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California-No disability benefits now defense wants to depo AME
#1
Hello,

I am 47 and had an AME done in June 2016.  I have been having a horrible time with the workers comp insurance carrier and their attorney. First back in Nov 2015 the claims specialist contacted SDI and said they were paying me when I have never received any disability payments from them. SDI deducted money and I was unable to get this corrected until May when I was finally able to obtain a letter from the claims specialist saying they were withholding any payments until they received the AME report for his determination of my temporary or permanent status. The report states I am permanent and stationary as of 6/21/16. I am not capable of performing my regular work activities. He apportions 100% of my impairment to industrial cumulative trauma.  I have been diagnosed with CRPS of the right arm and hand. The most accurate measurement of the patient's impairment is obtained by using Table 13-22, page 343, class 2 = 18% WPI Now that I have a rating and I am permanent they want to depose the AME which won't be until October and still are not making any temp or perm disability payments to me. I have already exhausted my SDI payments and I Have applied for social security. I just don't understand how they can get away with not paying me any payments? They are paying for all of my medical treatments. Any advice us greatly appreciated. My attorney says we can't do anything until after the AME is deposed but there has to be something??
 
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#2
Even if they decided to pay your TD, they would have to deduct & reimburse SDI the overlap $$.
As An alternative You might be able to settle.
If you don't trust the advice of your atty, you can contact others before deciding to switch.

Both sides have multiple levels of appeals even even after the court makes a decision. Many claims take years to resolve.
Sounds like you need to settle as there could be more delays with hearings an appeals yet to come.

Since you are only partially disabled you can get a job within your restrictions without jeprodizing your claim for PD benefits.

They have to pay the benefits they are not disputing. If the issue is just whether the rate should be TD or PD, they should pay the minimum minus the SDI lien. Delays happen all he time. They will not "get away with it" if you request the court add a penalty for unreasonable delay once you have evidence to support it.
Those decisions can also be appealed to a higher court.
You don,t want a bad/erroneous AME opinion to lead to an unfair determination. 
Both sides often find it difficult to support the legal process as fair when you feel it affects you negatively.

Possibly SDI will restart if the TD period is still in dispute.
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
(07-27-2016, 02:12 AM)CRPS485 Wrote: Hello,

I am 47 and had an AME done in June 2016.  I have been having a horrible time with the workers comp insurance carrier and their attorney. First back in Nov 2015 the claims specialist contacted SDI and said they were paying me when I have never received any disability payments from them. SDI deducted money and I was unable to get this corrected until May when I was finally able to obtain a letter from the claims specialist saying they were withholding any payments until they received the AME report for his determination of my temporary or permanent status. The report states I am permanent and stationary as of 6/21/16. I am not capable of performing my regular work activities. He apportions 100% of my impairment to industrial cumulative trauma.  I have been diagnosed with CRPS of the right arm and hand. The most accurate measurement of the patient's impairment is obtained by using Table 13-22, page 343, class 2 = 18% WPI Now that I have a rating and I am permanent they want to depose the AME which won't be until October and still are not making any temp or perm disability payments to me. I have already exhausted my SDI payments and I Have applied for social security. I just don't understand how they can get away with not paying me any payments? They are paying for all of my medical treatments. Any advice us greatly appreciated. My attorney says we can't do anything until after the AME is deposed but there has to be something??

I agree with everything 1171 wrote above.

Is your date of injury after 1/1/2013 (please do not write your exact date of injury just if it was after 1/1/2013)? If your date of injury is after 1/1/2013 the insurance company no longer has to provide advances on PD payments and can hold on to them until you settle. I have noticed by reading this site many are advancing PD anyway which is a good thing.

Once they P&S you, they no longer have to pay you TTD. For this reason I do no know how much if any TTD benefits will be paid to you even after they depose the AME because they will deduct payments paid to you from SDI. I agree with what 1171 wrote above about this.

What I do recommend is to request an expedited review from SSDI. You can do this if you are in severe financial need as you are. It may benefit you to retain a SSDI attorney for this, but you may be able to do this on your own. Otherwise it can take years for some to get approved. I have seen patients get approved within 3 months by requesting an expedited type of review. I am not sure how they did this, but other posters on this site have been successful.

Have you applied for SSI (supplemental security income)? You apply for this at your SSDI office and it is different from SSDI. It is for those who are both disabled and are in severe financial need. You may also qualify for CalFresh (formerly food stamps) as well as other benefits.

You can also request from your attorney to ask the insurance company for advances on your PD, although it looks like he cannot do this until after the deposition (however it does not hurt to ask).

Did the AME state you can return to work with restrictions at all?

If you were injured after 1/1/2013 you may qualify for supplemental job displacement benefits if you cannot return to work. These vouchers are valued at $11,000. and one is a check for $5,000. that can be used on anything.

Please do not take what the defense is doing personal. What you wrote above is common, with deposing the AME etc. This system works very slow. I am not sure if there is anything more your attorney can do at this time. As I wrote above you can request advancement on PD (you may have to wait for AME depo) and you can also ask about supplemental job displacement benefits.

I recommend joining a support group or forum on-line for RSD/CRPS. There are different types of treatments to help with pain and also help with preventing spreading.
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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