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9 ай бұрын
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@avarora 2 сағат бұрын
If you ask the adjuster to send the qme to a treating doctor and they ignore, the defense attorney ignore the request also. What is the next step?
@avarora 3 сағат бұрын
It is true that work comp judges do not like to trial cases? And they encourage the parties to reach an agreement. Why that would be? @90 % of cases settle before trial and then 90% settle in the day of trial? What is the average percentage of cases going to trial?
@alexsanchez-jp4pl 4 сағат бұрын
Can you please tell me why I’m bien sent to see the QME for second time? Thank you
@avarora 2 күн бұрын
If a qme report is very accurate and follows all medical reports and gives a rating based on medical evidence can the insurance try to trash that Qme and ask the judge for another evaluation with another doctor? Ptp and qme are on the same opinion and all medical reports are correctly reviewd.
@myworkerscompguide Күн бұрын
Yes. Insurance companies will often fight unfavorable QME reports by trying to get additional or replacement medical opinions. However, it can be difficult to get a QME report thrown out and a new QME assigned and that generally would require a trial and evidentiary finding by the judge.
@avarora Күн бұрын
@@myworkerscompguide in unrepresented cases, it can be even more difficult for insurance to undermine a state assigned doctor( qme), then the whole purpose of a qme / neutral doctor is invalidated, when the qme reviewed and based the decision on ptp medical records.
@avarora 2 күн бұрын
If you want to get the opinion of an vocational expert, does that happens before filing for an MSC? If the insurance is still not accepting your disability and you want to retain the services of a vocational expert when that is the best time to do it? How can an unrepresented person get vocational expert testimony?
@myworkerscompguide Күн бұрын
When a DOR is filed for a MSC, there should be a dispute that is ready to go to trial and the party filing the DOR can list the efforts they made to resolve the dispute. If an injured worker wants a vocational expert, that would be obtained before filing a DOR on the level of PD because discovery would not be complete yet. It can be very difficult to prove a 100% case as the defense will often fight that to the end. If you are trying to prove 100% PD and do not have an attorney, I'd strongly recommend reaching out to your local I&A Officer at the WCAB for answers, or reach out to a local attorney for a consultation.
@avarora Күн бұрын
@@myworkerscompguide it's seems to be a very unfair system. Why would a judge would not find 100% total disability when Qme says 100%, when ptp says the same, when the vocation expert says 100%, and all the facts are showing that the person is indeed disabled, and the insurance agreed to pay inhomecare services to a third party to care for the injured worker. I would assume that any normal judge seeing the medical condition and all supporting evidence from all doctors, multiple qme s from different area of expertise,, and vocational expert, and the need of mobility assistance and handicap transport, severe disability prescription medications and ald services to decide that that poor human can ever be employed. Seems unbelievable that any judge can humiliate and condem to slow death such an Injured worker.
@avarora 2 күн бұрын
I know somebody that the Qme doctor found to be unable to participate in the open labour market on Qme report and even the rating is 100 percent. Does that mean that person will get payment for life at 66%. Is a vocational expert needed to agree on the same statement?
@myworkerscompguide Күн бұрын
A vocational expert is not required to get 100%. The injured worker will get permanent disability for life at the temporary disability rate if either the judge awards 100% or the insurance company agrees to it. Getting the QME to say 100% is just one step.
@avarora 2 күн бұрын
In the situation that you have a bad injury, and the Qme doctor says you can not work in labour market, and the doctor maintains their decission even after being deposed, that means a total disability? Who and what law regulates the individual capacity to participate in the open labour market? Does vocational experts rule on that or there is a federal or state law that has specific conditions which prevent a person to be in the open labour market?how does a qme doctor reaches the conclusion of ( unable to participate in the open labour market)?
@myworkerscompguide 2 күн бұрын
Generally yes. If the QME says the applicant is precluded from participating in the open labor market, that generally means the injured worker is 100% totally disabled. It generally comes down to all of the evidence, from the PTP to the QME to vocational experts and the applicant's testimony. There are some conditions that are presumed to be 100% disabled in California, but otherwise it depends on the facts of the case. Every case is unique.
@avarora 2 күн бұрын
@@myworkerscompguide is there any law that determines the individual inability to work, In SSA they say if a person loses a day or two each month because of their medical condition , is considered disability. Does the same applies to worker compensation? On what basis the Qme determines this. I assume as a judge you may have seen this in at least few cases
@myworkerscompguide Күн бұрын
@@avarora There is no strict definition such as losing two days per month. With QME's it generally comes down to the QME's opinion based on his or her training, experience, and expertise. There are some statutory presumptions that someone is 100%, but most doctors will impose permanent work restrictions based on each individual case.
@aliciacolbert247 3 күн бұрын
How do you know if your MMI and I am Permanent and stationary
@myworkerscompguide 3 күн бұрын
A doctor, either the primary treating physician or the QME, will write a report finding the injured worker to be permanent and stationary (P&S) which is essentially the same as Maximal Medical Improvement (MMI).
@aliciacolbert247 3 күн бұрын
Thank you @@myworkerscompguide
@aliciacolbert247 3 күн бұрын
Well I've had three surgeries on my right shoulder I have another tear, the qme doctor tell me that the treating doctor should have given me a shoulder replacement the second or third surgery so he set up an appointment with the treating physician the treaty physician had a negative remark to make got mad cuz I told her what t qme doctor said made a negative comment and brush me out the office she did order physical therapy for my right shoulder and neck I never received authorization or appointments I'm still in severe pain it's a lot over 5 years I've been going through this
@myworkerscompguide 3 күн бұрын
@@aliciacolbert247 Cases like that can be frustrating, and can take some time to get to P&S status.
@aliciacolbert247 3 күн бұрын
My pretty physician has me as permanent stationary this case has been going on over 5 years frustrating as an understatement when you still suffering and does a qme doctor restrictions out rules a treating physician restrictions when your injury already@@myworkerscompguide
@Kim-kq8wn 3 күн бұрын
In the middle of DOR hearing process, can a presiding Judge change an assigned Judge without any supporting document on EAMS (per I&A) and any notice to the parties with reason? I already had two hearings with the previous judge who is still serving his duty at my current venue.
@myworkerscompguide 3 күн бұрын
That happens regularly. The only time that I'm aware of that a case must return to the same judge (if possible) is once trial has started and the matter has gone on the record. Otherwise a case can go through multiple Status Conference or MSC judges. Quite common.
@inertmission4427 5 күн бұрын
Have you given anymore thought to explaining CA Labor code 5100-5106? Currently discussing a possible settlement with the insurance company and trying to learn if the WCAB does have the right to alter a C&R after the injured party and insurance company reach an agrreement.
@myworkerscompguide 5 күн бұрын
I need to do a video on that. But a judge cannot alter settlement documents that have been submitted unless all parties agree to the change. Conceivably if the judge had all the parties on the phone, and all parties agreed to a higher settlement amount, the judge could write that new amount on the documents and note who/when/where agreed. But even that is rare because the judge will want the parties to write the change, and to note that the documents are now a (for example) "First Amended C&R," and to have the parties initial or sign the change. And a judge cannot just change terms or add language because the judge feels it is needed. From the WCAB Policy & Procedure Manual, "A WCJ may refuse to approve a compromise and release agreement unless it is amended in a manner suggested by the WCJ; however, the WCJ cannot rewrite the agreement without the parties' consent. (See Burbank Studios v. WCAB (Yount) (1982) 47 Cal. Comp. Cases 832, at 836.)"
@inertmission4427 4 күн бұрын
@@myworkerscompguide Thank you for your reply. My confusion comes from CA Labor code 5101 - The WCAB may recalculate the lump sum to include (lesson) Net Present Value (NPV) or Present Worth of 3% per (future) year; and CA Labor code 5102 - The WCAB may order the lump sum be paid directly to the employee OR placed in a Trust OR the State Compensation Insurance Fund, to be managed by a Trustee. I don't doubt I'm misunderstanding these codes, and will be looking forward to your future videos and expertise. Thank you.
@myworkerscompguide 4 күн бұрын
@@inertmission4427 Those statutes don't apply to settlements. They apply to commutations. That's the "lump sum" that the statutes talk about - a commutation. That would generally take place either after a Findings and Award issues, or after Stipulations with Request for Award is approved, and the injured worker files a Petition for Commutation. A commutation often does take the present cash value into effect.
@inertmission4427 4 күн бұрын
@@myworkerscompguide Thank you!
@myworkerscompguide 4 күн бұрын
@@inertmission4427 It's a very confusing system. I'm happy to help inform.
@ftsftw418 8 күн бұрын
Yes
@simorebuths7301 9 күн бұрын
Thanks for the video. Can you explain what kite is? Thank you so much.
@myworkerscompguide 8 күн бұрын
In easy to understand language - the general rule is that PD ratings for different body parts get combined rather than added together. However, a court case (Kite) said that in the proper case, and if supported by the proper analysis from the doctor, the ratings can be added together. That was because the doctor was able to provide analysis that the synergist effect of the disabilities was more significant than the combined values chart would provide, and that the ratings should be added together to provide the most accurate rating for the injured worker. It's not seen often.
@simorebuths7301 8 күн бұрын
@@myworkerscompguide than you so much for explaining it to me thank you sir.
@myworkerscompguide 8 күн бұрын
@@simorebuths7301 Happy to help inform.
@Johnny-jr2lq 9 күн бұрын
It’s been 5 years since I was injured apparently they finally offered to settle. But after my attorney takes his cut I’ll end up with 40k that’s like 8k a year that seems seriously low. Mind you I wasn’t at fault at all whatsoever for my neck injury. Car ran into the back of my work truck while I was on break in the passenger seat.
@myworkerscompguide 8 күн бұрын
Workers' comp settlements are often very low, especially if future medical care is kept open and if the insurance company has already advanced all of the permanent disability before settling. I had a case years ago where the injured worker was very upset because he was getting "nothing" in the settlement, but the insurance company had paid him close to $100,000 in temporary disability, had paid for close to $100,000 in medical bills, and had already advanced him many tens of thousands of dollars in PDA's. But we were keeping medical care open (a benefit with no dollar limit) and there was no remaining PD, so he felt like he was getting nothing. But that was because much of it was already paid out and the medical wasn't paid directly to him. As you have an attorney, you would have to ask him or her about your settlement as your attorney knows your case best.
@simorebuths7301 9 күн бұрын
🔥🔥🔥🔥thanx for the video dude! We been needing this one!!!!
@myworkerscompguide 8 күн бұрын
Happy to help inform.
@donovanwisdom310 9 күн бұрын
EDD will also pay the difference between TD and SDI benefits if EDD’s weekly benefits are higher than TD.
@myworkerscompguide 8 күн бұрын
This can be true. Generally EDD's rate and the TD rate are fairly close to one another, but there are unique cases. Every case is different.
@j.f-ou812 10 күн бұрын
Today I got let go after returning to work at limited duty with doctor ordered 6 hr work day instead of 8hr while recovering from work back injury that led to back surgery among other treatments prior to the surgery . after 3 months home Returned and worked 3 months when manager said we cannot accommodate you not Being able to do the job position duties 100% anymore. I was still getting WC payments for the lost weekly time since returning.Can I get back on weekly full benefits again until I'm fully healed ,released ,and able to look and get new job/work? (commercial electricial\ maint. worker.} thanks
@ftsftw418 10 күн бұрын
I had 6 injuries at one time had 2 surgeries waiting on 2 more
@myworkerscompguide 8 күн бұрын
Eesh. When I refer to an injury in workers' comp, that's commonly known as one accident or mishap or something going wrong (like one car accident, or one fall down the stairs). There may be multiple body parts injured (broken leg, neck sprain, headaches, broken collar bone), but it was just one injury that occurred.
@ftsftw418 10 күн бұрын
All the same injury
@ftsftw418 10 күн бұрын
Why would ttd stop if you are still under Dr care
@myworkerscompguide 10 күн бұрын
In the California system the injured worker is entitled to any reasonable and necessary medical treatment to cure or relieve the effects of the industrial injury. That basically means the injured worker gets medical treatment for that injury for life. Temporary total disability is generally only paid when the injured worker is off work, and unable to work, due to the injury. So the worker may heal enough to return to light duty work and keep treating, and then heal enough to return to full duty and still keep treating. The treatment frequency and intensity would likely drop, but doctor visits can continue. Also, temporary disability can stop if the two year cap is reached, or if the injured worker is released to light duty and the employer can accommodate the restrictions.
@ftsftw418 10 күн бұрын
@@myworkerscompguide I been on it for 130 week an waiting on neck surgery in Oklahoma you are aloud 156 weeks of ttd
@ftsftw418 10 күн бұрын
@@myworkerscompguide I been waiting for them to approve neck surgery
@Kim-kq8wn 11 күн бұрын
A Judge’s false statements on MOH, orders, and/or R&R are also perjury (felony) based on CA Penal Code Section 118 PC by CCR Tit. 8, §350?
@myworkerscompguide 11 күн бұрын
I've never heard that before, and my gut says 'no' that's not the case. A judge swears to faithfully perform his or her duties, and to fairly hear disputes and issue decisions. Perjury comes from a sworn statement under oath that the person knows is not true, such as deposition testimony or trial testimony. To apply that to a judge's Minutes of Hearing or Orders does not sound accurate to me. Though, I've never researched the issue.
@Kim-kq8wn 10 күн бұрын
Thank you!
@myworkerscompguide 10 күн бұрын
@@Kim-kq8wn Happy to help inform.
@ruesanavarro3230 11 күн бұрын
Judge, please help me and guide me what to do I had an injury in my knee because I trip and fall at work while taking care of the patient, and due to some financial strain I have to move from CA Los Angeles to Oklahoma where my son is so we can save money. but now I am having hard time finding a doctor that will accept me in Oklahoma most doctor in google search are in texas which is a challenge because its at least 2 hours drive and I can't drine , or I'm afraid to drive because my knee stift and lacked at times and when it happened its really painful and debilitating me, so no to driving to avoid accident. please direct me to what to do in my situation, Thank you on advance
@edwardkareem6446 12 күн бұрын
So I've been waiting for this video thank you so much I'm waiting on my Qme report I do have two body parts one from my lower back and the other for my GI stomach all I care about is being paid out for future medical how does that work I just had a lumber laminectomy about 2 years ago and I still have two herniated discs that affect me an everyday life will they pay me out for future medical thank you so much
@myworkerscompguide 12 күн бұрын
To get paid out for future medical with a lump sum would mean settling by way of a Compromise and Release instead of with Stipulations with Request for Award. With a typical C&R a lump sum payment is made and the insurance company closes its file, and the injured worker is responsible for paying for future medical care. I've done a few videos on C&R issues, but this one may answer your questions - kzbin.info/www/bejne/nanWgaV3f7Bneck
@Kim-kq8wn 12 күн бұрын
Can the Medical Unit issue a replacement QME Panel even though the previously issued panel was already utilized? If not, is there any regulation about it?
@myworkerscompguide 12 күн бұрын
The Medical Unit does issue replacement QME panels. The required form is this one - www.dir.ca.gov/dwc/FORMS/QMEForms/QMEForm31_5.pdf and probably the most common reason is that the QME has reported in the case but is no longer licensed as a QME. The pertinent regulations are listed on the form.
@Kim-kq8wn 12 күн бұрын
Thank you so much for your prompt response and have a good day!
@myworkerscompguide 12 күн бұрын
@@Kim-kq8wn Happy to help inform.
@mumrah07 13 күн бұрын
This situation happens almost never.
@myworkerscompguide 12 күн бұрын
I've sure seen it a lot, but okay.
@mumrah07 12 күн бұрын
@@myworkerscompguide well in 25 years I've seen it happen maybe twice? If an applicant is in proper, there's this invention called a telephone whereby the insurance company can directly communicate with the applicant to ask questions. It's a really amazing invention. But yes tell yourself this happens frequently If it makes you feel better for content purposes.
@badgalsheilabb2548 13 күн бұрын
What happens when the insurance company only accepts Certain body parts And you have reached mmi Already, in was given a rating for the accepted body parts from a qme of 39 percent but your still being treated for the part they didn't Accept with a attorney doctor what happens now
@myworkerscompguide 12 күн бұрын
If you have an attorney representing you, I'd recommend talking to your attorney about strategy and expectations. If you do not, you may want to consider reaching out to a local attorney for a consultation. If body parts are still denied, and the case is nearing resolution, if a settlement cannot be reached for some sort of compromise then those denied body parts may need to be set for trial.
@michaelarmstrong9512 13 күн бұрын
what if you have multiple injuries on 1 claim and its too much for 1 doctor at a time but all the same system? also is there a way to change the venue?
@myworkerscompguide 12 күн бұрын
In the California system, there is generally a primary treating physician (who acts as the gate-keeper of sorts) who then refers out to various specialists. So it is not uncommon that there is a primary treating physician who is an occupational medicine specialist, who then refers out to an orthopedic surgeon, a neurologist, a podiatrist, and a chiropractor. As to venue, any party can file a Petition to Change Venue. There are special provisions for doing it within 30 days of filing an Application. After that, it is generally done for good cause and convenience of witnesses.
@pauldoddy9714 13 күн бұрын
Thanks! You give really good advice on WC.
@myworkerscompguide 13 күн бұрын
Thanks. Just trying to help inform.
@pauldoddy9714 13 күн бұрын
@@myworkerscompguide . Can I ask a question about the IME Dr I saw?
@myworkerscompguide 13 күн бұрын
@@pauldoddy9714 You can ask, but I can really only answer questions about how California's workers' comp system works in general. I can't give advice, and I'm not familiar with the workers' comp system in other states. I say that because IME's are fairly uncommon in California.
@pauldoddy9714 13 күн бұрын
@@myworkerscompguide Ok! In NJ we have IME's. What's the difference..
@myworkerscompguide 13 күн бұрын
@@pauldoddy9714 In California we have qualified medical examiners (QME) and agreed medical examiners (AME) and rarely independent medical examiners (IME). The rules that apply to each type of examiner vary depending on statute. It would depend on what the New Jersey statutes provide as to IME's there. I couldn't really say.
@anonanonme2463 13 күн бұрын
OMG you hit everything and named except mine is right foot ankle and left knee. I've been on TTD for almost 5 years. 1st surgery right foot; butcher job. About ten months later after all the doctors barking 2nd surgery limb salvaged right foot. Left knee hurt bad; now most cartagena or all gone; hole saw drill used and drilled straight through outside joint along knee cap into tibia to bone marrow for "stem" cells for right foot. Right foot cut in half under tibia and destroyed bone and joints from previous surgery removed and titanium hardware installed with heel now cut open and another "screw" drilled through heel through foot and back into the top arch. Left knee 1st year doctor recommended TKR, but ins. Doctor says I'm big boy 30lbs. Over weight limit for knee surgery; they just chopped up foot 2x already. Now ins. Doctor claiming arthritis Left knee; doctor and me ask them what happens to an untreated join and your surgeon drilling through it taking cartilage and leveling big hole on top of tibia in a weight bearing join? Arthritis duh.... I have constant pain at average level 8 barking hobble gar enough to reach the can, but spend majority moving around on an office chair. I have a bright line of pain searing going down side of foot under ankle, under foot and up the outside of foot under ankle; exactly where 2nd surgeon cut foot in half. I pestered that doctor why doesn't he get an xray to see? Didn't happen and was mmi last 12/23 nothing about release for work. I was sent to an FCE and IME two days in a row 03/24. DO NOT LIE AT ALL, BE TRUTHFUL. Main doctor wrote restrictions; permanent; desk work, and other restrictions. Meaning I can't run, jump and climb, etc.. Left knee RFA over year ago; healed up from nerve burn on the pain nerves three months; PRP lasted about three months; all they did was take some of the edge off pain. Now after being ghosted by ins. Co. ( they are very good at that) put in and got approved for xray previously mentioned, but nothing on his treatment plan? I finally found an attorney who took this circus as a case. First doctor wondering about medical malpractice due to going into surgery for tendon and ligaments reconstruction and came out with tendon cut, two bolts drilled through top of arc down through and out of heel, etc. Sorry for vent but your video was also exactly describing my circus.
@myworkerscompguide 13 күн бұрын
Sorry to hear that. If you don't have an attorney, I'd recommend reaching out to a local attorney for a consultation as it sounds like your case is quite complicated.
@BearPapa49 13 күн бұрын
It really worked out for me to stay the course with my attorney with regards to multiple injury body parts . It was complex a bit but fluid most the time . Your videos are great keep up the work Jeremy . Question please . If I reopen a new claim ( before the 5 year statue of limit ) do I have to do a new deposition ?
@myworkerscompguide 13 күн бұрын
I think most injured workers are generally better off with an attorney, rather than going it alone. It's just such a strange and confusing system. As to the deposition, it depends. The filing of a Petition to Reopen is good cause for the defense to be able to take the deposition of the injured worker a second time. But they are not required to do so. Each case is different, and it will depend on how the adjuster and defense attorney look at the file.
@BearPapa49 13 күн бұрын
Thank you Jeremy i appreciate you
@myworkerscompguide 13 күн бұрын
@@BearPapa49 Happy to help educate how the system works.
@Analysemarie 14 күн бұрын
I spoke with the defense attorney today on my case. He stated that the judge is going to think my settlement offer is too low. He is going to reach back out to the claim specialist for a higher settlement offer. Is that something that normally takes place? He also stated that I need to witnesses to sign. Can one of them be a family member ?
@Analysemarie 14 күн бұрын
How do you know if you have permanent disability advances? Is that once you agree to a settlement but haven’t signed paperwork yet or is that once you sign papers? I’m supposed to sign paperwork this week but we came to agreement on settlement June 17. After that the claim specialist ignored my emails for almost 5 weeks I’m just curious if that cost part of my settlement? I haven’t received anything from EDD (side note)
@myworkerscompguide 14 күн бұрын
Defense attorneys often appear in front of judges, and after doing the job for a number of years can get a good feeling of what local judges will and will not approve. So it's not unheard of. The C&R does need to be signed either by two witnesses, or you can sign it with a notary public who notarizes your signature. Either works. As to a family member, the Labor Code says, "Every release or compromise agreement shall be in writing and duly executed, and the signature of the employee or other beneficiary shall be attested by two disinterested witnesses or acknowledged before a notary public." So a family member could sign, but it would need to be someone disinterested. So, not a spouse or child.
@myworkerscompguide 14 күн бұрын
@@Analysemarie The defense attorney or adjuster can confirm if there are PDA's. They will also be listed on the C&R. A typical C&R is a set sum of money, less any PDA's listed specifically on the C&R at the time of drafting, and less any additional PDA's made after the drafting but subject to proof (so the defense has to show that they actually paid them).
@Analysemarie 14 күн бұрын
@@myworkerscompguide OK great thank you so much.. to clarify if papers haven’t been drafted yet I wouldn’t have any PD advances?
@Analysemarie 14 күн бұрын
@@myworkerscompguide thank you the defense attorney stated that he felt the judge would say it wasn’t an adequate settlement amount and more settlement. He stated that he’s going to reach out to the claim specialist and ask for a better settlement offer. He says that the judge works above him and he’s close friends outside of work with her yet she follows rules to the T.
@aqt12761 14 күн бұрын
Hi, can you do video on FCE in the context of QME and MMI
@myworkerscompguide 14 күн бұрын
I like that idea. I'll try to get that out soon.
@jaliscomx328 16 күн бұрын
Can an insurance company argue apportionment even with no prior injuries or accidents, a clean record per say.
@myworkerscompguide 16 күн бұрын
It will really depend on what the QME and/or PTP finds. If there were no prior injuries or accidents, potentially there may be some congenital defect or other non-industrial cause/condition that caused part of the permanent disability. The insurance company can argue many things, but it really boils down to a doctor's opinion, and that doctor's opinion must be substantial medical evidence, so it must be based on an accurate medical history, a complete exam, a correct application of the law, etc.
@jaliscomx328 16 күн бұрын
@@myworkerscompguide thsnk you sir! Always very helpful
@myworkerscompguide 16 күн бұрын
@@jaliscomx328 Doin' my best!
@7clovers007 17 күн бұрын
If the qme says not permanent stationary, but require further medical treatment.... does TTD resume?? If way under the 2yr ttd mark...
@myworkerscompguide 16 күн бұрын
It would often depend on whether the employer can accommodate any temporary light duty work restrictions. If yes, then no TD. If not, then TD would likely resume. But each case is unique.
@7clovers007 16 күн бұрын
@myworkerscompguide So bck in may.. I was laid-off and or terminated... but the Workmans Compensation Claim is still Active... I received ttd at home for several months, as at the time, the employer could not accommodate.. then, recently..they stopped ttd.. it's been nearly 2months without ttd.. I'm suffering.. I saw the second qme for the primary injury recently, he has declared not permanent stationary, but will need further medical treatment.. Will ttd resume during this time??.. of further medical treatment??
@myworkerscompguide 16 күн бұрын
@@7clovers007 Generally if an injured worker is not yet P&S, and is either completely off work or on light duty temporary restrictions that the employer cannot accommodate, and two years of TD have not been paid out, and it is within five years of the date of injury, and there are not other disputes such as treatment outside the MPN, then TD would be paid. You may want to reach out to the I&A Officer at your local WCAB office to discuss your options, or talk to a local attorney for a consultation.
@7clovers007 16 күн бұрын
@@myworkerscompguide Thank you for this information.. I appreciate it.
@myworkerscompguide 16 күн бұрын
@@7clovers007 Best of luck to you.
@edwinortiz7798 17 күн бұрын
I just got expedited hearing andthe same day i went online and it said Hearing disposition OTOC and interim order : taking of calendar , i have aproved surgery but havent get any checks yet. what is that otoc?
@myworkerscompguide 16 күн бұрын
OTOC means Order Taking Off Calendar, which means (often times) that the dispute was resolved, and the parties requested that the judge take the hearing off calendar as it was no longer needed. It may be that your hearing was over the surgery authorization, and since that was approved, the hearing was taken off calendar. If it was taken off calendar without your knowledge, then I would guess you have an attorney. If that's the case, you would need to ask him or her as your attorney knows your case best.
@edwinortiz7798 16 күн бұрын
@@myworkerscompguide thank you for your answered
@michaelarmstrong9512 17 күн бұрын
how do you argue apportionment? my qme is saying a car accident is part to blame for a current injury and I was fine after 6 months, no pain at all
@myworkerscompguide 16 күн бұрын
Apportionment is not very scientific. The Labor Code says, "The employer shall only be liable for the percentage of permanent disability directly caused by the injury arising out of and occurring in the course of employment" so the QME must determine what percentage of the disability was directly caused by the injury, and what percentage was caused by other injuries or causes both before and after the injury. Fighting apportionment determinations by a QME can be complicated. I'd recommend either talking to the I&A Officer at your WCAB office or to a local attorney for a consultation.
@jash2681 17 күн бұрын
Great video. That formula is confusing but you made it clear in you explanation.
@myworkerscompguide 17 күн бұрын
Thanks. Happy to help inform.
@Analysemarie 17 күн бұрын
hi, sorry... I have a question for you like always.. I received an email from my claims specialist and their Attorney asking a few questions. One of the questions he asked was if we have a PR4 report from any of the treaters? He stated W/out a retable report, we have an uphill battle. I'm trying to settle my case with a C&R without a QME. I want to seek my own treatment without constant rejection from wc insurance or things taking forever
@myworkerscompguide 17 күн бұрын
What the attorney or claims adjuster said is correct. It's not impossible to settle a case without a ratable report, but it is more difficult. If the PTP writes a P&S report, they usually do it on a PR-4 form as that has all the areas that need to be completed. Many treating doctors don't like to do that type of report, and they just defer to a QME. It is difficult to settle a case without a P&S report because the judge must determine adequacy, and the easiest way to do that is to review the WPI analysis, the final PD rating, and anticipated future medical care. To settle without that information the C&R needs to have a very good explanation of why the parties are settling without a QME report, how the parties determined the settlement amount, and why the parties feel that amount is a fair and reasonable settlement. Even with that the judge may still set it for a Status Conference so the judge can talk to the injured worker to ensure he or she understands the options available and what the settlement means.
@Analysemarie 17 күн бұрын
@myworkerscompguide thank you so much. I appreciate all your help. I did have report from a pain management specialist. Is that something that could be taken into consideration?
@myworkerscompguide 17 күн бұрын
@@Analysemarie Certainly. The more explanation that goes into the C&R, and the more medical reports that it refers to (and are filed for the judge), then the easier it is for the judge to determine if the settlement is adequate.
@Analysemarie 17 күн бұрын
@myworkerscompguide wonderful thank you so much! I have MRI, x-rays physical therapy, orthopedic surgeon and pain management specialist reports. I’m hoping all those help .. 🤞🏼 I have an over the phone meeting on Monday with the attorney.
@myworkerscompguide 17 күн бұрын
@@Analysemarie Best of luck to you. You can also always call the I&A Officer at your local WCAB office to go over your options.
@BearPapa49 17 күн бұрын
Jeremy fast question. If I settled a wc claim and I re file again for a new claim before the statue of limitation runs out , do I have to do a new deposition?
@myworkerscompguide 17 күн бұрын
Maybe. The defense generally has the right to take the injured worker's deposition when there is a new injury or when there is a significant change in facts. If the defense took a deposition after injury one, and then injury number two is pled, then the defense has the option to take the injured worker's deposition again. They do not have to, but they can.
@champton4155 17 күн бұрын
Mr Lusk how do I contact you regarding my serious WC claim?
@julioarias5827 18 күн бұрын
Insurance lawyer offered me an amount without Authority now the insurance wants to close the case but for a less amount then their attorney offered can that be taken to trial?
@myworkerscompguide 17 күн бұрын
There are many factors. If the settlement was just regarding the level of PD and settling with Stipulations, then that dispute could be taken to trial. But if the defense attorney offered a C&R, and then changed the offer before everything was finalized, then going to trial would not serve much purpose as the judge cannot order or award a C&R. You may want to call your I&A Officer at the local WCAB office and talk to them about your options.
@julioarias5827 12 күн бұрын
@@myworkerscompguideomg i cant believe you actually responded thank you! can i go to trial to make my case and get more money or is the judge only going to look at my Injury rating and go from there ?? My attorney told me if we go to trial the judge is only going to give me a settlement that does not include the buy out for future medical care but instead i will have open medical for the rest of my life and give me an ammount for the rating given by the QME doctor
@myworkerscompguide 11 күн бұрын
@@julioarias5827 First, you have an attorney, so he or she knows your case best. I can only answer general questions about how the system works. What your attorney told you about the judge only being able to award the PD, and not a buyout of future medical, is correct. So a case can go to Trial if there is a dispute, but a judge cannot order a C&R. A judge can only award what is basically the equivalent of Stipulations with Request for Award. So if the parties want a C&R, it needs to be negotiated between the parties.
@rawtruthisahardpilltoswall6180 18 күн бұрын
So I just received the compromise and release. Settlement is what we agreed on but there’s the part of the general release they want me to sign and for that they are offering $500 more on top of the settlement. So is a must that I sign that part in order to receive the settlement? And is those $500 negotiable?
@myworkerscompguide 18 күн бұрын
A. Everything is negotiable. B. Judges in workers' comp really don't like those general releases, as the WCAB only wants to see workers' comp issues, and often times those general releases pertain to many other issues that are not workers' comp. C. There is no way that I could offer you any advice on that type of issue. I'd strongly recommend reaching out to your I&A Officer at your local WCAB office, or talking to a local attorney for a consultation. There can be real significant impacts from the terms of those agreements.
@rawtruthisahardpilltoswall6180 18 күн бұрын
@@myworkerscompguide thank you very much for your quick response. So judges not liking those general releases is that mean good or bad for my case? Thanks 🙏
@myworkerscompguide 17 күн бұрын
@@rawtruthisahardpilltoswall6180 It's neither good nor bad. But the general rule in workers' comp is that a settlement can only settle that date of injury. So if the injured worker was hurt on May 19, 2023, and then the settlement says that it settles "any and all injuries whether known or unknown to any parts of the body" it likely won't get approved by a judge because the other injuries are not specified and a judge cannot determine adequacy.
@rawtruthisahardpilltoswall6180 17 күн бұрын
@@myworkerscompguide dang! So it is a possibility mine won’t be approved! I’ve been waiting for this for so long already and I just signed cause I thought I had to.
@rawtruthisahardpilltoswall6180 17 күн бұрын
@@myworkerscompguide I am working with an attorney and he said to sign it. But I did think it was a little weird but then again I didn’t know anything about it till I decided to look into it and came up on your videos. Thank you for the info either way. I appreciate it
@Cheezmo 18 күн бұрын
What if I’ve been put on P&S and the company has not reached out to discuss modifications at all?
@myworkerscompguide 18 күн бұрын
I'm not sure what you mean. Every case is so different. Are you still employed with the employer at which you were injured? Did the QME impose permanent work restrictions? Did the PTP? Do those two doctors disagree with one another? Have you been working light duty? Are you interested in returning to that employer? Workers' comp cases in California really are unique every single time.
@Cheezmo 18 күн бұрын
@@myworkerscompguide I am still employed. QME did impose permanent restrictions. The PTP has not yet. I do not think they disagree but PTP still might want to do one more procedure. No light duty available so I’ve been home since November. Work will not allow me to return with restrictions for my job. They have been downsizing so don’t see them finding me something else. QME placed P&S with restrictions in May but HR has not reached out to me.
@myworkerscompguide 17 күн бұрын
@@Cheezmo Every situation is unique, so to discuss your options I would recommend calling the I&A Officer at the WCAB or talking to a local attorney. Generally, it is legal in California that if an injured worker has permanent work restrictions, then the employer can let the employee go after going through the interactive process and not finding either modified or alternative work. I often tell my clients that if their condition is P&S, and they don't expect to return to the same employer, that they should start looking for another job wherever they can find one as they'll need income. You can't survive on the $290 a week for the PD rate.
@Cnewsum13 19 күн бұрын
Got hit head on by a car working as a trash worker. Broke my tib fib in my right leg and tore my acl in my left leg and had hip surgery on my right side. This happened February 2023 and I am now about 85% back healthy and walking. This was considered heavy duty work doctor released me as medium work. Lawyer asking for 200k. Is that too low and what’s the percent of me getting that big of a settlement?
@myworkerscompguide 16 күн бұрын
I really couldn't say. Every case is so unique. I've had cases with very significant injuries and significant medical expenses paid by insurance, but the recovery goes very well so the final settlement is small. Plus, it depends on whether you settle with open future medical care or close it out. As you have an attorney, he or she would know your case best, and what it is potentially worth. Best of luck to you.
@mattwolf1718 20 күн бұрын
Why is workers comp insurance company requesting a 1020 form from me all of a sudden?
@myworkerscompguide 20 күн бұрын
I'm not familiar with a form 1020. Maybe it's for a state other than California?
@davidmurphy4632 21 күн бұрын
Is there any outline for how long defense attorney has to submit c&r?
@myworkerscompguide 21 күн бұрын
No. If the defense attorney moves too slowly an injured worker can file a DOR for a hearing.
@davidmurphy4632 21 күн бұрын
For anyone waiting it’s likely the defense attorney is lagging on submitting paperwork……just found out it’s been over a month since signing and something that probably takes them an hour has been sitting for weeks…..
@myworkerscompguide 21 күн бұрын
Usually the defense attorneys move fairly quickly on getting those submitted because the claims adjuster (his or her client) wants that file closed. It could be that they are trying to get EDD clearance to confirm either no benefits paid or that there's no outstanding lien. That can take weeks, and unfortunately I've even seen it take months. But ideally the defense attorney would communicate the reason for the delay to the injured worker.
@leonardoalvarez5965 22 күн бұрын
How many times can you file workers comp ? Cases
@myworkerscompguide 22 күн бұрын
There is no limit to the number of workers' comp cases you can file as an injured employee in California. That said, most California employees likely never file a claim, while if someone else has filed ten or more cases over the years that will likely raise red flags at the insurance company. It seems fairly rare that someone files double-digit numbers of workers' compensation injuries.
@Chiqfrmdasoup 23 күн бұрын
This happen to me lady ran a light hit me the car i was in rolled over she told police i ran red light they believed her i got citied for runnig light my laywer got the charges amnded and dropped to equipment faluire havent recieved no money
@myworkerscompguide 22 күн бұрын
Generally no money is paid out for personal injury claims until they settle, while workers' comp will start paying money to the injured worker and doctors as soon as the case is accepted. Since you have an attorney, he or she would know your case best, and I'd recommend talking to your attorney about your case.
@Chiqfrmdasoup 23 күн бұрын
I completed my physical therapy dr requested 6 more weeks got approved have a apt to do surgery on my acl end of this month its been 3 months already is there a value u can put on it ?
@myworkerscompguide 22 күн бұрын
I cannot put a value on it. If it is just an ACL reconstruction, and you settle with open future medical care, and the recovery is good, then the value is not very high. The AMA Guides do not rate knee surgeries very high. If there are complications, or repeat surgeries, or a bad recovery/outcome, or if more is found, or if future medical care is closed out, the case is worth more. Every case is unique. I'd recommend talking to a local attorney or the I&A Officer at your local WCAB.
@franciscorubalcaba861 24 күн бұрын
I got a call from Workers comp , they said the dr put me as permanent disability , and they said the dr valued it at 14k and that I need to sign forms and they will send me 14k in a check , I'm just very confused . It's due to a back injury I got at work , I just want more details and want to understand it more
@myworkerscompguide 24 күн бұрын
It sounds like the doctor said your condition was P&S, and that level of WPI found by the doctor rated out to a PD level that equates to $14,000 roughly. They will likely send you checks of $580 every two weeks until the full roughly $14,000 is paid off. If you don't have an attorney, you should call the I&A Officer at your local WCAB office to discuss your options, and see if the report was sent to the DEU for an impartial rating. If it was the PTP who issued the report, you have the option of going to a QME who is an independent doctor, and you can discuss that with the I&A Officer as well.
@franciscorubalcaba861 24 күн бұрын
@@myworkerscompguideoh ok , I will take that advice but I was also confused because I am still at the same job working , and I'm working full duty , so if I sign the forms will they put me off work ?
@myworkerscompguide 23 күн бұрын
@@franciscorubalcaba861 I cannot speak to your individual case. I can only discuss how the system works in general. To discuss your case you should talk to a local attorney or the I&A Officer at the WCAB. In general, it is very common that a worker is injured, reaches P&S status, resolves the claim with Stipulations with Request for Award, and keeps working at the same employer. However, if the parties enter into a C&R instead, often times the insurance company will want the injured worker to resign from that job.
@authenticallyempowered1 24 күн бұрын
I am prose and was offered 20k, which I declined. I countered offered at 30k. They met me halfway at 25K, only if I sign off the (S&W). Recently, I did sign (C&R), so I can move on with my life because I am faced with multiple repos, displacement and bankruptcy. The attorney is now dragging his feet to process the walk through for approval. Can I retract my signature and proceed to trial? I say that because, something is not adding up. Weeks prior, I was being coerced and pressured to sign before I could speak with an I&A officer to get answers to questions in the comments section before I signed off on anything. A priority hearing is scheduled for July 25. I feel this is another unreasonable delay. What is the worst case scenario and is it possible expedite settlement check. I thank you in advance.
@myworkerscompguide 24 күн бұрын
I would strongly recommend talking to either your local I&A Officer about your options, or talking to a local attorney. I can only answer questions as to how the system works. I cannot offer advice as to what you should or should not do. A few thoughts to keep in mind are that if a case goes to trial, the judge cannot award a C&R. A Judge can only either find industrial injury or not, or award indemnity or not, generally. But they cannot order a C&R. So if the case goes to trial, it will not resolve with a C&R. Also, if a case goes to trial, it will need to be set for a MSC (that'll take a couple of months) and then the parties will have to complete and file the PTCS and exhibits, and it'll be set for trial in a couple of months, and then once trial is concluded, the judge will have 90 days to issue a decision, and then either party can appeal that for about one month afterwards. So a trial is not a fast process. Also, it is odd that a case is set for a Priority Conference when the injured worker has no attorney. A Priority Conference is usually set for represented applicants.
@authenticallyempowered1 24 күн бұрын
@@myworkerscompguide Thank you for your prompt response. So in a nutshell they can withdraw signed settlement before walk through and go to trial without contacting me? Also, how is it possible for an insurance adjuster to deny a claim without a valid (QME) report? The adjuster denied claim August 2023 based on a bogus phycological evaluation, which that provider was referred by the workers comp doctor, I was duped. I was not interviewed by the (QME) until November 1, 2023, which it was determined an industrial injury occurred, something does not add up it makes no sense. Thank you in advance for your feed back.
@myworkerscompguide 24 күн бұрын
@@authenticallyempowered1 Withdrawing from a settlement, whether it be applicant or defense, is generally frowned upon and contract law principles often come into play. There are different standards that apply before and after a judge approves the settlement. As to your specific situation, you would need to talk to either the I&A Officer at your local WCAB, or talk to a local attorney. As to the denied psychiatric claim, I can say that those claims are often denied and often very difficult to prove at trial, especially when there is a defense of a lawful, good faith, non-discriminatory personnel action.
@authenticallyempowered1 24 күн бұрын
@@myworkerscompguide thank you for putting in the time to respond, I truly appreciate that. It set my mind at ease. Have a great rest of your day!
@myworkerscompguide 24 күн бұрын
@@authenticallyempowered1 And to you. Best of luck to you in your case.