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  1. #11
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,021

    Default Re: Reimbursement Mileage Not Paid

    they received my form, on 08/20/10. The Insurance Adjuster told me he just paid the bill, on 10/26/10 and that the check is on the way. Check will arrive on 10/30/10, 73days after I sent it.
    8/20 to 10/26 is 47 working days....10% self imposed penalty under LC5814 is due.
    5814. (a) When payment of compensation has been unreasonably
    delayed or refused, either prior to or subsequent to the issuance of
    an award, the amount of the payment unreasonably delayed or refused
    shall be increased up to 25 percent or up to ten thousand dollars
    ($10,000), whichever is less. In any proceeding under this section,
    the appeals board shall use its discretion to accomplish a fair
    balance and substantial justice between the parties.
    (b) If a potential violation of this section is discovered by the
    employer prior to an employee claiming a penalty under this section,
    the employer, within 90 days of the date of the discovery, may pay a
    self-imposed penalty in the amount of 10 percent of the amount of the
    payment unreasonably delayed or refused, along with the amount of
    the payment delayed or refused. This self-imposed penalty shall be in
    lieu of the penalty in subdivision (a).
    There is discussion on penalties here http://www.dir.ca.gov/chswc/LC5814Rpt.html
    You can't file a petition for penalties with the WCAB until you have notified the ER/IC a penalty is due. In writing, with the reason/s.

    Info on filing is here http://www.dir.ca.gov/dwc/iwguides/IWGuide18.pdf It's not as easy as "file a petition with the board''.

  2. #12
    Join Date
    Oct 2010
    Posts
    263

    Default Re: Reimbursement Mileage Not Paid

    I do not have a Workers Comp case, only a case # with the Insurance Company. I am not represented by an Attorney.
    Once the check comes in, I will request that the adjuster pay me the 10% due based on this statue.
    Thank you,

  3. #13
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,021

    Default Re: Reimbursement Mileage Not Paid

    You can't file anything with the WCAB with out a Application for Adjudication of your claim. The WCAB judge has no jurisdiction, and cannot resolve any disputed issues.

    It may not be in your best interest to file an App/Adj at this time... depending on the facts surrounding your claim, the IC may have to file, if that happens, they will be liable for your atty fees.

    Have you as least consulted with an attorney ?

  4. #14
    Join Date
    Oct 2010
    Posts
    263

    Default Re: Reimbursement Mileage Not Paid

    I have consulted an Attorney. I was told that I would need to file a Declaration of Readiness and Application for Judification. I will decide what to do once I receive the check in the mail, maybe today. The adjuster told me he is getting the second claim processed at this time.
    The Attorney is holding off until I see my Ortho Doctor on 09 November 2010 and see what he writes back to the Insurance Company regarding the progress of my injuries.
    I have pain in my right hand now, swollen in the arc of my inner right hand. The pain radiated down to my wrist. Im using Aleave and cold compress plus Vicodin for the pain. Will wait to see the doctor on 09 November regarding this injury to my opposite hand and also my progress on my surgery to my left wrist. The swelling in right palm is in the middle of my palm around 1/4 inch from the start of my wrist.

  5. #15
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,021

    Default Re: Reimbursement Mileage Not Paid

    I was told that I would need to file a Declaration of Readiness and Application for Judification.

    The Attorney is holding off until I see my Ortho Doctor on 09 November 2010 and see what he writes back to the Insurance Company regarding the progress of my injuries.
    The AA/Applicant Atty is waiting to see If there is a need for PQME. PQME is used to resolve a disputed medical issue, IF the PQME report is favorable to the IW, the CA must begin to pay benefits, OR, they file the Application for Adjudication of the claim. When that happens, The ER/IC is liable for the AA fees. Thats' why the IW should hold off on filing an App/Adj until after a medical/legal evaluation.

    If the Dr on Nov/9 is PQME, that will determine the next steps.
    If this is simply a treating physician... you're looking at potential delays if the CA disputes the Dr opinion.

    I'd have to think the mileage reimbursement is minor to other issues in your claim.... particularly any 10% penalty.
    Penalties are traditionally resolved at the time the claim settles.

  6. #16
    Join Date
    Oct 2010
    Posts
    263

    Default Re: Reimbursement Mileage Not Paid

    I just received my mileage reimbursement check in the mail. This did not have the 10%. Not a big deal.
    My major concern is what my PQME Doctor is going to say about the results of surgery on left wrist. I still have swelling and limited motion in wrist.
    The scar still hurts, very sensative to the touch. I believe that he will ask for a few more PT to help with the swelling and flexibility.
    I will have a few left over when I see him. I would like to find out about the pain in my right wrist, inside on the bridge of the palm. I have a bump on the corner of my
    palm due to the computer pad and mouse. Hope I have not warn out my right hand, using this hand for a year due to pain and surgery on the left wrist, intersection syndrome and De Quervains.

  7. #17
    Join Date
    Oct 2006
    Posts
    9,109

    Default Re: Reimbursement Mileage Not Paid

    that's why they can get away with it.
    not just with you but hundreds of times.
    you only see your check not the big picture.

  8. #18
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,021

    Default Re: Reimbursement Mileage Not Paid

    My major concern is what my PQME Doctor is going to say about the results of surgery on left wrist.
    YOu don't go to PQME to "see how the surgery went"... you go to resolve a disputed medical issue.
    There is no patient/doctor relationship with your PQME.
    I believe that he will ask for a few more PT to help with the swelling and flexibility.
    I will have a few left over when I see him
    If there is PT post surgery required, your surgeon orders that, and the request doesn't even have to go to UR for prior authorization. And, under the regs, only the surgeon can Rx the PT. There are post op MTUS/treatment guides in the Title 8 CCRs.

  9. #19
    Join Date
    Oct 2010
    Posts
    263

    Default Re: Reimbursement Mileage Not Paid

    Thank you.

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