California Worker's Compensation - Help For Injured California Workers

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  1. #1
    Join Date
    Jul 2010
    Posts
    21

    Default Unemployment and Work Restrictions

    California, 2004 work injury; I was laid off and I have permanent work restrictions. I'm having a hard time finding a job within my work restrictions. Do I have any rights for retraining or anything through workers comp insurance.

  2. #2
    Join Date
    Oct 1971
    Posts
    3,503

    Default Re: Unemployment and Work Restrictions

    As long as you're under restrictions and your employer fails to accommodate those restrictions for any reason, including a layoff, your wage loss payments should be reinstated.
    Call your adjuster tomorrow and inform him of your situation.
    If he fails to reinstate your payments in a timely manner, hire an attorney.

    Take Care
    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

  3. #3
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,011

    Default Re: Unemployment and Work Restrictions

    --------------------------------------------------------------------------------

    As long as you're under restrictions and your employer fails to accommodate those restrictions for any reason, including a layoff, your wage loss payments should be reinstated.
    Not necessarily.
    Actually there isn't enough info here to tell what the situation may be.
    We don't know the current status of the claim. Is there a settlement by Stipulations w/Award, Finding w/Award by WCAB judge, a C&R ?

    What happened when you were declared MMI?
    Did your ER make a valid job offer within the 60 days, and/or are you eligible for increase/decrease under sect 4658 (2) Disability Payments.
    If you RTW/return to work with your pre injury ER, you would be eligible to TPD/Temp Partial Disability benefits.
    If your ER cannot provide a modified/alternative job, you may be eligible for a SJDV/voucher for retraining services.

    If you are not to return to your pre injury ER, you could be eligible for UI benefits, but TTD/TPD would not be paid as wage differential. (not in Calif)
    Permanent Disability Advances/PDAs are intended to be wage differential when you are unable to return to your pre injury wage.

    Info on TTD/TPD/PDA's, SJDV etc is here http://www.leginfo.ca.gov/cgi-bin/di...file=4650-4664
    Fact sheets and FAQ's are here http://www.dir.ca.gov/dwc/WCFaqIW.html

  4. #4
    Join Date
    Jul 2010
    Posts
    21

    Default Re: Unemployment and Work Restrictions

    I was given a 5% permanent rating for my cervical spine. My case is still open and I continue to treat for FMS. I have permanent work restrictions of: No lifting over 5lbs, no work at or above shoulder level, no repetitive use of upper extremities, sedentary work only with a break every hour.

    I have had work restrictions since I was injured in 2004. I continued to work for the same employer. But due to the economy, I was laid off. I am an Administrative Medical Assistant, but with these work restrictions it is almost impossible to get a job.

    My case has not been settled. I do not have an attorney. I am collecting Unemployment benefits. The only thing I have received from the insurance company was the 5% rating, for which I did receive compensation. They offered a settlement in form of S&A or C&R but I refused, what they were offering was not even enough to cover my medical treatment, since I am treating with a rheumatologist for fibromyalgia my doc says it is permanent. I will need ongoing treatment. (not sure if I did the right thing)

    Thanks to those who have helped.
    Last edited by molly; 07-09-2010 at 09:46 AM.

  5. #5
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,011

    Default Re: Unemployment and Work Restrictions

    You have a 'settlement' by default. The PPD indemnity is paid out over time, the number of weeks associated with the 5%, medical remains open.
    You won't get enough money in a C&R to cover the potential cost of treatment to Fibro or RSD... which may be the case here.....go to www.rsds.org for more information on this.

    It's probably not a good idea to close the medical... IMHO anyway.
    I have had work restrictions since I was injured in 2004. I continued to work for the same employer. But due to the economy, I was laid off. I am an Administrative Medical Assistant, but with these work restrictions it is almost impossible to get a job.
    Have you discussed with your PTP reducing the restrictions... you are 6 years post injury. May be a possibility.

    The job market is severely restricted due to the economy... as you are no doubt aware. The restrictions don't help any for sure. Unfortunately, there really isn't much more available to you under the WC claim.
    You are not eligible for a SJDV/voucher as you did return to work with your pre injury ER.
    The only benefits you are eligible for at this time is the FMC/Future Medical Care award. If the PPD is paid out, there are no more money/weekly benefits for you under this claim. You are also past the 5 year SOL/statute of limitations to petition to reopen the org claim.

    I am suprised, with the restrictions you describe, you were rated a 5% PD/WPI... probably should have been somewhat higher. DId you dispute that rating by requesting PQME evaluation...?

  6. #6
    Join Date
    Jul 2010
    Posts
    21

    Default Re: Unemployment and Work Restrictions

    To be honest, I think about getting my restrictions lifted/reduced but when I was working I could barely get through my work day. Since I have been unemployed now for 4 months, my pain level has decreased. Physically and mentally not working has been good thing, but financially terrible...

    I was P&S'd by the ortho for my cervical spine approx 2005, which he is the one that gave me the 5% rating. He referred me to the rheumy and I've been treating with him since. My adjuster submitted the ortho P&S report only for final rating, 4 years later. This is where I get confused. My adjuster told me that rheumy doesn't count because my injury is an orthopedic injury, but yet the insurance carrier has been authorizing the rheumatologist treatment for 5 years now. I did not request the PQME, my adjuster said I have a year from the last time I saw the doctor to request.... Should I request the PQME although I am still treating with the rheumatologist? Also, in the ortho P&S report, the doc states he gave a 75% disability rating due to Fibro...
    Last edited by molly; 07-09-2010 at 10:25 AM.

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

    Default Re: Unemployment and Work Restrictions

    YES... you should dispute the rating... the CA is BSing you...you do NOT have a year from the PTP rating to dispute...only 30 days actually. Don't know why you would be told that.... the rheumy IS ratable...the can be a 3% addon for 'pain'... subject to the PDRS rules and coversion. There must be 'pain' included in the org rating.
    You are still past the 5 yr SOL to petition to reopen for new and further PD... thats' not going to change.
    My adjuster submitted the ortho P&S report only for final rating, 4 years later.
    That was wrong too.... should/must be within 30 days of the PTP rating/report issues. Doubt there is anything much to be done about the PD/WPI rating now. Unless of course you have somthing in writing from the CA misadvising you... (??)

    Have you considered application for SSDI benefits... RSD/Fibro can be considered 'total disablity' under SSA definition and rules.

  8. #8
    Join Date
    Jul 2010
    Posts
    21

    Default Re: Unemployment and Work Restrictions

    I will contact my adjuster to request the PQME. She is somewhat difficult, do you suggest I hire an attorney if she gives me a hard time about this? I do not have anything in writing, she verbally stated this to me.

    I have considered applying for SSDI, should I ask my rheumy to place me on TTD before I apply since I am receiving unemployment benefits?


    Thanks for all your help.

  9. #9
    Join Date
    May 2009
    Posts
    158

    Default Re: Unemployment and Work Restrictions

    Molly,
    maybe the best thing to do now is call a few attorneys for a consultation
    you may need to call many to find one willing but you will find one who will
    listen...

    the good news is you have the FMC...
    you are still under a doc's care...if you are in pain and unable to work ask
    your PTP about applying for SDI...state disability insurance...
    you may be entitled to 52 weeks of benefits...CA.

    also apply for SSDI now...you can do this online if you wish....it could be
    a long process to get approved for social security benefits...
    some members here have been approved in less than 6 months...

    if you have the time read the thread by BROWNEYEDGURL a member here..
    and the thread from CHARLES STEVENS on SSDI. approval process..

  10. #10
    Join Date
    Jul 2010
    Posts
    21

    Default Re: Unemployment and Work Restrictions

    Since I have been treating under FMC and was working with permanent restrictions, if my doctor finds me Temporarily Totally Disabled then who would pay disability benefits the insurance carrier or CA state disability?

    If the Insurance carrier denies benefits which I'm sure they probably will, would CA disability pay benefits? If so, would the work comp make this an issue and state delay payments?

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