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Worker Comp in California

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CikanVuz

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

A friend injured his back at work due to continuous heavy lifting (filed claim 7/15/14)

he returned to work yesterday on a modified work plan, but his pain increased. He went to the HR person and was informed anymore time off would be PTO time and not WC time. When he ran out of PTO time, he would miss work unpaid. He informed her he had an appointment with this WC dr today. This morning he was told via message that she had switched his doctor and cancelled his current appointment (without his authorization) He is supposed to go for weekly evaluations; missing his appointment today and going to the new dr next week would make him miss his weekly evaluation. He also is supposed to be going to PT three times a week but his work says he has to find a place that is in their plan that is open after work hours; it is a small town so there are none that are open after 5 pm.

Can his employer do these things to him? It seems they are making it so he cannot follow doctors orders and not allowing him time off to get better.

Also, he is entitled to Medical Mileage but has to have someone come pick him up and drive him to and from all his medical appointments. When does the medical mileage start? From where the driver had to leave to pick up the person and then return to where he was afterwards, for from at the injured party's home?
 


Ladyback1

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

A friend injured his back at work due to continuous heavy lifting (filed claim 7/15/14)

he returned to work yesterday on a modified work plan, but his pain increased. He went to the HR person and was informed anymore time off would be PTO time and not WC time. When he ran out of PTO time, he would miss work unpaid. He informed her he had an appointment with this WC dr today. This morning he was told via message that she had switched his doctor and cancelled his current appointment (without his authorization) He is supposed to go for weekly evaluations; missing his appointment today and going to the new dr next week would make him miss his weekly evaluation. He also is supposed to be going to PT three times a week but his work says he has to find a place that is in their plan that is open after work hours; it is a small town so there are none that are open after 5 pm.

Can his employer do these things to him? It seems they are making it so he cannot follow doctors orders and not allowing him time off to get better.

Also, he is entitled to Medical Mileage but has to have someone come pick him up and drive him to and from all his medical appointments. When does the medical mileage start? From where the driver had to leave to pick up the person and then return to where he was afterwards, for from at the injured party's home?
:

1) if the Dr. released him to RTW w/ modifications, and the employer was accommodating the restrictions, then the employer was correct in telling him if he took time off from work it would PTO and not work comp.

2) mileage begins from the injured worker's location.

Your friend really needs to read the CA guidebook/pamphlet for injured workers!
The answers to most questions are in there. And if he still has questions then he can contact the information and assistance unit: http://www.dir.ca.gov/dwc/IandA.html
 

CikanVuz

Junior Member
:

1) if the Dr. released him to RTW w/ modifications, and the employer was accommodating the restrictions, then the employer was correct in telling him if he took time off from work it would PTO and not work comp. But if the Modifications are not working and worsening his injury, it is wc related it seems to me since he needs to go to the dr for further modification or assessment. And his plan requires him to see the dr once a week, PLUS pt 3 times a week and they are not allowing that. I do not see how they can legally, at this point in the game, change doctors on him and hinder his treatment...

2) mileage begins from the injured worker's location. Ok, TY

Your friend really needs to read the CA guidebook/pamphlet for injured workers!
The answers to most questions are in there. And if he still has questions then he can contact the information and assistance unit: http://www.dir.ca.gov/dwc/IandA.html
He does not have internet access and they did not provide him with one at any point and time yet. All he has is his copy of the claim form. He was never given the option to pre-designate a primary physician prior to his injury or at time of employment and while they have one poster posted regarding minimum wage and such, it is 6 years old and not in the area that all employees frequent on a daily work day so he has no way of knowing anything. Hence I am asking for him here. I did read the guidebook and saw the part about MPN and HCOs but he does not know what plan type they have so he has to find that out too.
 

CikanVuz

Junior Member
:

1) if the Dr. released him to RTW w/ modifications, and the employer was accommodating the restrictions, then the employer was correct in telling him if he took time off from work it would PTO and not work comp. But his time off is for his required follow-up dr appointments and due to even with the modifications, his injuries becoming aggravated. I do not see how an employer can legally change the dr. I know they have the right to pick on, but then the employee can change it. (They also never provided forms to pre-designate and physician at time of employment nor any time prior to the injury either.) Plus I know if there is no local PT office with extended hours, they have to make allowances and adjustments so he can attended his PT sessions.

2) mileage begins from the injured worker's location. Ok, TY

Your friend really needs to read the CA guidebook/pamphlet for injured workers!
The answers to most questions are in there. And if he still has questions then he can contact the information and assistance unit: http://www.dir.ca.gov/dwc/IandA.html He does not have internet access and his employer supplied him nothing more than a copy of the claim form. Also, there is no WC notice poster posted at work. The only thing posted is a minimum wage poster from back when the minimum wage was 6 bucks and it is not posted where the employees clock in and out nor in a locations accessible to all workers so he has nothing to find any information out at other than having someone ask for him. I did read it and told him first off he needs to see if he has MPN or HCO
Plus His case worker was at the Drs appointment he went to even though his boss "cancelled" that appointment. The case worker spoke with the boss and then called him back and said his boss is in the wrong but that is all I know so far. I provided him with the ph# to the local WC office but no one was available and the general switchboard told him to expect a call back wednesday or thursday.
 
What is the name of your state (only U.S. law)? CA

A friend injured his back at work due to continuous heavy lifting (filed claim 7/15/14)

he returned to work yesterday on a modified work plan, but his pain increased. He went to the HR person and was informed anymore time off would be PTO time and not WC time. When he ran out of PTO time, he would miss work unpaid. He informed her he had an appointment with this WC dr today. This morning he was told via message that she had switched his doctor and cancelled his current appointment (without his authorization) He is supposed to go for weekly evaluations; missing his appointment today and going to the new dr next week would make him miss his weekly evaluation. He also is supposed to be going to PT three times a week but his work says he has to find a place that is in their plan that is open after work hours; it is a small town so there are none that are open after 5 pm.

Can his employer do these things to him? It seems they are making it so he cannot follow doctors orders and not allowing him time off to get better.

Also, he is entitled to Medical Mileage but has to have someone come pick him up and drive him to and from all his medical appointments. When does the medical mileage start? From where the driver had to leave to pick up the person and then return to where he was afterwards, for from at the injured party's home?
You should get an Attorney to assist you with your case. An Attorney will help you get your benefits if you are disabled and cannot work. Depending on the injury, you can get disability benefits which include bi-weekly payments AND, if your disability results in any permanent impairment, you will recieve payments according to the extent of the permanent impairment via a rating.

As it is right now, you should make an appointment with your newly appointed doctor and see what he says. If you are unhappy with your new doctor, you can find another one within your employer's medical network (if they have one). An Attorney will help you with problems you may have with your employer while doing this! Not to get an Attorney may be very detrimental to your claim.
 

CikanVuz

Junior Member
His case worker showed up at the Dr appt today ( good thing he went even though his boss "cancelled the appointment".) He told her what was going on, the case worker called the boss for the other side of the story and found my friend was being totally truthful in what was happening and said the boss is totally in the wrong and in for a rude awakening. Sad part is they will probably fire my friend over it all even though that too would be illegal....
 
His case worker showed up at the Dr appt today ( good thing he went even though his boss "cancelled the appointment".) He told her what was going on, the case worker called the boss for the other side of the story and found my friend was being totally truthful in what was happening and said the boss is totally in the wrong and in for a rude awakening. Sad part is they will probably fire my friend over it all even though that too would be illegal....
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. Surely, it would be wrongful for your friend to be terminated over this situation, but if your friend violated any company standards, it may be hard to prove such termination was for protected activities concerning a work-related injury! It is paramount that your friend seek out an Attorney ASAP!!
 

Ladyback1

Senior Member
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. Surely, it would be wrongful for your friend to be terminated over this situation, but if your friend violated any company standards, it may be hard to prove such termination was for protected activities concerning a work-related injury! It is paramount that your friend seek out an Attorney ASAP!!
ACTUALLY...it is paramount that the "friend" find out what his rights and responsibilities are as an injured worker. No need for an attorney for that as there is plenty of info on the internet. And...did the "friend" file this as an accident/injury or an occupational disease? There are different rules usually for the two different types of claims.


Getting an attorney involved may not change a single thing. PLUS, if there is ever a settlement in the future? The attorney is going to take 20-30% of the settlement (at least!).

As a former claims examiner, I can tell you that it is a red flag that the "friend" was off of work for apparently a month, and the first day back on modified duty the friend's pain increased. I would be looking at malingering or secondary gain concerns, or possible psychosomatic concerns.

(FWIW: for just about any injury to heal? You are going to have to experience pain--whether the pain is from going back to work, or from physical therapy).
 
ACTUALLY...it is paramount that the "friend" find out what his rights and responsibilities are as an injured worker. No need for an attorney for that as there is plenty of info on the internet. And...did the "friend" file this as an accident/injury or an occupational disease? There are different rules usually for the two different types of claims.


Getting an attorney involved may not change a single thing. PLUS, if there is ever a settlement in the future? The attorney is going to take 20-30% of the settlement (at least!).

As a former claims examiner, I can tell you that it is a red flag that the "friend" was off of work for apparently a month, and the first day back on modified duty the friend's pain increased. I would be looking at malingering or secondary gain concerns, or possible psychosomatic concerns.

(FWIW: for just about any injury to heal? You are going to have to experience pain--whether the pain is from going back to work, or from physical therapy).
The friend apparently was disabled with his injury for the month he was off and then experienced enough pain that he wanted to consult with the doctor that was already set up to see him. Pain that increases while working or doing anything, is reason enough to go to the doctor and get taken away from such activity until the pain subsides.

Sorry, but your opinion on malingering don't sound like thats the case. Psychosomatic issues? I don't think so. He should see an Attorney who will help him with his issues and concerns!

I believe that it is 15% of the settlement that is the percentage of what an Attorney in Ca. can take as payment for representing his client in a Worker's Comp. Case.

The issues seem too complicated for the OP's friend to try and figure the system out by researching. Many workers cannot handle their own work-related cases without getting taken advantage of by their employers. The best advice anyone in this forum can give him is to get an Attorney--pronto!
 
"Did the friend file this as an accident/injury or an occupational disease?"

Ladyback1: If you re-read the OP's post, you will see that the OP's friend injured his back due to continuous heavy lifting. It was probably filed as a 'continuous trauma' claim.
 

quincy

Senior Member
The friend apparently was disabled with his injury for the month he was off and then experienced enough pain that he wanted to consult with the doctor that was already set up to see him. Pain that increases while working or doing anything, is reason enough to go to the doctor and get taken away from such activity until the pain subsides.

Sorry, but your opinion on malingering don't sound like thats the case. Psychosomatic issues? I don't think so. He should see an Attorney who will help him with his issues and concerns!

I believe that it is 15% of the settlement that is the percentage of what an Attorney in Ca. can take as payment for representing his client in a Worker's Comp. Case.

The issues seem too complicated for the OP's friend to try and figure the system out by researching. Many workers cannot handle their own work-related cases without getting taken advantage of by their employers. The best advice anyone in this forum can give him is to get an Attorney--pronto!
If CikanVuz' friend has a legal question or concern, the friend should post with it. No matter how close CikanVuz may feel to this friend, s/he does not have access to all of the facts.

Trying to guess at the medical conditions of someone who has not even posted to this forum is a bit silly.

Ladyback provided a helpful link. If CikanVuz' friend has questions, the friend can use the link to get further assistance.


(a note to Nellibelle: I received your rather nasty private message and forwarded it to the administrators of this site. Please do not send me any more)
 
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If CikanVuz' friend has a legal question or concern, the friend should post with it. No matter how close CikanVuz may feel to this friend, s/he does not have access to all of the facts.

Trying to guess at the medical conditions of someone who has not even posted to this forum is a bit silly.

Ladyback provided a helpful link. If CikanVuz' friend has questions, the friend can use the link to get further assistance.
Who is trying to guess at a medical condition? The OP posted that his friend injured his back at work! I believe the OP and my advice was based on what the OP said. The friend can also consult an Attorney, which would benefit him more than the link provided!

As a member of this forum, I have the perrogative to give my opinions or advice based on knowledge to even Op's who come to this forum seeking help for their friends, and I'll continue to do so. You should be so compassionate. :rolleyes:
 

Ladyback1

Senior Member
"Did the friend file this as an accident/injury or an occupational disease?"

Ladyback1: If you re-read the OP's post, you will see that the OP's friend injured his back due to continuous heavy lifting. It was probably filed as a 'continuous trauma' claim.

But YOU don't know.

Do you know how the two types of claims are handled differently? I do (did it for 5+ years)

What do you know about malingering? Or psychosomatic pain? Do you know anything about somatoform disorder? I know about all these things (several years as an EMT, 5+ years as a work comp examiner, and extensive experience with reading and interpreting medical/chart notes)

A healing injury is going to cause pain! It just is. And if you can not understand that...well, I can't help you!
Furthermore, depending on the injury: A month off of work could be far too long of inactivity, which in turn would cause an increase of pain upon activity.

Look--I realize that you are trying to help, however, you provide inaccurate at best, horrible at worst, advice to people who have no clue.
 
But YOU don't know.

Do you know how the two types of claims are handled differently? I do (did it for 5+ years)

What do you know about malingering? Or psychosomatic pain? Do you know anything about somatoform disorder? I know about all these things (several years as an EMT, 5+ years as a work comp examiner, and extensive experience with reading and interpreting medical/chart notes)

A healing injury is going to cause pain! It just is. And if you can not understand that...well, I can't help you!
Furthermore, depending on the injury: A month off of work could be far too long of inactivity, which in turn would cause an increase of pain upon activity.

Look--I realize that you are trying to help, however, you provide inaccurate at best, horrible at worst, advice to people who have no clue.
Why make it so complicated? It is rather simple to understand a back injury. The OP said his friend injured himself by heavy continuous lifting, yet you say may have been filed as an occupational disease. You also say the injured worker is faking it and/or having psychosomatic pain. Who's guessing here?

It is easy to see that the injured worker cannot work in his condition, based on what the OP has said. He needs to keep his appointment with his doctor to see what needs to be done--continue working or take more time off. And, he needs an Attorney to assure he gets his benefits.

By the way, I've been personally involved with 2 California Workers Compensation claims in the last 15 years and I do know how complicated the system can be for injured workers! The OP's friend needs an Attorney!

Also, I agree with you that a healing injury is going to cause pain, but such pain may result in the doctor requiring the injured worker to take mroe time off. And, your statement that my advice is inaccurate at best, is in itself, inaccurate, in view of my posts in this thread.
 
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Ladyback1

Senior Member
Why make it so complicated? It is rather simple to understand a back injury. The OP said his friend injured himself by heavy continuous lifting, yet you say may have been filed as an occupational disease. You also say the injured worker is faking it and/or having psychosomatic pain. Who's guessing here?

It is easy to see that the injured worker cannot work in his condition, based on what the OP has said. He needs to keep his appointment with his doctor to see what needs to be done--continue working or take more time off. And, he needs an Attorney to assure he gets his benefits.

By the way, I've been personally involved with 2 California Workers Compensation claims in the last 15 years and I do know how complicated the system can be for injured workers! The OP's friend needs an Attorney!

Also, I agree with you that a healing injury is going to cause pain, but such pain may result in the doctor requiring the injured worker to take mroe time off. And, your statement that my advice is inaccurate at best, is in itself, inaccurate, in view of my posts in this thread.
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.
 
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