Hello There, Guest! Login Register
Index    |     Search    |     Members    |     Help

Thread Rating:
  • 0 Vote(s) - 0 Average
  • 1
  • 2
  • 3
  • 4
  • 5
On WC but not on WC??
#1
Question 
Hello everyone! Im needing a bit of help with my California Wc case. The thing is i caught a patient (saved her life) and hurt myself. I have three herniated discs now and i have had care twice (on a lien bases) in the past two years only. I cant understand why someone whos claim was accepted by the insurance company initially has gone two years without wc and the proper medical care? The only reason they recently responded regarding the case is simply due to the fact that an expedited hearing (about medical) was filed. AND BAM! After two years of hearing nothing from them except that they accepted the claim, the new claims adjuster sends me documents stating i can seek medical on there dime, but i cant receive temporary disability or a voucher for job replacement (when i clearly cant caregive). I already got Td though -_-  So i only had td for about maybe seven months and that maxed out. Due to them not sending me wc checks for months! How are we to survive when a doctor has you temporarily totally disabled and you are not getting td or wc checks? Also the insurance company recently tried to settle with me three times, but none of the offers even come close to what i deserve for the past two years of no work! Also i had another job also in caregiving when i got hurt and due to being off work so long i was let go. So i lost two jobs due to this injury, can i recover the lost wages from both?
 
Reply
#2
california comp does not reimburse lost wages. it can pay temporary and permanent disability.
if you have persuasive supporting medical evidence you can ask the court to decide your disability.
you might want to obtain legal representation to help resolve the dispute.
if so you can find a list of atty comp specialists in your area here
caaa.org
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.
 
Reply
#3
(02-16-2017, 07:55 PM)Babybadback Wrote:
Hello everyone! Im needing a bit of help with my California Wc case. The thing is i caught a patient (saved her life) and hurt myself. I have three herniated discs now and i have had care twice (on a lien bases) in the past two years only. I cant understand why someone whos claim was accepted by the insurance company initially has gone two years without wc and the proper medical care? The only reason they recently responded regarding the case is simply due to the fact that an expedited hearing (about medical) was filed. AND BAM! After two years of hearing nothing from them except that they accepted the claim, the new claims adjuster sends me documents stating i can seek medical on there dime, but i cant receive temporary disability or a voucher for job replacement (when i clearly cant caregive). I already got Td though -_-  So i only had td for about maybe seven months and that maxed out. Due to them not sending me wc checks for months! How are we to survive when a doctor has you temporarily totally disabled and you are not getting td or wc checks? Also the insurance company recently tried to settle with me three times, but none of the offers even come close to what i deserve for the past two years of no work! Also i had another job also in caregiving when i got hurt and due to being off work so long i was let go. So i lost two jobs due to this injury, can i recover the lost wages from both?
Something does not sound right. I need some information before I can give you my opinion.

Do you have an attorney? I ask this because if your claim has been accepted why are doctors doing things on liens? Usually when this happens your claim is denied, an applicant attorney has sent you to a doctor outside of your insurance companies MPN or injured worker went to a doctor outside of the MPN.

Doctors are rarely doing treatments these days on liens and there is no reason to with an accepted claims. They do not have to provide you with treatment if you are seeing a doctor outside of the MPN. Does your work comp  insurance carrier have an MPN and if so are you seeing a doctor within it?

In regards to TTD, you can receive it up to two years unless your doctor or a QME or AME deemed you permanent and stationary, and if so TTD stops. Has a doctor done this? If your treating doctor has not and a QME has you should apply for state disability through EDD. If you have not been deemed P&S your work comp should continue to pay you TTD up to two years.
http://www.edd.ca.gov/File_and_Manage_a_Claim.htm

If you were offered a voucher then your employer is stating they will not allow you back to work. Has this happened?

What is the specialty of the doctor you are at and who sent you to him your attorney or claims adjuster? Have you had a surgery? 

Who filed for the hearing you or 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.
 
Reply
#4
Rolleyes 
I have these answers for you my friend! Yes i do have an attorney, I had to change attorneys due to the first one not doing the job as if my life depended upon it. That is how i  was being treated by Doctors outside of the insurance companies mpn that my attorney had picked out and set me up with! They didn't tell me what a mpn was or that i had to treat with a doctor in it, so i was being treated only for several  months until the doctors office suddenly closed down!  My claim was accepted right away when i became injured April 6th 2015! I had documentation accepting the claim but that was all i heard from Sedgwick until January 2017! When i switched lawyers and had my attorney set up a expedited trial to discuss the lack of medical  treatment provided. The Chiro i was seeing provided a work status report (no work) granting me state td until it maxed out. I now am treating with a Physician in the MPN, i had to request the link for the website from my attorney and navigate the website setting up my own appointment! Again i was given a work status report stating that i am not to be working! Now im being sent by the new primary to about four other doctors, but i will not be able to see the Urologist, pt, Neurologist or any of them until the claims adjuster approves the doctors referral! Which they will most likely try to avoid doing as i am due to be seen by my second QME doctor in April 2017.  This is a QME not an AME or IME just so you know ive had to educate myself on these terms and regulations due to the lack of information coming from my previous attorney. The first QME deemed me as MMI and left his report incomplete waiting for the mri results. A year later i had  to send the QME doctor my personal records of the mri so he could complete his report. He said i would not need a surgery only Motrin over the counter and that i was MMI, but i had no treatment at all! My new attorney then tried to deposition the QME doctor! He had vanished off the face of the earth, so his report was struck from record and a new QME was scheduled. I have three disc herniation's and the excuse being used is that one disc may have been injured at work but not the others. I had absolutely NO MEDICAL RECORDS until this injury so that is a crock of crap. The employers excuse for not sending me wc regularly was that, they offered me 5 hours a week working as a receptionist. The doctor has me completely off work though, and the job offer had not been offered to me until January of 2017 so its a lie that they ever offered me work before then. I was also sent a document stating i would receive a voucher but then received another document days later retracting the offer due to them offering me work.  The new doctor in the mpn is a surgery and trauma specialist. Again my attorney sent me the link to find doctors in the mpn and i found the new primary and scheduled the appointment. I have not had any surgeries but fear after all this time that i may need one in order to just not be in pain any more. My attorney filed the hearing. Sorry if my response is all over the place, just trying to give you all the info you need.
 
Reply
#5
Once that QM wrote you were MMI which is P&S means TTD stops. Did your new attorney go to this hearing yet and if so why have you not received back payment for TTD? You have a lot of issues an I cannot answer them without knowing specifics. Since you were never notified of the MPN, they may owe you back TTD (unknown). Have you applied for state disability? If you do not get approved I recommend applying for that through EDD. Your attorney is going to have to fight for you to get your back payment of TTD worked out. Both your attorney and insurance company may be waiting on new QME report, but this would just be a guess on my part, so I recommend to ask your attorney.

Did your new attorney help you pick a doctor in your MPN? Your treating doctor is important, what is his specialty. Make sure you google check his reviews and any attorney before hiring one.

It is unfortunate you were treated this way. Hopefully everything gets straightened out.
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
#6
(02-27-2017, 12:07 AM)California_Help Wrote: Once that QM wrote you were MMI which is P&S means TTD stops. Did your new attorney go to this hearing yet and if so why have you not received back payment for TTD? You have a lot of issues an I cannot answer them without knowing specifics. Since you were never notified of the MPN, they may owe you back TTD (unknown). Have you applied for state disability? If you do not get approved I recommend applying for that through EDD. Your attorney is going to have to fight for you to get your back payment of TTD worked out. Both your attorney and insurance company may be waiting on new QME report, but this would just be a guess on my part, so I recommend to ask your attorney.

Did your new attorney help you pick a doctor in your MPN? Your treating doctor is important, what is his specialty. Make sure you google check his reviews and any attorney before hiring one.

It is unfortunate you were treated this way. Hopefully everything gets straightened out.


Even if the whole report was struck from the record by the judge? See the QME put me at mmi and p&s 5% whole person impairment, but this was before my atty tried to subpoena the qme to no avail. The hearing was cancelled, due to it only being about medical and they recently approved and set up PT. No my atty did not they emailed me a link to the mpn website, i then navigated the website called a doctor and set up an appointment. My atty had great reviews and was researched extensively before i switched attys.
 
Reply
  


Forum Jump:


Browsing: 1 Guest(s)