Worker Comp in California

[commentator]

Worker's comp claims are set up so that people are paid according to tables and standards already established. They can't negotiate any more than the standard operating procedure for their particular injury. They can either do this themselves, with the help of their state worker's comp caseworker, or they can elect to give 15% of the money they may receive to some attorney who doesn't do anything or get them anything that wouldn't have happened anyway.

In worker's comp cases, getting an attorney is generally not necessary, and is generally not helpful. Watch too much daytime tv, and you'll be believing that "the insurance companies are out to cheat you!" and "we are the ones you need to call to make sure you are treated fairly!" but it certainly isn't the case.

If your friend is fired (without some valid reason) after his worker's comp claim is settled, then he really might want to consider an attorney at that point. I am by no means an expert in this field but I live with someone who is, and he particularly bemoans how badly people can be ripped off sometimes if they are convinced they need an attorney when injured at work.

 

[Nellibelle]

LoL...you have been personally involved in 2 claims? Wow, 2 whole claims.
Let's see in my 5+ years, I personally adjusted well over 750 claims (some were medical only claims, some were time loss claims, some were medical maintenance, thank God none were catastrophic claims!)

I never said that the friend was faking. What I did say was that if friend was complaining of pain the first day he returned to work, it was a red flag (by industry standards) of possible malingering or secondary gain issues. (and it is!) By industry standards, and a variety of medical standards, if they waited a month to start physical therapy that is too long. If the injury is a sprain/strain then the recommendations are usually 2 days of rest, with ice/heat as needed, mild to moderate pain relievers and/or anti-inflammatories. But, since the OP hasn't come back, and may not know what the diagnosis is (since it is his "friend") then I can't tell you what the accepted medical course of treatment should be. Look at ACOM or ODG for guidelines regarding the accepted medical course of treatment for specific diagnoses.

But, let me tell you this: you being personally involved with two claims over the course of 15 years does not begin to give you the knowledge, skills or expertise to tell anyone what they need to be doing.

I beg to differ! I handled one of my claims because the Attorney wanted me to settle for 10k when I wanted more! I fired him and negotiated a settlement that was more than 3x's that amount.

I agree, it is too long to wait to start PT after a month, but as the OP said, it is hard to schedule appointments after 5:00 p.m. Also, we don't know how serious the injury is, but a month of pain needs to be closely scrutinized by a doctor, who may need to schedule an MRI. These are all procedures that have to be either okayed by the IC or an Attorney is needed to file a DOR (Declaration of Readiness to Proceed) and get before the judge with issues why the injured worker isn't getting what the doctor thinks he should with regard to treatments.

Based on what I know and have experienced, it is more reasonable for the injured worker in this case to seek an Attorney because many many injured workers get their medical treatments taken care of without any payments for permanent injury unless an Attorney sees that they get it. I've seen it happen several times.

 

[Ladyback1]

I beg to differ! I handled one of my claims because the Attorney wanted me to settle for 10k when I wanted more! I fired him and negotiated a settlement that was more than 3x's that amount.

I agree, it is too long to wait to start PT after a month, but as the OP said, it is hard to schedule appointments after 5:00 p.m. Also, we don't know how serious the injury is, but a month of pain needs to be closely scrutinized by a doctor, who may need to schedule an MRI. These are all procedures that have to be either okayed by the IC or an Attorney is needed to file a DOR (Declaration of Readiness to Proceed) and get before the judge with issues why the injured worker isn't getting what the doctor thinks he should with regard to treatments.

Based on what I know and have experienced, it is more reasonable for the injured worker in this case to seek an Attorney because many many injured workers get their medical treatments taken care of without any payments for permanent injury unless an Attorney sees that they get it. I've seen it happen several times.

PT should have been started within a week of the first Dr. appt (or at the very least authorization should have been sought). Do you realize that only a few injuries would require a month off of work? Do you know that studies have shown (and from my own personal experience) that the longer a worker is off of work, the more likely it is that he/she will not return to work? Complaints of pain are subjective and are not a diagnosis. Work Comp is based on objective medical findings. And without objective medical findings, there really isn't anything to adjust! ALSO...every adult has some degree of back "issues". It's a natural process as the entire body ages and deteriorates, so the friend could be having "pain" for a variety of reasons. You really know very little about Work Comp, the medical and psychological issues that come into play in a claim, and should not be screaming that someone needs an attorney. OH! And your comment about many injuries having an impairment? Not so anymore. 6th Edition of The Physician's Guide to Permanent Impairment typically does not factor in "pain" in the impairment rating. When pain was a legitimate criteria for an impairment rating your statement would have been true (more or less)

 

[Nellibelle]

PT should have been started within a week of the first Dr. appt (or at the very least authorization should have been sought). Do you realize that only a few injuries would require a month off of work? Do you know that studies have shown (and from my own personal experience) that the longer a worker is off of work, the more likely it is that he/she will not return to work? Complaints of pain are subjective and are not a diagnosis. Work Comp is based on objective medical findings. And without objective medical findings, there really isn't anything to adjust! ALSO...every adult has some degree of back "issues". It's a natural process as the entire body ages and deteriorates, so the friend could be having "pain" for a variety of reasons. You really know very little about Work Comp, the medical and psychological issues that come into play in a claim, and should not be screaming that someone needs an attorney. OH! And your comment about many injuries having an impairment? Not so anymore. 6th Edition of The Physician's Guide to Permanent Impairment typically does not factor in "pain" in the impairment rating. When pain was a legitimate criteria for an impairment rating your statement would have been true (more or less)

I agree with you that pain, in itself is not a diagnosis. When one has a muscle strain there is pain and would probably require less than a month off of work, however, if one has a herniated disk, it could require much more time off of work and even an operation! That is why a doctor may feel the need to perform an MRI. We don't kn ow how serious the injured worker's back injury is! If it is and continues to cause pain, then he needs to keep in contact with his doctor and if the IC/employer is keeping him from getting treatment, he needs to get an Attorney to file a claim with the WCAB! That way, the injured worker WILL be able to see what the objective medical findings are!

I also understand that the natural process is that as we age, the body deteriorates and there are residual effects from that natural process, but when a worker is engaged in continuous heavy lifting on a daily basis, there is a risk of injury to one's back. In this case, it is rather profound and not attributed to any natural process.

Really, Ladyback1, nobody is screaming for an attorney here and you are embellishing a matter that is rather simple and self explanatory.

 

[quincy]

Again, your friend needs to consult with an Attorney (many in California who would take your friend's case), who can keep abreast of your friend's situation. ... It is paramount that your friend seek out an Attorney ASAP!!

Nobody is screaming for an attorney? What is the "It is paramount that your friend seek out an Attorney ASAP!!" then?

And the " ... he needs an Attorney to assure he gets his benefits," and, "The OP's friend needs an Attorney!" and, "The best advice anyone on this forum can give him is to get an Attorney--pronto!"

The State of California Department of Industrial Relations states, "The vast majority of workers' compensation claims are resolved between injured workers and claims administrators with no problem. ... You're not required to have an attorney, even if you have a disagreement with the claims administrator ... Your attorney's fee will be paid out of a portion of your workers' compensation benefits. If you decide not to get an attorney, the I & A (Information and Assistance) officer at your local DWC district office can help you with your claim."

The State of California Department of Industrial Relations also states, "Your local I & A officers are a great resource and their services are free."

There is no need for an attorney, ASAP or otherwise, unless this is an extremely complicated case. Because the person involved has never posted to this site, there is no way to judge the injury or the need for an attorney.

The original poster, if s/he ever decides to return and wade through this unnecessarily-long thread, can visit the following website for accurate information and a way to contact I & A officers for advice that is relevant (and not guesses based on a secondhand account about an injury that happened to a friend): http://www.dir.ca.gov/dwc/wcfaqiw.html

 

[Ladyback1]

I agree with you that pain, in itself is not a diagnosis. When one has a muscle strain there is pain and would probably require less than a month off of work, however, if one has a herniated disk, it could require much more time off of work and even an operation! That is why a doctor may feel the need to perform an MRI. We don't kn ow how serious the injured worker's back injury is! If it is and continues to cause pain, then he needs to keep in contact with his doctor and if the IC/employer is keeping him from getting treatment, he needs to get an Attorney to file a claim with the WCAB! That way, the injured worker WILL be able to see what the objective medical findings are!

I also understand that the natural process is that as we age, the body deteriorates and there are residual effects from that natural process, but when a worker is engaged in continuous heavy lifting on a daily basis, there is a risk of injury to one's back. In this case, it is rather profound and not attributed to any natural process.

Really, Ladyback1, nobody is screaming for an attorney here and you are embellishing a matter that is rather simple and self explanatory.

So, your "advice" incorrect. Good to know, good to know.

(one does not need an attorney to file anything with the state --as it relates to work comp-- and that is true across the majority of the states)