Declared Disabled

**Phoenix500** · 03-27-2012, 06:05 AM

My workers compensation claim was made in the State of: California. I was injured in 2009 due to a slip and fall injury that caused various injuries involving knee, back, and shoulder injuries. Had total knee replacement surgery done that required manipulation, and still having problems with. Also have a pending carpal tunnel surgery pending. Was declared disabled by Social Security, and just received notification that I have been retired due to disability from my job injuries. Once you are retired due to disability from your job how does this affect your W/C case.

**BvIA** · 03-27-2012, 06:37 AM

Once you are retired due to disability from your job how does this affect your W/C case.

Doesn't have any affect, WC benefits are not contingent upon continued employment.

Your WC benefits though will affect your SSDI...you are capped at 80% of your pre injury average wage. The retirement won't affect your WC or SSDI. If you are a public service/state employee though...your PERS could affect your SSA benefits.

**Phoenix500** · 01-28-2013, 06:27 AM

My workers compensation claim was made in the State of California. My claim was made in the State of California. I was injured in May 2008, and again in July 2009. My employer retired me with disabilities due to my injuries caused by the 2009 injury. I was MMI by my PTP, and the insurance carrier sent me through the AME process. In the AME report the doctor indicated that “As this patient is not yet permanent and stationary, I will need to defer my definitive opinions on this patient’s impairment rating and vocational rehabilitation at this time. Does this mean that the insurance carrier will not be paying me any PD because I am not declared P&S at this time, and if any monies are due, when will the insurance carrier pay them? The AME report also stated that the patient also needs two surgeries, and after completion of surgery the patient will be evaluated again. If I decide not to have the surgeries, what will happen than? Any help or comments on this topic would be helpful.

**BvIA** · 01-28-2013, 07:13 AM

If you have not rec'd the 104 weeks of TTD, those may be due again.
Or, you should apply for SDI. That would pay an additional 52 weeks.

If you decline recommended treatment/surgery, you'd be automaticlly MMI, and rated 'as is' for PD.

If you have already rec'd the 104 weeks of TTD... there should be an estimate of PD, and those PDA's begin.

The AME report also stated that the patient also needs two surgeries, and after completion of surgery the patient will be evaluated again.

Your injury is such that the AME is recommending TWO surgeries...and yet you are contemplating refusing? You WANT to be "disabled"...

If you refuse the surgery, the presumption is you will be looking for work that fits your permanent restrictions and physical status.
Frankly... guess I just don't get it.

Listen to your attorney...s/he has the file, and knows your situation. Message board is generic at best.

**Phoenix500** · 01-30-2013, 05:50 AM

My original injury date was August 08, and TTD ended in August 2010. After that I filed for SDI and got approved first time around. As far as my surgeries go, I had a knee replacement done, and a year later, I had to have a knee manipulation done in which I had some complications with after the surgery. Either way neither surgery did any good. No, I don’t want to be disabled but at this point I feel that I am not emotionally or physically ready to have the surgeries especially at the age of 59. Should I ask my PTP to send me to a pain management specialist or psychiatrist prior to me making my decision on these surgeries? I am 80 percent sure at this time that I may have to deal with my situation as is due to being traumatized by the complications after the knee manipulation surgery.

**BvIA** · 01-30-2013, 06:50 AM

You can request pain management. There may be psych counseling provided, relative to managing your pain levels. The ER/IC isn't liable for the being traumatized, or for counseling regarding further treatment/surgery.

When you deny a recommended treatment, even surgery, you are automatically declared MMI and rated in your current condition for PD.
In any settlement of your claim, (other than C&R) you would have access to future medical. Stipulations w/Request for Award, or Findings by a judge
If you C&R, you will not be paid full value for surgeries being recommended. There is no guarantee you'd seek such treatment, or live long enough. They'd rather provide the medical access, and just wait this out to see exactly what the future exposure would be. But you'd never be able to pay for surgery with the amount paid to cash out the medical in your claim.