it makes a difference. My adjuster is meeting with the DA for the first time today. I have already booked my flights and hoping to have them reimbursed. Couldn't wait for the decision by the DA because the fares were climbing and my appointment is set. My adjuster said he would address it and reimburse if possible. I doubt there is a closer QME and feel that mine is a fair one.
 
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#58
if possible it should be the same QME, so I'd expect the same travel arrangements would apply.
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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#59
If you have denied body parts I recommend to hire an attorney.

You are absolutely owed an additional $5,000. voucher on top of the $6,000. voucher you received. There are deadlines to apply so make sure you apply. You can call an I&A officer and discuss how to apply for it. This $5,000. voucher is basically a check that you can use for anything and does not have to be used for school. Claims adjusters do not have to notify injured workers about this additional voucher, and why many are not getting claimed.
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.
 
Reply
#60
Hi all!
So here is the update.
1) I got a last minute status hearing before a judge who ruled that I could keep my QME appointment for my additional body part because it was warranted by my physician
2) QME determined that my neck was involved in original injury and should be added
3) Got an ADJ number from I&A officer so able to get the additional $5,000 voucher
4) Calculation from my neck being added brought my total percentage up from 18 to 25, not sure what that means financially yet
5) Offered to settle my case for global C&R of 75,000, defense said they were waiting on QME report (which they have now)
6) Defense claims EDD overpayment of 7,500 during the time I started getting my PD payments (confused by this because I thought those two were mutually exclusive
7) Spoke to EDD and they agreed to reduce it to 5,000
Questions:
Does this mean I'm personally responsible to pay back that money?
Doesn't workers comp usually pay back EDD liens?
How do I arrange my global settlement?
How do I find out how much my neck addition added to my PD amount?
Thanks!
 
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