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Thread: Injury Rating

  1. #1
    Join Date
    Dec 2007
    Posts
    91

    Default Injury Rating

    I was injured in march and june 2005. I was MMI P&S by the AME Ortho with an 12%rom and 12% wpi in august of 2008 the ortho said that 40% for march and 60% for june total of 100% work related, I was also P&S MMI for psych from the ptp on april 2008 with an wpi of 24% and 100% work related, I The psych AME rated me at 18%. and 100% work related The Internal AME rated me at 18% and 100% work related. my question is , that my A/A did an in office rating 27% for march and 37% for june as it stand for now ,56% if combined dose this make any sense. my ER layed me ofF do to reduction in force, I should be entitled to a 15% increased in PD . the SDI lien has not been payed by the ER self Insured. to this day I have not been P&S MMI by my PTP. ....The CA sent me a check of PD advance with dates 8/2007 -2/2008 , SDI lien dates are 8/2007-8/2008 the dates over lap .

  2. #2
    Join Date
    Oct 2006
    Posts
    9,109

    Default Re: Rating ?

    is there a question in there?
    I'm guessing you're confused about the SDI lien.
    only TTD overlaps SDI;PPD does not.

  3. #3
    Join Date
    Dec 2007
    Posts
    91

    Default Re: Rating ?

    Is the rating to be done by A/A or the DEU and is it to be combined ,the ortho,psych,internal, the March and the june injury?

  4. #4
    Join Date
    Oct 2006
    Posts
    9,109

    Default Re: Rating ?

    multiple body parts from the same injury are combined.
    separate injuries are not combined.

    the rating schedule has a chart in the back to help with combining the multiple disability ratings
    http://www.dir.ca.gov/dwc/DEU.html

    P.S.
    An impairment rating (WPI)is not the same as a disability rating
    Last edited by .SH; 03-26-2009 at 11:17 AM.

  5. #5
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,021

    Default Re: Rating ?

    Q: Which combining chart do I utilize for a rating under the new schedule?

    A: Use the combined values chart found in section eight of the new schedule. This is the chart that has been adopted by regulation and applies to all ratings under the new schedule. Do not use the combined chart contained in the AMA Guides.
    AME Ortho with an 12%rom and 12% wpi

    The Internal AME rated me at 18%

    P&S MMI for psych from the ptp on april 2008 with an wpi of 24%
    psych AME rated me at 18%.
    The AME ratings are going to trump the PTP ratings...
    So, Ortho will be 12%, Internal 18% and Psych will be 18%... the PTP ratings will be tossed.


    that my A/A did an in office rating 27% for march and 37% for june as it stand for now ,56% if combined dose this make any sense.

    Is the rating to be done by A/A or the DEU and is it to be combined ,the ortho,psych,internal, the March and the june injury?
    The AA rating has NO bearing on your claim. If you/AA disagree to the combined rating when it is calculated, a DEU rating will be necessary.
    If you have 3 'body parts' claimed in the injury, there would be overlap in the AA calculations... how would there be one rating for March, and one for June. You have 3 AME's providing WPI ratings that will be combined.

    This will probably have to go to DEU anyway. There should be only ONE primary AME, and the other AME's reports combined into that one AME's final report where a final PD/WPI rating would be calculated.

    While the PTP/AME is using AMA guides to rating impairments that number will be coverted to a WPI, and the WPI rating will be used to determine the dollar amount of PD indemnity you will be entitled to.

    You/AA and CA/DA can resolve the claim at MSC informally through a Stipulation w/Award by agreeing to a % WPI, and the FMC issues/needs. Or C&R at MSC...
    Or, this can go to trial once discovery is closed..which would be determined at MSC. IF this were to go to trial, a DEU rating will be necessary as the judge can/will only use a DEU rating to issue a Finding & Award/Order.

  6. #6
    Join Date
    Dec 2007
    Posts
    91

    Default Re: Rating ?

    my AA said that it can not be combined due to some case that is being rebutted in court.
    My rating has not been sent to the DEU ,like I said I had called my A/A to find out what my rating was and he gives me a dollar amount with F/M open.
    My A/A said that the CA/DA would agree to the amount. The CA/DA through out my clame the CA/DA has delayed and denied everything, but now thay are willing to accept the first offer.
    Is there a case that can be used to combine WPI?

  7. #7
    Join Date
    Oct 2006
    Posts
    9,109

    Default Re: Rating ?

    if you want more litigation you should get another atty. someone who will spend a more time and willing to go to court repeatedly. The fee will have to be shared. talk to other attys before dropping your current one as it may be more difficult this late in the claim.

    yes the Benson decision in december of 2007 determined that your claims were not combinable.
    you can find a brief summary and a link to the case here
    http://www.dir.ca.gov/wcab/wcab_enbanc.htm

    There is no case that allows WPI to be combined in ways other then that specified by the AMA guides. Without changing your ratings the formulas for calculating PD are very specific and not open to subjectivity, modification, or negotiation.
    Last edited by .SH; 03-27-2009 at 08:18 AM.

  8. #8
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,021

    Default Re: Rating ?

    Is the rating to be done by A/A or the DEU and is it to be combined
    The DEU... your AA rating has no bearing or validity on your claim.

    My rating has not been sent to the DEU ,like I said I had called my A/A to find out what my rating was and he gives me a dollar amount with F/M open.
    If the DA is agreeing to the ratings as they stand, and the medical to be left open, that would be a Stipulation w/request for Award. This would settle your claim.

    The CA/DA through out my clame the CA/DA has delayed and denied everything, but now thay are willing to accept the first offer.
    This is not about negotiations... the indemnity is set by statute, and medical is subject to ACOEM/MTUS guidelines...and the UR process. There is no way to force a lump sum settlement, and the IC is within their rights to pay out the indemnity bi weekly, or all at once leaving you with the medical benefits intact.

    IF you were to agree to a C&R, as you have already been provided PDA's (The CA sent me a check of PD advance with dates 8/2007 -2/2008 ,) there doesn't appear to be much money left here... after the AA fees are taken out...there wouldn't be much for you to take to the bank.

    The IC will reimburse EDD for the overpayment on SDI, unless you received TTD for the whole amount. You should have received a check for the difference between the SDI rate, and the TTD rate. Otherwise you will have to write the check for SDI reimbursement.

  9. #9
    Join Date
    Dec 2007
    Posts
    91

    Default Re: Rating ?

    The IC will reimburse EDD for the overpayment on SDI, unless you received TTD for the whole amount. You should have received a check for the difference between the SDI rate, and the TTD rate. Otherwise you will have to write the check for SDI reimbursement.
    After TTD ended(104 weeks) I started to reciving SDI from 8/2007-8/2008. The IC sent me the PDA check Last month 2/2009 with the same dates that I was receiving SDI. I never Cashed the PDA checks.

    This is not about negotiations... the indemnity is set by statute, and medical is subject to ACOEM/MTUS guidelines...and the UR process. There is no way to force a lump sum settlement, and the IC is within their rights to pay out the indemnity bi weekly, or all at once leaving you with the medical benefits intact.
    You are corect. the IC is the one that is offering the dollar amount and open medical. My AA is the one that came up with the rating.my concern is not the offer , it is the rating that is or not corect.

    IF you were to agree to a C&R, as you have already been provided PDA's (The CA sent me a check of PD advance with dates 8/2007 -2/2008 ,) there doesn't appear to be much money left here... after the AA fees are taken out...there wouldn't be much for you to take to the bank.
    I do not want a C&R . The offer is way over 100K.
    Last edited by IN THE DARK; 03-27-2009 at 01:32 PM.

  10. #10
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,021

    Default Re: Rating ?

    After TTD ended(104 weeks) I started to reciving SDI from 8/2007-8/2008. The IC sent me the PDA check Last month 2/2009 with the same dates that I was receiving SDI. I never Cashed the PDA checks.
    Then there should be no issue with the SDI... cash the PDA's. They are advances on your indemnity, and will continue 'til satisfied.

    The only reason for this to go further, as the ratings are being agreed to per the AME reports... would be if you/AA dispute the ratings.

    IMHO... send the AME reports to the DEU for an informal rating.

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