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Wokers Compensation Re Injury

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juliana21

Junior Member
What is the name of your state (only U.S. law)? CA

I re injured my shoulder that I originally injured back in 2009. I was denied treatment by my continuing care doctor, so I sought out care through my personal doctor. I returned to work the next day. I informed my employer and everyone who needed to be informed of the re injury. I was than sent to Occupational Health to determine if the injury was new or part of the 2009 injury. It was determined to be part of the 2009 injury and with the appointment that Work Comp (Sedgwick) scheduled I received a set of work restrictions. These restrictions have put me out of work now, Sedgwick has told the Work Comp office of my employer that they would not be paying me for lost wages that were a result of the appointment that they had sent me to. Their reasoning is that the work restrictions did not come from my continuing care doctor that can't see me until end of January 2012. Can Work Comp really not pay me for lost wages due to a appointment that they sent me to.

Also I am able to work but my work restrictions need to be explained in depth, the doctor who originally wrote them is now not authorized to treat me. Can I go to my own orthopedic doctor and have the work restrictions rewritten? How will this effect Work Comp?

Also I due have a attorney who has chosen to drop the case and not communicate with me. I have serious questions about non payment of lost wages as well as switching my doctor due to denial of treatment, my attorney at this time will not return my phone calls or answer my questions. I need to at least switch my doctor so that I can get work restrictions redefined so I can work? What can be done about my attorney that has lost interest in the case?
 


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Willlyjo

Guest
What is the name of your state (only U.S. law)? CA

I re injured my shoulder that I originally injured back in 2009. I was denied treatment by my continuing care doctor, so I sought out care through my personal doctor. I returned to work the next day. I informed my employer and everyone who needed to be informed of the re injury. I was than sent to Occupational Health to determine if the injury was new or part of the 2009 injury. It was determined to be part of the 2009 injury and with the appointment that Work Comp (Sedgwick) scheduled I received a set of work restrictions. These restrictions have put me out of work now, Sedgwick has told the Work Comp office of my employer that they would not be paying me for lost wages that were a result of the appointment that they had sent me to. Their reasoning is that the work restrictions did not come from my continuing care doctor that can't see me until end of January 2012. Can Work Comp really not pay me for lost wages due to a appointment that they sent me to.

Also I am able to work but my work restrictions need to be explained in depth, the doctor who originally wrote them is now not authorized to treat me. Can I go to my own orthopedic doctor and have the work restrictions rewritten? How will this effect Work Comp?

Also I due have a attorney who has chosen to drop the case and not communicate with me. I have serious questions about non payment of lost wages as well as switching my doctor due to denial of treatment, my attorney at this time will not return my phone calls or answer my questions. I need to at least switch my doctor so that I can get work restrictions redefined so I can work? What can be done about my attorney that has lost interest in the case?
You're attorney needs to file a DOR (Declaration of Readiness) with the WCAB (Workers Comp. Appeals Board). This will enable you to find out the defendant's reasoning about various issues concerning your case. Your attorney will go before the judge in the DA's (Defendant's Attorney) presence and discuss concerns that the judge will listen to and offer feedback.

As the case progresses, the Defendants may pay your TTD and/or Partial Disabiliy benefits or they may not. But it is up to your attorney to keep on top of your claim. Eventually, if not settled before hand, the judge will settle the matter in a mini-trial where all of your issues will be settled.

It shouldn't take more than a couple years in your case, to get to trial or settlement. Some cases go on for 10 years though.
 

commentator

Senior Member
Now that was about as clear as mud, wj. It sounds, from the information we get, that you may have let the window to request additional treatment for the original injury expire. Had it been more than two years since you had seen a doctor or actually had treatment for the 2009 injury? If so, then they probably do not have to pay for your time lost from work to see a doctor regarding this injury. It appears you were injured/re-injured on the job one day. You called the company doctor yourself without reporting the injury, and couldn't get in to see them. Then you saw your regular doctor. You went in and reported the injury and were set up for an Occupational Health evaluation, and were given restrictions. You are on worker's comp and being paid right now, but you want to be paid for the time while you were off while seeingthe doctor originally, or seeing the O.H. evaluator, right?

Since you seem very confused about how this situation may work, do not seem to be willing to ask your HR and obtain any answers from them, you probably do need an attorney who is interested in your case. Is it possible that your attorney is telling you something you do not want to hear, and this is the reason you are not communicating well, or that you are calling the attorney far more often than might be reasonable? Hiring another attorney may be necessary.
 
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Willlyjo

Guest
Now that was about as clear as mud, wj. It sounds, from the information we get, that you may have let the window to request additional treatment for the original injury expire. Had it been more than two years since you had seen a doctor or actually had treatment for the 2009 injury? If so, then they probably do not have to pay for your time lost from work to see a doctor regarding this injury. It appears you were injured/re-injured on the job one day. You called the company doctor yourself without reporting the injury, and couldn't get in to see them. Then you saw your regular doctor. You went in and reported the injury and were set up for an Occupational Health evaluation, and were given restrictions. You are on worker's comp and being paid right now, but you want to be paid for the time while you were off while seeingthe doctor originally, or seeing the O.H. evaluator, right?

Since you seem very confused about how this situation may work, do not seem to be willing to ask your HR and obtain any answers from them, you probably do need an attorney who is interested in your case. Is it possible that your attorney is telling you something you do not want to hear, and this is the reason you are not communicating well, or that you are calling the attorney far more often than might be reasonable? Hiring another attorney may be necessary.
I disagree! This injury is a work-related injury! Of course they have to pay for his lost time from work to see a doctor! It doesn't matter if he re-injured an old injury--it is still a new claim! If he can't work, he is eligible for up to104 weeks of TTD (total temporary disability) or until his condition becomes permanent and stationary.
 

Proserpina

Senior Member
OP, please review the respective post histories of those who have answered your post.

There is a reason why commentator is considered one of the most respected, accurate and reliable posters on the entire forum.

:)
 
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Willlyjo

Guest
OP, please review the respective post histories of those who have answered your post.

There is a reason why commentator is considered one of the most respected, accurate and reliable posters on the entire forum.

:)
Despite the fact Commentator is so respected, he was wrong! What does my posting history have to do with my response to the OP in this thread? My response was right on! If you don't have anything constructive to add to this thread, Prosperpina, then it isn't necessary for you to post! ;)
 

Zigner

Senior Member, Non-Attorney
Despite the fact Commentator is so respected, he was wrong! What does my posting history have to do with my response to the OP in this thread? My response was right on! If you don't have anything constructive to add to this thread, Prosperpina, then it isn't necessary for you to post! ;)
It's always good to point out things that call your credibility in to question. Things like just about every post you've made.
 
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Willlyjo

Guest
It's always good to point out things that call your credibility in to question. Things like just about every post you've made.
Thanks for you valuable input Zigner! :rolleyes: It was really remarkable and intelligent! :rolleyes:
 

commentator

Senior Member
Well, moving on here. Thank you for kind words.

What I was trying to establish is whether or not the person's most recent shoulder problem was part of the old injury, and if so,if it happened within the window of time when they will continue to work with an old injury, or whether it is to be considered a fresh new injury, based on some new reason (such as "I picked up a heavy box,")a new worker's comp case due to a new workplace injury, irrelevant to whether it was an injury to the same body part (shoulder) as the other one.

From what the OP says, "It was determined to be part of the 2009 injury and with the appointment that Work Comp (Sedgwick) scheduled I received a set of work restrictions. These restrictions have put me out of work now, Sedgwick has told the Work Comp office of my employer that they would not be paying me for lost wages that were a result of the appointment that they had sent me to. Their reasoning is that the work restrictions did not come from my continuing care doctor that can't see me until end of January 2012. Can Work Comp really not pay me for lost wages due to a appointment that they sent me to? (which incidentally is also clear as that proverbial mud)
it appears that the answer to this question the Op has asked may be Yes.

And that Sedgwick may be denying this claim. Someone, either the OP or an attorney that represents him needs to be talking directly to Sedgwick and getting answers. I fear that the reason his attorney has become unresponsive is that there is no profit for him/her in pursuing this case, that he has told the OP this, and the OP just doesn't want to hear it.

I agree with wj to some extent. Old or new injury,there is still the right to file a worker's comp claim. There is still an appeals process if the OP disagrees with the decisions of the WC provider. But the OP's attorney has quit him for some reason, I think he knows what it is, suspect he has already heard something he doesn't want to hear and he just doesn't want to admit it.
 

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