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  1. #1
    Join Date
    Sep 2009
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    3

    Default Police Officer Injuried While on Duty

    My husband injured his back(fractured L4 & L5, torn ligaments, bulging disc) while on duty back in March of 2009. He has been out on Workman's Comp for the past six months. He is suppose to return to work light duty next week. My question is what do we need to do prior to him returning to work? His work allows him to collect W.C for 1 year per area of injury, this being said he has 15+ years left on the force and I can almost bet over those 15+ years he will hurt himself again. We are being told that we need to get an attorney to insure that we get life time medical on his back. Do we need to do this before he returns to work light duty next week? Thanks

  2. #2
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,011

    Default Re: Police Officer Injuried While on Duty

    There are some diffiernt provisions for public service employees... police, firemen etc. But other than those rules, and some collective bargining provisions, they are subject to and eligible for the same laws and benefits as other workers in Calif.

    His work allows him to collect W.C for 1 year per area of injury,
    Not sure what you mean by that...but once he is released at MMI, and to light duty, his condition will be evaluated, and rated for PD/WPI... a predetermined number of weeks for each 1% of that rating will be paid as indemnity for the injury and reduced earning capacity.

    The ''possibility'' of reinjury is not a consideration in a comp claim. Only one injury, or even multiple body parts are dealt with in each claim...on it's own merits. Aggreviation to a body part could be a new injury/claim, IF there is such occurrence.
    We are being told that we need to get an attorney to insure that we get life time medical on his back.
    There is no such thing as ''life time medical''... comp provides benefits to the injured worker due to an injury suffered on the job, medical treatment is but one of those benefits. The ER is the insured party, and carries liability for the PD/WPI, as medical, for as long as medical necessary... subject to prior authorization, and MTUS/ACOEM treatment guidelines, and UR process. The ER/IC continues to control the medical as long as the benefit remains open. IF you accept a lump sum payment to close the claim... the medical closes with that payment.
    Do we need to do this before he returns to work light duty next week?
    You consult with an atty at the first problem with a denial of benefits, or when you have a disputed medical issue. Or, at least prior to any negotiation of a settlement.

    The default settlement in all comp claims is periodic/bi-weekly payments on the indemnity, and open medical as above. If you are not disputing the PD/WPI rating... or any other issues, there is probably no need for an attorney, and forfeiting up to 15% of the award.

    This may be of interest to you...Article 7. City Police and Firemen, Sheriffs, and Others http://www.leginfo.ca.gov/cgi-bin/di...file=4850-4856

  3. #3
    Join Date
    Sep 2009
    Posts
    3

    Default Re: Police Officer Injuried While on Duty

    Let me try and clarify just a bit.....

    We have been told be fellow officers at his station that W.C. will pay up to 1 year on his injury. It has been 6 months. If he injurers his L4- L5 again, he will only be covered for 6 months because he has already used 6 months. A fellow officer sued the city for lifetime medical treatment on their back so if they reinjure the same area they will be covered. Is this not true? What happens if upon returning to work my husband reinjures his back?

    Not looking to make money off my husbands injury. We are just looking to make sure that his back will be covered if reinjured.

  4. #4
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,011

    Default Re: Police Officer Injuried While on Duty

    Temporary disability benefits are paid for up to 104 weeks/TWO years, with in 5 years of the injury/DOI. BUT... once he is MMI/max medical improvement, that TTD stops. He will be rated,and PPD/Permenant Partial Disability benefits begin.

    Not one year has your fellow officers have told you...

    A fellow officer sued the city for lifetime medical treatment on their back so if they reinjure the same area they will be covered. Is this not true?
    You do not 'sue' for future medical...that comes with the claim. Unless you close the medical by a settlement/lump sum payment, the medical stays open. WC is not ''health insurance'', the employer is covered as the insured party, not the employee. Only the body part is covered in a work injury. If you close the medical for money... additional treatment will be out of your pocket.
    What happens if upon returning to work my husband reinjures his back
    That would be a new claim. Aggreviation to a pre exsisting injury is a new claim/injury. And additional % of PD/WPI would be deducted from the next award.
    Not looking to make money off my husbands injury. We are just looking to make sure that his back will be covered if reinjured.
    His back is covered now, for the natural progression of the injury/illness.... IF there is another new injury/claim. that would be covered under that claim.

    IF he is working in your back yard... no coverage.
    If he trips over your kids bike in the driveway... no coverag.

  5. #5
    Join Date
    Oct 2006
    Posts
    9,108

    Default Re: Police Officer Injuried While on Duty

    california gives all work injuries lifetime medical; an atty is not required.
    workers comp pays temporary disability for 104 weeks per injury.

    you husband needs reliable information more then anything else.
    he can start here with the fact sheets:
    http://www.dir.ca.gov/dwc/iwguides.html

    all re-injuries are new injuries and a entitlement to all benefits just like a first injury.

  6. #6
    Join Date
    Sep 2009
    Posts
    3

    Default Re: Police Officer Injuried While on Duty

    Thank you.

    Now when will Workman's Comp have you sign off on the injury? Should we have someone look over the paperwork prior to signing?

    I understand now that Workman's Comp will cover an injury for 104 months. Just to clarify.... if he was to re injure his back while at work that will be a NEW claim and not a continuation of the previous claim? What is to prevent Workman's comp from claiming that the first injury never healed completely? An MRI was done to diagnosis the problem but another was not done upon him returning to work.

  7. #7
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,011

    Default Re: Police Officer Injuried While on Duty

    I understand now that Workman's Comp will cover an injury for 104 months.
    104 WEEKS, not months. You are capped at 104 weeks of TTD paid within 5 years of the DOI.

    Now when will Workman's Comp have you sign off on the injury? Should we have someone look over the paperwork prior to signing?
    Sign off ? There is nothing to sign off on unless you are accepting a C&R/lump sum payment. If you do that, you could see a voluntary termination....
    If you are accepting the PD/WPI rating done by the PTP, or PQME, the PD indemnity will be paid out over time. The medical remains open under a future medical award. You have 5 years from the org DOI to petition the court to re-open the claim for new and further disability.
    Just to clarify.... if he was to re injure his back while at work that will be a NEW claim and not a continuation of the previous claim?
    A 'new injury' is a new injury/claim. Doesn't matter how it's turned.
    What is to prevent Workman's comp from claiming that the first injury never healed completely? An MRI was done to diagnosis the problem but another was not done upon him returning to work.
    WC does not provide medical treatment until you have reached pre injury condition. Only to a point you are stable/MMI. At that time, your condition is rated, and PD/WPI indemnity is due. So it doesn't matter that the org injury hasn't ''healed''. Treatment in comp is not like your GHP or personal health coverage. The benefits are severly limited. Once the PTP determines MMI.. you don't need, or get additional MRI's or other diagnosits to return to work, unless a AME/PQME does them to calculate a final PD/WPI rating.

    I have to tell ya, your quesitons don't seem to indicate you've read the fact sheets or other information available at the DWC web site.
    Have you consulted with an attorney?
    That is where you get legal advise... message boards are not good for that.
    Or a I&A officer at the WCAB ?

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