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  1. #1
    Join Date
    Aug 2010
    Posts
    22

    Default Judge Orders Back Pay, TTD and Medical Treatment

    I have a couple of questions:

    1. What happens if the insurance company takes longer than the 20 days (ordered by a judge) to pay my TTD benefits and allow medical treatment?
    2. Are the 20 days calendar days or business days?
    3. Does the 20 day limit start on the day they post the check or is it exactly 20 days after it is finalized and filed?
    4. Why is this called and "award"? I am only asking for what I am due after giving the company I work for many years of my life and, being a top employee all those years and never being hurt. It's hardly an "award."

    Here's more info in case you need it:

    First off, I shoulder surgery last year for an on the job injury. It didn't get any better and my doctor recommended more surgery which was denied. My employer told me to go home until they contact me. My attorney filed a From 9.

    I went to court earlier this month and my employer's insurance carrier's attorneys scheduled me for a doctor appointment AFTER the court date.The insurance company's main attorney wasn't even there, so the judge rescheduled my court date for a week later.

    I went to their doctor and he agreed with the doctor who has treated me for over a year in that I need surgery.

    I go to court the following week and my attorney and their attorneys worked out a deal (I assume they read their doctor's report and decided to start my benefits). The deal is: I get all my back TTD pay for the last 4 months, I get paid every week until I can go back to work and I get reasonable medical treatment.

    Since everyone agreed on what I was getting, my attorney says they likely won't appeal it. They had ten days to appeal it and I haven't heard anything yet whether or not they appealed anything and it's been 16 days.

    The judge ordered the insurance carrier to pay me and allow medical treatment within 20 days.

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

    Default Re: Judge Orders Back Pay, TTD and Medical Treatment

    4... because you went to court and a judge "awarded" you the benefits. It's not about what you are 'due".
    It doesn't matter how many years you may have devoted. There is no '"entitlement" to WC benefits...you are either eligible based on medical evidence, or not. The ER is the insured party...not the IW. WC ''insurance" is not medical coverage for the EE.

    1..2..3, you should discuss these issues with your attorney. If these have not come up at this point... don't anticipate problems... deal with them as they arise. Better yet...let your atty handle the claim.

    WC generally works on working days.. vs calendar days... but, some issues are determined on calendar vs working days.

  3. #3
    Join Date
    Aug 2010
    Posts
    22

    Default Re: Judge Orders Back Pay, TTD and Medical Treatment

    Quote Quoting BvIA View Post
    4... because you went to court and a judge "awarded" you the benefits. It's not about what you are 'due".
    It doesn't matter how many years you may have devoted. There is no '"entitlement" to WC benefits...you are either eligible based on medical evidence, or not. The ER is the insured party...not the IW. WC ''insurance" is not medical coverage for the EE.
    Then perhaps that is *the* major problem that needs to be rectified in the WC system. Maybe "due" is the wrong word. I think you saying "entitled" is a more appropriate term. I AM entitled WC benefits and it doesn't matter how long I've worked for my company; I am not saying since I've given the company I work for X years of my life that I am entitled to WC benefits, ANYONE that works at a major corporation that has to carry WC insurance should be entitled WC benefits IF they get injured on the job. The system is fubar and it needs to be dismantled and put back together again.

    When I add the part about how many years I've worked for this company, I am saying that my WC benefits should not be questioned because: a) I am entitled WC benefits because the judge said so, b) I've been working for 27 years and I have never once called in sick until last year when my doc sent back to work before I was ready (I used all my sick time and vacation time in one month), and, c) My doctor, as well as my the attorneys of my employer's IC, are saying I need surgery again.

    I realize what you're saying that no one is entitled to WC benefits, what I am saying is that it is wrong even if it is how things are done. Now I've been 4 months without pay and without treatment because the attorneys of my employer's IC want to try and hold out on me. You cannot sit there and tell me that this is the proper way to treat anyone (I'm not talking about just me) and that WC is a fair and just system. My perfect credit is now shot and I'll be paying for years to get out of debt which I've never been in. No one should have to endure what I've endured and I've had it easy compared to a lot of other people. That's just wrong no matter how you slice it.

    1..2..3, you should discuss these issues with your attorney. If these have not come up at this point... don't anticipate problems... deal with them as they arise. Better yet...let your atty handle the claim.

    WC generally works on working days.. vs calendar days... but, some issues are determined on calendar vs working days.
    Thanks. My attorney is on vacation this week and these questions didn't arise until it looked like they were going to hold out on me again. It's hard not to anticipate problems when I've been bent over every time I pass a barrel. I'm the type of person that solves problems before they arise and I'm not used to waiting for problems to happen and then solving them because it's a backwards way of doing things.

    Thanks again for the info.

  4. #4
    Join Date
    Aug 2011
    Location
    Georgia
    Posts
    800

    Default Re: Judge Orders Back Pay, TTD and Medical Treatment

    Quote Quoting NameTaken View Post
    I realize what you're saying that no one is entitled to WC benefits, what I am saying is that it is wrong even if it is how things are done.
    You'll have to excuse BvIA. He gets hung up on the semantics of the word "entitled". Of course you ARE entitled to the benefits, if you're found to be eligible for them. In my opinion, there's not much difference in eligible or entitled. The problem arises when people who are not legitimately injured claim the benefits. That's why BvIA is so hesitant to replace "eligible" with "entitled" - and it makes sense.

    The system is fubar and it needs to be dismantled and put back together again.
    Of course the system is broken. Only the IW's, collectively, can push for change. Do what I've been doing. Write (repeatedly) to your State representatives and tell them. Don't just approach them with the problems, offer them some solutions.

    a) I am entitled WC benefits because the judge said so,...
    You're right. And the IC is entitled to dispute the Judge's determination - it's in the rules.

    b) I've been working for 27 years and I have never once called in sick.....
    That's very admirable, and a lot of others have done the same, but the employers and insurance companies don't care.

    .......the attorneys of my employer's IC, are saying I need surgery again.
    .......the attorneys of my employer's IC want to try and hold out on me.
    Those two statements seem a bit contradictory.

    This is a classic "starve-out" strategy. You're not the first, and won't be the last.

    I fully empathize with your plight. I'm sorry you're having to deal with this. Hopefully, your attorney can get things fired up and get you on your way to recovering, both physically and financially.

  5. #5
    Join Date
    Aug 2010
    Posts
    22

    Default Re: Judge Orders Back Pay, TTD and Medical Treatment

    D'oh! I should've proof-read my post before submitting. What that was *supposed* to say:

    "My doctor, as well as the doctor of the attorneys of my employer's IC, are saying I need surgery again.

    I think I started to type, "...my employer's IC's attorneys doctor..." and it sounded more confusing. I changed it and didn't fix it properly.

    Anyway, thanks for the info, LeglEgl. I appreciate it.

  6. #6
    Join Date
    Aug 2011
    Location
    Georgia
    Posts
    800

    Default Re: Judge Orders Back Pay, TTD and Medical Treatment

    Quote Quoting NameTaken View Post
    What that was *supposed* to say:

    "My doctor, as well as the doctor of the attorneys of my employer's IC, are saying I need surgery again.
    Easy to get tongue-tied when you're just insanely frustrated.

  7. #7
    Join Date
    Aug 2010
    Posts
    22

    Default Re: Judge Orders Back Pay, TTD and Medical Treatment

    Today is day twenty and still no word. I asked my attorney if WC can be penalized for going over 20 days and he told me the 20 days is only for a Supreme Court appeal (and 10 days Court En Banc) and that I may not receive my TTD backpay until after that. I know the IC has 20 days to appeal in Supreme Court, but in the last part of court order, after listing what benefits the IC has to pay, it says, " within twenty (20) days from filing this order, respondent or insurance carrier shall comply within."

    Doesn't that mean that is they don't appeal the benefits listed in the court order that they must give me the benefits in the court order within 20 days?

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