California Worker's Compensation - Help For Injured California Workers

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  1. #1
    Join Date
    Jan 2010
    Posts
    4

    Default Workmans Compensation Benefits Stopped

    I am going to try and simplify this. I am a master technician for Ford for over 20 yrs and I have belonged to the same Union for over 15 years. I was presently in my new employer for approx. 2.5 months. I was pumping on a clutch continuously and something in my knee popped and I was in extreme pain and could not move my leg.


    DOI 4/2008
    Went to doctor had MRI, Xrays injections.
    Needed complete Knee Replacement
    Past knee issues never a work injury.
    The Insurance company for where I work finally approved the surgery but I had it done under my wife's insurance. It was fine they approved it.

    I have been sent to 2 different QME doctors and they both agreed with my doctor and said that I am unable to ever go back to my job again. I received a letter from this insurance company who is claiming to be my employer (which they are not) on the day before Thanksgiving saying I needed to report to work that Monday for some kind of clerical job. I contacted an attorney right after. I was given no notice or training or even a release from any doctor let alone my own. They discontinued my payments and then after talking with my attorney reinstated them. Christmas Eve I received the same notice saying if I did not show up for this same clerical job on that Monday they would suspend my WC payments once again. My attorney filed with WC board and I am still waiting. 1 week ago I received the last QME doctor's report stating that I am not permanent and stationary and that I am unable to return to this job due to my injuries and will require future surgeries. All of the doctors have not released me but the insurance company feels that they are able to release me and that I should go and work for them (not my employer Ford) in a job that I have not been trained for, is not a Union job, or within my contract and is 45min to 1hour away from my home.

    I am now in the waiting game. I have applied for SSI SS and SDI. I was turned down by SDI which I do not understand and I am now in the appeal process. I am receiving now only $425.00 every 2 weeks as apposed to the $1825.00 every 2 weeks I was receiving. I do not know what to do. I have been waiting to hear from my attorney and they are waiting for the appeals board to do a rush hearing. I am not released for work and can not work and can not survive on this payment.

    Do you have any suggestions that can help me?

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

    Default Re: Workmans Compensation Benefits Stopped

    There isn't anything for you to ''do'' about this. You're going to have to wait for the hearing and the judge to make a decision on what to do about your benefits.

    When you say 'your doctor', that appears to be different than a WC Dr your ER/IC has a right to have you see to treat.
    When the carrier/IC approved the surgery, why did you let your wifes carrier/GHP pay for the surgery?
    What you do there is complicate your claim.
    All of the doctors have not released me ...
    Your doctors don't have to release you to return to work. All it takes is one Dr to say you are able to perform some type of sedentary work for your TTD benefits to stop.
    Appearantly, the carrier has such a report, and has estimated your PPD rating...that is why your TTD went down to the PPD rate. Looks like you are being paid advances on your PPD indemnity.

    Once your ER/employer files the claim with their IC, the IC becomes the ''employer'' for the duration of your claim. It wouldn't be the norm for a IC to have you come to work for them...but your ER could be offering light duty, or alternative work. ie the clerical position. You do not have to be 'trained' nor a union job for light duty capacity. They are trying to get you on a wage vs disability payment. So the IC is your ''employer'' until the claim settles, they are paying you.

    It would appear you were denied SDI because of the WC benefits. You can't receive WC disability for the same time you would be paid SDI.
    If you are receiving PDA/disability advances, and your Dr certifies you are unable to work, you could be paid SDI. There are seperate rules for EDD/SDI/UI benefits.

    There are too many complexities in your claim, you have an attorney, information here is generic at best, and may or may not apply to your situation.
    Let your atty do his job, and explain these issues if necessary.
    You can't provide enough facts here, nor should you, to tell exactly what the situation is. There is little your union has to do with your comp claim.

  3. #3
    Join Date
    Jan 2010
    Posts
    4

    Default Re: Workmans Compensation Benefits Stopped

    Well the surgery needed to be done asap. Workmans Comp has been reimbursed. It was a matter of paper work and time. This was actually suggested by the IC. The IC is not disputing that.

    My doctor and the QME (WC doctors) all have not released me to any kind of work. My real employer will not have a worker come back to work without a doctor's release. All my doctors reports concur with each other. I was suppose to be retrained but the IC company did not give the legal amount of time to respond, this is one of many reasons it is going back to the WC board. I was hired by a union shop so if I am put into a position it has to be a union position or it goes against the contract of the employer. My employer (Ford)has not offered anything because I am not released by any physician to do anything and I will need additional surgery.

    My doctor has filled out his portion of SDI and I did mine. It just seems like a waiting game. The IC stopped all payments at the time I applied for SDI. SDI said because I was not working for the past 1.5 years I was not paying into SDI but my employer was and I have for my whole life. So it is kind of confusing. Do you know if SDI supplements the WC PDA advances?

    I understand that this site does have generic information. I am just trying to see if anyone is under the same situation as me and has had any resolution.

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

    Default Re: Workmans Compensation Benefits Stopped

    There may be lots of IW's who have experienced similar situations as you... but all are different and unique to the individual. Making compairsions would only lead to more confusion.
    SDI said because I was not working for the past 1.5 years I was not paying into SDI but my employer was and I have for my whole life. So it is kind of confusing.
    SDI is not a savings account to draw on... it's like auto coverage...if you don't pay the premiums...there is no coverage.
    SDI is paid wholly by the EE. ER pays nothing toward your SDI benefits. If you don't have qualifying wages, and premiums paid during the quarters used to calculate the benefit, you won't have a benefit. SDI is just like any other STD/LTD insurance coverage.
    SDI may pay supplemental to WC, but that depends on your total benefit amounts. I'd have to imagine this would be rare.
    I was suppose to be retrained but the IC company did not give the legal amount of time to respond, this is one of many reasons it is going back to the WC board.
    Based on your DOI, there is no VR/retraining. If you did not have an award for VR prior to Jan 1, 2009 you have no vested rights to VR. It's over. Unless you have something going on that you can't tell here... you have no VR..The recent en banc decision is here .http://www.dir.ca.gov/wcab/EnBancdec..._ADJ347040.pdf

    I was hired by a union shop so if I am put into a position it has to be a union position or it goes against the contract of the employer. My employer (Ford)has not offered anything because I am not released by any physician to do anything and I will need additional surgery.
    There would be no reason for your ER to address a return to work until you are declared MMI. Then they have 60 days to make a valid job offer, or you could see a increase of 15% in your PD award.
    Even though you may require additional surgery, you can still be MMI, rated and resolve the claim by Stipulations w/Award. Future medical would still be available.

    Depending on your PTP determination, you may or may not be able to return to your pre injury job, or ER... in that case, union or no union, it won't make any difference.
    I was hired by a union shop so if I am put into a position it has to be a union position or it goes against the contract of the employer. My employer (Ford)has not offered anything because I am not released by any physician to do anything and I will need additional surgery.
    Understood... What 'resolution' are you seeking ?

  5. #5
    Join Date
    Jan 2010
    Posts
    4

    Default Re: Workmans Compensation Benefits Stopped

    I am trying to have my benefits reinstated by WC since I have not been considered permanent and stationary by anyone.... I was also given an opportunity for a retraining certificate to get training in another career. This was sent after the expiration date like everything else that the IC has done. My attorney says I am able to receive this benefit and this IC has sent everything after the fact. Another reason we are going to the WC appeals board.

    So if you are saying there is nothing I can do. What is it that people do when their benefits are stopped and a worker is still considered injured and working in a position for over 20 years (a career). Do they just go away and live in a cave because they have no means of financial funds, even though they have worked their whole lives in this state? I am trying to figure out what my next step is so my family and I are not out on the street. My wife works full time and has a decent income but not enough to support a family of four and I am unable to go back to my job? Are there options out there?

  6. #6
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,011

    Default Re: Workmans Compensation Benefits Stopped

    You asked ''what can I do?"...you have an attorney, there is nothing for 'you' to do. Any appeal or hearing will be handled by your atty. If you want to 'do' this yourself, you'll have to file a substitution of atty, and name yourself as pro per. Thats' what I meant, 'you can't do anything' about the WC delays/denials.
    I am trying to have my benefits reinstated by WC since I have not been considered permanent and stationary by anyone....
    Your AA may be successful in getting the TTD benefits reinstated from the date stopped... but you should be prepared for TTD to stop again come April... at that time, you will be statutorily MMI. TTD will stop. And if you can't be rated to PD/WPI, you won't be receiving any PDA's. IF you get the SDI, that will be all the income you will receive. TTD is capped at 104 weeks paid within 5 years... based on your DOI.
    What is it that people do when their benefits are stopped and a worker is still considered injured and working in a position for over 20 years (a career). Do they just go away and live in a cave because they have no means of financial funds, even though they have worked their whole lives in this state?
    SDI is good for 12 months of benefits. Period. There are no extensions for SDI benefits, as there are for UI.
    If you can't return to work, you would not be eligible for UI. And, based on the length of time you have been TTD, you would not qualify for UI.

    WC is geared to treat/recover and return to gainful employment... as fast as practical. I know you have a serious injury, but unfortunately the statutes don't recoginze ''truly injured workers'' as Arnold likes to call us.

    Once your condition is stable, your ER/IC will seek a determination of MMI/max medical improvement. Even IF there is the possiblity of need for surgery in the future. If you don't need treatment/surgery now... you'll be MMI. Benefits in WC are extremely limited.
    WC is not based on how long you have worked.
    It's about liability, WC is not a benefit or entitlement, it's a law.
    Unless you are determined to be 100% PD/WPI, which is very rare under the new rating guides, it would be expected you can perform some type of work. Pre injury or otherwise doesn't matter. That's workers compensation.
    I was also given an opportunity for a retraining certificate to get training in another career. This was sent after the expiration date like everything else that the IC has done.
    Based on your DOI, there is no VR/vocational rehabilitation. You may be eligible for a SJDV/voucher like I said, but there are no timeframes on those to be notified 'late' on. And, the vouchers are based on a PD/WPI rating.
    4658.5. (a) Except as provided in Section 4658.6, if the injury
    causes permanent partial disability and the injured employee does not
    return to work for the employer within 60 days of the termination of
    temporary disability, the injured employee shall be eligible for a
    supplemental job displacement benefit in the form of a
    nontransferable voucher for education-related retraining or skill
    enhancement, or both, at state-approved or accredited schools, as
    follows: http://www.leginfo.ca.gov/cgi-bin/di...file=4650-4664
    If thats' what you mean by 'certificate', possibly your AA is going to ask the WCAB judge to order this provided, and determine the value. It will be up to you to seek the program at an approved facility. There are no more counselors for the voucher program.
    I am trying to figure out what my next step is so my family and I are not out on the street. My wife works full time and has a decent income but not enough to support a family of four and I am unable to go back to my job? Are there options out there?
    I don't know what to tell you. Once you are MMI, and rated, you'll receive PDA/advances on your indemnity. That amount will probably the checks you are receiving now. A substantial reduction to your TTD rate. A predetermined number of weeks will be paid. Then the money/income is done as far as comp goes. As I said, it is expected that you will return to some type of work.
    Based on what you say here, I would doubt you qualify for SSA/SSDI benefits, but you should apply if you haven't. Info on how SSA decides if you are disabled under their rules is here http://www.ssa.gov/dibplan/dqualify5.htm

  7. #7
    Join Date
    Jan 2010
    Posts
    4

    Default Re: Workmans Compensation Benefits Stopped

    I have applied for SSA/SDI I am just waiting to hear from them. I was also wondering if you knew the answer to this question.

    I was going to apply for UI but I don't think I fit the criteria. I have not been terminated but I am not working for them. I have not received anything stating I know longer work for Ford. If I am considered unable to go back to my previous work, is that considered terminated or leaving the position? Are my $400.00 checks considered income or part of a payout?

    Thanks for all your help

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