California Worker's Compensation - Help For Injured California Workers

• California Worker's Compensation - Quick facts about worker's compensation law, benefits and lawyer fees.

• California Worker's Compensation Resources - Links and resources for injured workers.

Page 1 of 2 12 LastLast
Results 1 to 10 of 19
  1. #1
    Join Date
    May 2010
    Posts
    2

    Default I'm in Too Much Pain to Work - What Should I Do?

    I had a hernia rpair from a work injury in 08. After surgery had minor painand went back to work. {didnt know I was entitled to a settlement}.Case closed. A few months later started having severe groin pain from lifting.Started new claim with new insurance company{previous ins co dropped my employer}.Had a triple neurectomy to eliviate pain, didnt work pain got worse. Ptp has me on 30lb wt restriction.Had Qme and he stated there was perm impairment or disability and needed future medical care but said i could go back to work without restrictions. My question is Can i go back to ptp and have him pull me off work due to pain getting worse. I deliver appliances and its starting to be too much to handle. Also can my employer fire me for doing this? thanks for any help

  2. #2
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,017

    Default Re: 2 Much Pain to Work/ What to Do

    You can continue to treat with the PTP, even though the PQME has determined you are MMI and released you to RTW/return to work. Being MMI doesn't mean you are not to receive additional treatment. Only that your condition is not expected to change in the next 12 months for the better/worse with or without treatment.

    "Pain" in itself is not a disability. Lots of people go to work every day with some level of pain. Only your PTP would be able to determine whether or not you should be TTD again. And he can do that, however the CA will dispute it, and could send you back to the PQME for a supplemental report as the PTP indicates your condition has changed.

    If you have not consulted with an attorney, you should do so.

    Filing a claim for WC benefit does not provide job protection. You can be subject to layoff/termination at any time.
    The law does prohibit termination for filing the claim, or receiving an award due to your injury. The law does not require the ER to provide any light duty job due to your restrictions. If you are eligible for unpaid leave under FMLA, you should request that now too.

  3. #3
    Join Date
    May 2009
    Posts
    158

    Default Re: 2 Much Pain to Work/ What to Do

    dont want to step over your toes here B but pain may not be a disability
    but pain IS disabling.....
    with the job you do its amazing you've been able to work at all, if your pain
    level is through the roof when you work tell your ptp you can no longer
    work with this level of pain....!!!!

    the qme is just a schlepp, if the carrier disputes/ptp fights it....
    you already got a bumm deal the first go around,dont let it happen twice...

    if your thinkin about an attorney get one, w/comp aint easy
    i know you already know this............. pv

  4. #4
    Join Date
    Oct 1971
    Posts
    3,428

    Default Re: 2 Much Pain to Work/ What to Do

    BvIA
    "Pain" in itself is not a disability. Lots of people go to work every day with some level of pain.
    Not true.
    Cronic pain is a qualifier for disability.

    Long Term Disability Insurer Must Consider Subjective Pain Under ERISA
    The 7th Circuit Court of Appeals agreed with her and ruled that an insurance company must consider a plaintiff’s subjective pain. It stated:

    [E]ven if the source of pain cannot be located, it nonetheless can be real. Furthermore, here the plan ignored the evidence in the [Functional Capacity Evaluation (FCE)] that [the plaintiff's] complaints of pain were reliable. Under these circumstances, we believe it was incumbent on the plan (or the plan's consultant) to do more than just dismiss the complaints out of hand. Instead, the plan must explain why, despite evidence to the contrary in the FCE, it nevertheless finds [the plaintiff's] complaints of pain unreliable and why, if the complaints in fact are reliable, the pain [the plaintiff] is experiencing is not completely debilitating.

    The holding of the case is important to anyone who is on long term disability. While most disability claims can be supported by objective medical testing and evidence, some cannot. This case may open the door for others who have been denied valid long term disability payments simply because current medical technology can’t validate their pain by objective means.
    http://law.freeadvice.com/insurance_...nder-erisa.htm


    Chronic Pain and Social Security Disability
    The chronic pain disability must be severe enough to significantly limit one’s ability to perform basic work activities needed to do most jobs. For example:

    Walking, standing, sitting, lifting, pushing, pulling, reaching, carrying or handling
    Seeing, hearing and speaking
    Understanding/carrying out and remembering simple instructions
    Responding appropriately to supervision, co-workers and usual work situations
    Dealing with changes in a routine work setting
    http://www.allsup.com/about-ssdi/ssd...onic-pain.aspx

    Tony
    Last edited by tony; 05-23-2010 at 05:04 AM.
    Moderator
    We reserve the right to forbid any user from participating in this forum, and to close any user account, at any time, for any reason. In the interest of the community, this may be done without prior notice or warning.
    http://www.workerscompensationinsura...inks/index.htm

  5. #5
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,017

    Default Re: 2 Much Pain to Work/ What to Do

    What you provide may be true for STD/LTD benefits, and/or a qualifier for SSDI benefits.
    STD/LTD, WC and SSDI all have unique threasholds to qualify for those benefits.
    Pain is not a workers compensation "injury".
    Under the current rating schedule and AMA guides to rating disability, pain carries a max add on to the PD/WPI rating of 3%.

    There may well be a rating for Chronic Pain, and the MTUS/ACOEM treatment guides address how pain is to be treated. For WC purposes, pain is not a ''disability'' that would qualify for TTD/TPD wage loss benefits. You would never receive a 100% PD/WPI rating for pain. (Not in California under the current provisions to rating pain, or even under the prior 1995 PDRS.

    Also in the reference you site above, there is a "plan" being discussed. The 'plan' must address and take into consideration the patients pain. And pay benefits to that... medical treatment basically as the patient is the insured party. SSA/SSDI does take pain into consideration, as well as ADA/FEHA/EEOC... that does not mean this applies to WC.

    The IW can and often does continue to experience pain due to the underlying injury/illness, is declared P&S/MMI and expected to return to work. Whether that happens or not is not the concern of the ER/IC...you can't force an IW to return to work in Calif. or any other state for that matter.
    In some other states, the ER/IC is required to assist in a job search, and if suitable employment is offered and refused, that can adversely affect continued disability/wage differential benefits.
    Walking, standing, sitting, lifting, pushing, pulling, reaching, carrying or handling
    Seeing, hearing and speaking
    Those conditions are also included in the threashold for requesting reasonable accommodation under ADA/EEOC/FEHA and Congress expanded definition of "disability''. Those have virtually no bearing on a WC claim when considering compensability. There may or may not be consideration under the AMA 5th edition to rating disability which is the current standard in California.

  6. #6
    Join Date
    Oct 1971
    Posts
    3,428

    Default Re: 2 Much Pain to Work/ What to Do

    BvIA
    For WC purposes, pain is not a ''disability'' that would qualify for TTD/TPD wage loss benefits.
    You're Wrong!!!

    Chronic Pain Regulations
    made under Sections 184 and 184A of the
    Workers’ Compensation Act
    S.N.S. 1994, c. 10
    O.I.C. 2004-299 (July 22, 2004, effective April 2, 2004), N.S. Reg. 187/2004

    Eligibility under these regulations
    4 A worker is entitled to an assessment to determine eligibility for benefits and services under these regulations if the medical evidence establishes that on or after April 17, 1985, the worker had chronic pain that was causally connected to an original compensable injury.


    Permanent impairment rating
    7 If a worker is found to have a pain-related impairment, the Board must pay the worker a permanent benefit based upon a permanent impairment rating.

    http://www.gov.ns.ca/just/regulations/regs/wocchron.htm


    The IW can and often does continue to experience pain due to the underlying injury/illness, is declared P&S/MMI and expected to return to work.
    Are you sure you want to go there again?
    I think we've debunked that myth several times now.
    http://www.workerscompensationinsura...ad.php?t=41727

    MMI refers to your allowed conditions and is not related to your ability to return to work.
    http://www.ohiobwclaw.com/thecompens...ocess/mmi.html

    Tony
    Last edited by tony; 05-23-2010 at 02:03 PM.
    Moderator
    We reserve the right to forbid any user from participating in this forum, and to close any user account, at any time, for any reason. In the interest of the community, this may be done without prior notice or warning.
    http://www.workerscompensationinsura...inks/index.htm

  7. #7
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,017

    Default Re: 2 Much Pain to Work/ What to Do

    I am not wrong...
    This consolidation is unofficial and is for reference only. For the official version of the regulations, consult the original documents on file with the Registry of Regulations, or refer to the Royal Gazette Part II.
    Regulations are amended frequently. Please check the list of Regulations by Act to see if there are any recent amendments to these regulations filed with the Registry that are not yet included in this consolidation.
    Although every effort has been made to ensure the accuracy of this electronic version, the Registry of Regulations assumes no responsibility for any discrepancies that may have resulted from reformatting.
    This electronic version is copyright 2009, Province of Nova Scotia, all rights reserved. It is for your personal use and may not be copied for the purposes of resale in this or any other form.
    It would help if you were to post laws/statutes applicable to the United States and specifically to the State of California. If you'd like to reference the Calif Labor Code, it's here http://www.leginfo.ca.gov/cgi-bin/ca...ebody=&hits=20
    Are you sure you want to go there again?
    I think we've debunked that myth several times now.
    I never said MMI did/does have anything to do with the IW ability to RTW... only that the ER/IC expect this to happen. There is no myth in that. Once there is MMI, there is a PD/WPI rating, and the claim move to resolution. In Calif, that happens to be by Stipulation w/Request for Award, or Finding w/Award and Order by a WCAB judge. The remaining option by agreement of the parties is a C&R. WC benefits do not go on forever but for those IW's with a 100% PD/WPI rating. Once the indemnity is paid out, there is nothing left but access to medical. That is controlled by use of MTUS/ACOEM treatment guides, and the UR process. Until the legislature sees the light in their errors, and Arnold is out on his ass, this is what we have to deal with.

  8. #8
    Join Date
    Oct 1971
    Posts
    3,428

    Default Re: 2 Much Pain to Work/ What to Do

    BvIA
    It would help if you were to post laws/statutes applicable to the United States and specifically to the State of California.
    Oops, my mistake, it doesn't matter, it still applies
    Chronic Pain has alway been and always will be compensable and a qualifier for disability.
    In comp cases, if the worker has chronic pain that is causally connected to an original compensable injury, it is compensable.
    How could it not be?

    I'll do some research and post some links.


    I never said MMI did/does have anything to do with the IW ability to RTW... only that the ER/IC expect this to happen.
    I could care less what they expect, you gave the impression it's the law, you post this repeatedly, without clarification.
    Hell, the carrier expects us to refuse our checks and go to work on a stretcher, I wouldn't post it daily.

    At the end of the day, if you're disabled from a work related injury for whatever reason, Chronic pain, toothache or infected toe nail, you qualify for comp.
    I know of no work related injuries, that comp is excluded from liability.

    Tony
    Moderator
    We reserve the right to forbid any user from participating in this forum, and to close any user account, at any time, for any reason. In the interest of the community, this may be done without prior notice or warning.
    http://www.workerscompensationinsura...inks/index.htm

  9. #9
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,017

    Default Re: 2 Much Pain to Work/ What to Do

    Chronic Pain has alway been and always will be compensable and a qualifier for disability.
    In comp cases, if the worker has chronic pain that is causally connected to an original compensable injury, it is compensable.
    How could it not be?
    There is treatment to Chronic Pain... never said there isn't. There is a max amount of indemnity due, and that is 3% in Calif. No more. And the Dr/PQME/AME as the case may be, must support that finding. AMA guides are just that...guides. Calif law provides for a PDRS/Permanent Disability Rating Schedule, that is used to convert the WPI rating to a PD rating for pre determined indemnity payments. AMA guides are not a 'law'.
    I could care less what they expect, you gave the impression it's the law, you post this repeatedly, without clarification.
    I have never represented that as the law. And I have always said, "It is expected you will return to work". You know that when the IW is declared MMI, the benefits are denied, delayed, and the carrier does everything possible to close the claim. For IW's to wait for a claim to close is potential for additional lost wages. VR or a concerted job search should begin in earnest as soon as the Dr releases for return to work. That is in the best intersts of IW and their family. That not always possible for all IW's. But should not be overlooked just the same.
    And, MMI does not mean the claim is closed, you are eligible for further treatment, or why would there be any discussion of "future medical treatment"...?

    Not all states permit total disability benefits to go on and on as long as there is ''disability''.... most change the classification from TTD to PTD, or PPD, that becomes semantics. The terminology may mean basically the same, but IW should be told there is a difference, and not all benefits will continue at the same rate as TTD was paid. The statutes are not universal... as what Ohio may provide.
    I know of no work related injuries, that comp is excluded from liability.
    Like you, I'd have to go back to the statutes, there are some states that don't allow CT/Cumulative Trauma ie carpal tunnel syndrome, or back injuries that occur over time.
    There are others that preclude psych/stress injuries. Ie, Calif bans psych claims until after the EE is on the job in excess of 6 months.
    Hell, the carrier expects us to refuse our checks and go to work on a stretcher, I wouldn't post it daily.
    That may be... I believe it would be disingenuous to tell IW's they don't have to return to work, that the comp/disability benefits will go on and on and on. That simply isn't true.

  10. #10
    Join Date
    Oct 1971
    Posts
    3,428

    Default Re: 2 Much Pain to Work/ What to Do

    BvIA

    I believe it would be disingenuous to tell IW's they don't have to return to work, that the comp/disability benefits will go on and on and on. That simply isn't true.
    I agree, that's why I never said or implied anything close to that.
    If you're going to accuse me of saying something, post the quote.

    I believe it's "disingenuous" to imply that Pain is not a workers compensation "injury"
    I also believe it's "disingenuous" to imply that MMI means you are "expected to return" to work.

    You can back track by saying you said "they expect" or whatever, the point is you've implied this bull to be fact, repeatedly.

    You are eligible for benefits as long as you're disabled or under restrictions for any reason. (including pain) now that is the undisputable truth!!

    Here is just one of several articles that verify pain is a qualifier for benefits under comp, no I won't post a dozen, one makes the point.

    In a recent claims audit of workers' compensation claims for a Texas municipal pool, the claims auditor was astonished by the number of lifetime medical claims. The indemnity benefits had been paid out, sometimes years ago, but the former employees were still treating on a regular basis. In most of the claims the reason the employee had been seeing the medical provider for years was due to chronic pain.

    The condition of chronic pain can continue for years or even the lifetime of the employee. In some cases the injured employee can return to work with the pain and 'live with it.' However, often the pain can be severe enough to be debilitating, preventing the injured employee from returning to work.
    http://blog.reduceyourworkerscomp.co...#axzz0otn6WoGs


    No, you can't file a claim for pain and suffering but pain related to your injury is relevant.
    Tony
    Last edited by tony; 05-24-2010 at 05:15 AM.
    Moderator
    We reserve the right to forbid any user from participating in this forum, and to close any user account, at any time, for any reason. In the interest of the community, this may be done without prior notice or warning.
    http://www.workerscompensationinsura...inks/index.htm

Similar Threads

  1. Pain While at Work - in Appeals
    By pain247 in forum Employment
    Replies: 1
    Last Post: 02-16-2010, 03:03 AM
  2. What Happens if I Can't Work Due to Pain?
    By retailwarrior in forum Medical Issues
    Replies: 2
    Last Post: 03-24-2009, 08:39 PM
  3. Looking for Work While in Pain
    By HeidiLynnM in forum Employment
    Replies: 12
    Last Post: 10-25-2008, 10:32 PM
  4. Going Back To Work Despite Pain
    By skeetobug in forum Employment
    Replies: 12
    Last Post: 06-04-2007, 01:33 PM
  5. Back to work but still in pain
    By caroline in forum Alaska
    Replies: 21
    Last Post: 01-10-2004, 11:41 AM

Bookmarks

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
 


Find a Lawyer