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  1. #1
    Join Date
    Mar 2012
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    1

    Default Can You Sue a Worker's Comp Insurance Company for Neglect

    My workers compensation claim was made in the State of: California
    My husband has been out on Workman's Comp since 6/10/10. We are nearing the 2 year mark. Now we find out that at 2 years they can stop paying. They will not deny or accept the upidural injections he needs. He had on in November and it helped so wanted that route before surgery because he is 63 years old. They are just not taking calls or responding to any letters or requests from Doctors. We have had a laywer since 4 months into the claim as we saw how things were going. Laywers are another troublesome part of this mess. You can't talk to one! No, you get a boiler room of people who type in your case file and promise they will send an urgent request to the laywer who never answers!

    Come June if they stop his TTD the company will let him go then we will have NO insurance, and no money. Anyone in California have a reasonable solution?

  2. #2
    Join Date
    Oct 2006
    Posts
    9,108

    Default Re: Want to Sue Worman's Comp Co for Neglect

    you can change comp attys at any time.
    try here for work comp specialists
    caaa.org

    if you want to file a civil suit, the toughest part is finding a lawyer. the damages have to be worth the time and expense.
    you'll have to have good medical evidence as to the value of damages as well as the contribution of the carrier's adjustment practices.
    have you filed for penalties?
    if they haven't first breached the work comp laws, you'll have little chance winning a negligence suit.
    so search for a civil lawyer first.

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

    Default Re: Want to Sue Worman's Comp Co for Neglect

    Apply for SDI/State Disability Ins benefits.
    SDI will pay an additional 52 weeks of benefits.

    It's up to your PTP/Dr to get prior authorization for medical care.... when/If the carrier fails to respond, the atty should file for a expediated hearing at the WCAB and let a judge decide the issues.
    The CA/Claims Adjuster won't talk to you as long as you have an attorney representing you in this claim.

    As SH said, you can change atty at any time, there will be but one fee.

  4. #4
    Join Date
    Oct 1971
    Posts
    3,546

    Default Re: Want to Sue Worman's Comp Co for Neglect

    Quote Quoting evelynbrown000 View Post
    Try to consult a lawyer that focus on workers' compensation issues. Anyone here has idea how much is the average cost of getting an attorney to help on this kind of issue?
    Zero, they are paid on a contingency (a percentage of any benefits won in dispute )

    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

  5. #5
    Join Date
    Feb 2007
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    Calif
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    Default Re: Want to Sue Worman's Comp Co for Neglect

    Atty fees in Calif are not set by law... WCAB judges apply/award fees based on the work performed, average between 9% and 12%, with a general max of 15%. Extremely complex claims, where an atty can show extraordinary amounts of work performed... judge may award higher fees.

  6. #6
    Join Date
    Mar 2012
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    37

    Default Re: Want to Sue Worman's Comp Co for Neglect

    I know I'm hijacking a little bit here....but my attorney wanted me to sign a fee schedule from the get-go at 15%. Is that normal, should I have negotiated? Thanks.

  7. #7
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    Feb 2007
    Location
    Calif
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    Default Re: Want to Sue Worman's Comp Co for Neglect

    Quote Quoting thanksAHnold! View Post
    I know I'm hijacking a little bit here....but my attorney wanted me to sign a fee schedule from the get-go at 15%. Is that normal, should I have negotiated? Thanks.
    Doesn't matter.. yeah..."normal"... WCAB judges award fees...doesn't matter what agreement you sign regarding atty fees... atty gets no more, no less than judge awards.

  8. #8
    Join Date
    Oct 1971
    Posts
    3,546

    Default Re: Want to Sue Worman's Comp Co for Neglect

    Quote Quoting BvIA View Post
    Atty fees in Calif are not set by law... WCAB judges apply/award fees based on the work performed, average between 9% and 12%, with a general max of 15%. Extremely complex claims, where an atty can show extraordinary amounts of work performed... judge may award higher fees.
    You mean like when they play ping pong with QME's and litigate the same issues for years?
    Now we see what the real problem is.
    No wonder the legal community is resisting the new reforms, I should've checked this earlier.
    Do you have a source for this info?

    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

  9. #9
    Join Date
    Feb 2007
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    Calif
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    Default Re: Want to Sue Worman's Comp Co for Neglect

    Source... there is no law governing atty fees for IW's in Calif.
    The labor code is clear in what info an atty must provide to an IW, disclosures, and file a notice with the WCAB, the amount of fee to be awarded is to be "reasonable".

    4906. (a) No charge, claim, or agreement for the legal services or
    disbursements mentioned in subdivision (a) of Section 4903, or for
    the expense mentioned in subdivision (b) of Section 4903, is
    enforceable, valid, or binding in excess of a reasonable amount. The
    appeals board may determine what constitutes a reasonable amount.
    (b) No attorney or agent shall demand or accept any fee from an
    employee or dependent of an employee for the purpose of representing
    the employee or dependent of an employee in any proceeding of the
    division, appeals board, or any appellate procedure related thereto
    until the amount of the fee has been approved or set by the appeals
    board.
    (c) Any fee agreement shall be submitted to the appeals board for
    approval within 10 days after the agreement is made.
    (d) In establishing a reasonable attorney's fee, consideration
    shall be given to the responsibility assumed by the attorney, the
    care exercised in representing the applicant, the time involved, and
    the results obtained.
    (e) At the initial consultation, an attorney shall furnish the
    employee a written disclosure form promulgated by the administrative
    director which shall clearly and prominently describe the procedures
    available to the injured employee or his or her dependents. The
    disclosure form shall describe this section, the range of attorney's
    fees customarily approved by the appeals board, and the attorney's
    fees provisions of Section 4064 and the extent to which an employee
    may receive compensation without incurring attorney's fees. The
    disclosure form shall include the telephone number of the
    administrative director together with the statement that the employee
    may receive answers at that number to questions concerning
    entitlement to compensation or the procedures to follow to receive
    compensation. A copy of the disclosure form shall be signed by the
    employee and the attorney and sent to the employer, or insurer or
    third-party administrator, if either is known, by the attorney within
    15 days of the employee's and attorney's execution thereof.
    (f) The disclosure form set forth in subdivision (e) shall
    contain, prominently stated, the following statement:
    "Any person who makes or causes to be made any knowingly false or
    fraudulent material statement or representation for the purpose of
    obtaining or denying worker's compensation benefits or payments is
    guilty of a felony."
    (g) The employee, the insurer, the employer, and the attorneys for
    each party shall sign and file with the board a statement, with the
    application or answer, under penalty of perjury that they have not
    violated Section 139.3 and that they have not offered, delivered,
    received, or accepted any rebate, refund, commission, preference,
    patronage dividend, discount, or other consideration, whether in the
    form of money or otherwise, as compensation or inducement for any
    referred examination or evaluation.

  10. #10
    Join Date
    Oct 1971
    Posts
    3,546

    Default Re: Want to Sue Worman's Comp Co for Neglect

    I wish you would post the link to your sources.

    That's a little different than what you originally posted.
    The above says:
    (d) In establishing a reasonable attorney's fee, consideration
    shall be given to the responsibility assumed by the attorney, the
    care exercised in representing the applicant, the time involved, and
    the results obtained.

    Hell I'll take it, it still gives me the ammo I need to support my position on SB863.

    This is the part that I support, I believe it will improve the current system and save millions of dollars in excessive and unnecessary litigation.

    In 2004, when the Medical Provider Network (MPN) system was created, it was thought that this program, which gave employers control over the selection of treating physicians, would reduce that medical expenses that are perhaps the most significant cost driver of the workers’ compensation system.
    However, there are several problems with the 2004 MPN system. Costs were not reduced as much as employers had hoped. And injured workers (IWs) often find it difficult, if not impossible, to secure physicians in this new network.

    Once an IW is in the MPN system, the Independent Medical Review (IMR) dispute resolution system was intended to resolve all disputes over medical treatment (MT). However, it is rarely, if ever used. Instead, parties continue to bring their MT issues to the WCAB for expedited hearings, with rights of appeal to higher courts, including the Supreme Court if necessary.
    The current reform package attempts to resolve these issues, along with many others. The primary change in this current proposal is that the IMR process was originally designed for, but rarely used for MT disputes in the MPN system, was made mandatory for almost all medical treatment disputes in the entire workers’ compensation system, with little or no involvement from the WCAB. Only an IMR reviewer is permitted to make a decision on medical treatment. In almost all MT cases, neither the WCAB nor any higher authority is permitted to weigh in on the issue of what constitutes reasonable and necessary medical treatment.The reform legislation seems to be designed to eliminate attorneys and the judicial system from the MT dispute resolution process.
    http://www.lexisnexis.com/community/...rovisions.aspx

    Now we see why the California Applicants’ Attorneys Association (CAAA) adamantly opposes the new reforms (SB863)
    They are looking after their own interest, not injured workers.
    They stand to lose millions of dollars in billable, unnecessary litigation.

    I had a feeling about this, I took it for granted and never bothered to verify my suspicions.
    I was too busy defending myself from the entire country.
    I shall re-post this in a new thread.

    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

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