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  1. #1
    Join Date
    Apr 2011
    Posts
    3

    Default Msc Workers Comp Hearing This Week After Insurance Company Denied My Claim

    I have an MSC hearing this week. I was injured when I slipped and fell on a wet floor where I bartended. Thought it was just a muscle pull and didnt file a workers comp claim. a week after I fell, I was laid off. I was told I could still file a workers comp claim, so I did. Now the insurance company said I was a disgruntled employee and denied my treatment and claim. When they were treating me, I had an MRI done (which showed a herniated disk) and an epidural.

    What will happen at this hearing and do I have a case, since I didnt file until after they laid me off because of my injury?

  2. #2
    Join Date
    Mar 2011
    Posts
    291

    Default Re: Msc Workers Comp Hearing This Week After Insurance Company Denied My Claim

    it's an informal conference between the parties to discuss the issues and how the parties wish to proceed to resolve them.

    you have year to file.
    whether you are/were disgruntled or not has no bearing on whether there was an injury at work.

    it depends on what evidence they have that it didn't happen.
    I assume there was one witness that says it did --you.

    this happens all the time and gets them no where.
    make sure your atty files for penalty--10% on all benefits.

    also consider making a fraud report.
    any one making false statements in order to receive or DENY benefits is liable.
    http://www.insurance.ca.gov/0300-fraud/

    if you were fired for reporting an injury you also can file for increased benefits for discrimination.

    throw the whole book and a couple of supplements at them.

  3. #3
    Join Date
    Apr 2011
    Posts
    3

    Default Re: Msc Workers Comp Hearing This Week After Insurance Company Denied My Claim

    Thank you and yes, No one saw me fall, But I did report it to the GM minutes after it happened, but didnt think I needed workers comp, because I thought I just pulled a muscle in my back. I do have a text message from the GM later on, when he told me to see a doctor. I also have a letter from the lady that did the owners books for 3 years (Payroll, etc) that said that employees were told not to claim workers comp or they could get fired, and had an example of an employee who that happened to. I got that letter from another employee who was laid off and never received overtime pay and he was talking them to the labor board, in which he won.

    I just want my back fixed. The wheels turn slowly dont they?

  4. #4
    Join Date
    Mar 2011
    Posts
    291

    Default Re: Msc Workers Comp Hearing This Week After Insurance Company Denied My Claim

    of course you do, but think of the next employee....

    legal wheels turneven more sssssssssssssllllllllooooowllllllllyyyyyyyyyyyy.
    you got a lot of evidence of fraudulent behavior. the fraud unit would like this case.

    knowing this you still kept working there! it was just a matter of time before it was your turn.......
    do you know that he has insurance?
    Last edited by SH.; 04-19-2011 at 05:02 PM.

  5. #5
    Join Date
    Apr 2011
    Posts
    3

    Default Re: Msc Workers Comp Hearing This Week After Insurance Company Denied My Claim

    Workers Comp Insurance? Yes they do

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

    Default Re: Msc Workers Comp Hearing This Week After Insurance Company Denied My Claim

    I did report it to the GM minutes after it happened, but didnt think I needed workers comp, because I thought I just pulled a muscle in my back. I do have a text message from the GM later on, when he told me to see a doctor. I also have a letter from the lady that did the owners books for 3 years (Payroll, etc) that said that employees were told not to claim workers comp or they could get fired,
    There are more issues here.
    The fact you notified the GM of the injury, even verbal, constitues knowledge of the injury. At that time, s/he was required to provide a DWC-1 Form, claim for WC benefits. And, instructions on how to access treatment for the injury. That would include a MPN/network if one is in place. This also triggers the SOL/Statue Of Limitations on filing a claim, and the 90 days for investigating.
    Upon informing the employer it was a work related injury did they give the injured worker a DWC-1?
    If no, 90 day compensability clock starts ticking immediately.

    If yes, nothing starts to toll the statute until employee files DWC-1, absent along discussion of adequate posting at the employers - if the postings were not proper, then it is a whole other can of worms.
    I have an MSC hearing this week.
    You've actually left out a lot of info here.
    What Dr/PTP did you see?
    What report is the CA disputing?
    Have you been evaluated by a PQME or AME (if you have an atty, it would be AME) You can't have an MSC without a PQME/AME medical/legal evaluation first.
    DO you have an atty handling this claim ?
    employees were told not to claim workers comp or they could get fired, and had an example of an employee who that happened to. I got that letter from another employee who was laid off and never received overtime pay and he was talking them to the labor board, in which he won.
    It is illegal for the ER to make statements intended to dissuade an EE from filing a claim for WC benefits. You could have action under labor code section 132(a). http://www.leginfo.ca.gov/cgi-bin/di...file=110-139.6
    This would be a seperate action, with the WCAB, and any penalties/fines awarded would come directly from the ER. WC carrier doesn't have anything to do with this one.

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