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  1. #1
    Join Date
    Jun 2010
    Posts
    6

    Default W/C Terminated My Benefits, Claims Overpayment - Will they seek Reimbursement?

    Today WC terminated my benefits and said they are back dating the terminated from 4/26/10 to present. They then stated that I received/they over paid me $4k. My question is this? Will they seek reimbursement for the $4K?

    By the way, I am in California.
    Last edited by ugh!; 06-25-2010 at 05:40 PM.

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

    Default Re: WC Terminated My Benefits & said they Over Paid by $4k. Will they seek Reimbursem

    If they are claiming overpayment of TTD/temp total disability, they will be entitled to take a credit against any indemnity you may be due.

    If they claim overpayment of PPD indemnity, it would be difficult to get any reimbursement from an IW. And there would be no benefits to take a credit against.
    However, the is case law where the ER/IC was permitted to take credit against future medical care. The IW would have to pay out of pocket for FMC until the overpayment is satisfied.

  3. #3
    Join Date
    Jun 2010
    Posts
    6

    Default Re: WC Terminated My Benefits & said they Over Paid by $4k. Will they seek Reimbursem

    They are saying they over paid my TTD and will take the over payment out of any settlement I have coming. My question now is what if the settlement is a lot lower than the 4K? If i'm understanding correctly, the balance left will be left for me to pay back as pay my own med bills until the balance is paid? I guess I just want to be sure that one day I'm not going to get a bill in the mail for the over payment. As it is, I have exhaused all my savings and credit since being on leave.

    California really needs to re-evaluate thier laws.
    Last edited by ugh!; 06-26-2010 at 09:50 PM.

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

    Default Re: WC Terminated My Benefits & said they Over Paid by $4k. Will they seek Reimbursem

    They aren't going to come after you for a TTD overpayment if the indemnity due is short of any credit they could take.
    And, IF they were to try to take the credit against any future medical care, it would have to be ordered by a WC judge.

    You should get a benefit printout from the CA and verify the dates TTD was paid, against the dates your PTP said you are due TTD. Or, if there is a AME/PQME certifying TTD.
    You should have been provided a benefits printout when you rec'd notice the TTD was changed to PPD.
    (2) Notice of Changed Benefit Rate, Amount or Schedule or that Benefits are Ending. If the claims administrator changes the benefit rate, amount or payment schedule, or ends payment, of a death benefit to a dependent, the claims administrator shall advise the affected dependent of the change and the reason for it, or of the new payment schedule. A notice that benefits are ending shall include an accounting of all compensation paid to the claimant. A notice that payment is ending shall be sent with the last payment unless the decision to end payment was made after that payment; in that case it shall be sent within 14 days of the last payment. Other notices concerning changed payments shall be sent before or with the changed payment, but not later than 14 days after the last payment which was made before the change.
    9812. Benefit Payment and Notice.
    http://www.dir.ca.gov/t8/9812.html

  5. #5
    Join Date
    Jun 2010
    Posts
    6

    Default Re: WC Terminated My Benefits & said they Over Paid by $4k. Will they seek Reimbursem

    First off, THANK YOU for helping me clear all this up and for helping me relieve a little stress.

    I am not familiar with the WC insurance terms so I apologize if I sound redundant in asking my questions. I just want to be clear.

    Example:

    I am over paid $4K. WC offers me $3k in a settlement. That leaves a balance of $1k. So to be clear, they WILL NOT have me pay back the balance, nor will they credit/add the balance to any future medical unless ordered by a WC judge.

    Is this correct?

    Also, when they terminated my benefits and advised me of the overpayment, they did not issue or provide a benefit print out of dates and amounts that I was paid. Sounds like I will need to make a phone call and request that paperwork.

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

    Default Re: WC Terminated My Benefits & said they Over Paid by $4k. Will they seek Reimbursem

    There is nothing set in stone.
    But a credit to be taken will be from benefits due... it would be like getting blood from a turnip to get a IW to write a check. It's not gonna happen.

    It's not about offering you something to settle, If you get an offer to C&R the claim, it would be with the credit already figured into the equation.

    IMHO... quit worrying about this overpayment, until it's time to worry about it.

    Ask/demand a benefit print out of your TTD and any other benefits paid. That should have come as I said before.

  7. #7
    Join Date
    Jun 2010
    Posts
    6

    Default Re: WC Terminated My Benefits & said they Over Paid by $4k. Will they seek Reimbursem

    One more question! Well, actually, I can't promise that it will be 1 more!


    Since WC terminated my benefits will State disability/Edd now pay and if so, will they pay back pay? I have left a message for EDD, but who knows when I will hear from them. I'd like to know what I can expect.

    THANKS again!

  8. #8
    Join Date
    Jun 2010
    Posts
    6

    Default Re: WC Terminated My Benefits & said they Over Paid by $4k. Will they seek Reimbursem

    one more thing....

    WC terminated my benefits as of the date of my QME appt. they say that is the date that i was actually MMI.

  9. #9
    Join Date
    May 2009
    Posts
    158

    Default Re: WC Terminated My Benefits & said they Over Paid by $4k. Will they seek Reimbursem

    of course you can, and should apply for SDI...if your PTP claims you are
    still disabled and cannot work...ask him/her their office should have the form

    if you have already done this, all you can do is wait for call/notice in mail..
    if you get denied for filing late, simply appeal with explanation..SDI personnel
    seem to understand some IW's are not aware of these benefits...
    they do indeed approve late apps.....

    the back pay part if any will most likely be determined by them,when your
    benefits should start....Bvia can give you much more info on this....

  10. #10
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,011

    Default Re: WC Terminated My Benefits & said they Over Paid by $4k. Will they seek Reimbursem

    Quote Quoting ugh! View Post
    one more thing....

    WC terminated my benefits as of the date of my QME appt. they say that is the date that i was actually MMI.
    PQME/AME as the case may be...is a medical/legal evauation to resolve disputed medical issues.
    If the CA requests the PQME to provide dates benefits are due, TTD/TPD/PD, those are the dates they are supposed to use.

    There were some changes in the ability to backdate a MMI date, I'd have to go back to see exactly what that was, but a MMI date in a report would generally be the date of the exam. IF the PQME indicates a date prior to the appt/exam, they will take a credit of overpaid TTD, If there are TTD benefits paid between the exam and date the report is rec'd, there could also be a credit of overpaid TTD. All depends on the dates the PQME puts in the report.

    I haven't see where EDD/SDI pays benefits that may be back due, that doesn't mean it can't happen. Only seen SDI paid from the date the PTP/DR certifies disability. Which IMHO would be in your favor anyway... SDI pays 52 weeks or more based on the dollar amount you are eligible for.

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