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  1. #1
    Join Date
    Sep 2009
    Posts
    12

    Default Partial Disability Help

    I had C-Spine surgery in 2007 and am still under the surgeon's care. I anticipate that he will determine that I'm p&s within the next few months. I devleoped shoulder problems as a result of my injury and was referred to a specialist for surgery. I'm now post-surgery and the shoulder doc has stated that I'm p&s. He mentioned a percentage of pd but I haven't seen anything in writing yet. Does my entire claim need to be resolved before I receive any pd? I returned to work several months ago but I'm curious as to how this all works.

  2. #2
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    17,941

    Default Re: Pd Help

    Were you not MMI when you returned to work ?
    Once the PD/WPI rating is calculated, by your PTP or PQME and/or the DEU, PDA/permenant disability advances must begin within 14 days.
    At the time you were declared P&S/MMI by your PTP, that ratable report should have issued within 5 working days. Then you would have 30 days to notify the CA if you dispute that rating...and CA would have that time too to notify you of your rights to a PQME for evaluation/rating.

  3. #3
    Join Date
    Sep 2009
    Posts
    12

    Default Re: Pd Help

    My PTP (neck surgeon) has not stated that I'm permanent and stationary. When I returned to work I received a letter from the CA stating that there wasn't enough information to determine any pd. The CA anticipated having sufficient information 6 months after my return to work (which was a couple of years ago) In the meantime, I was referred to the shoulder specialist for additional treatment. The shoulder doc is writing his p&s report for the CA. Will this report be incorporated into the PTP's final report? Will the PTP determine the amount of pd for both body parts? I really appreciate the information on this site as I don't have an attorney and don't feel I can rely on information from the CA.

  4. #4
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    17,941

    Default Re: Pd Help

    Does my entire claim need to be resolved before I receive any pd?
    Depends on the factors here.
    The shoulder being a compensable consequence to the org injury, you'd be rated PD/WPI to the neck injury, taking into consideration the shoulder as a "whole person impairment".

    If the shoulder is a seperate injury/claim, you'd could be rated seperately for PD/WPI. As you had returned to work, I'd have to think this would be a seperate injury/claim.

    There is something missing here though.
    When I returned to work I received a letter from the CA stating that there wasn't enough information to determine any pd. The CA anticipated having sufficient information 6 months after my return to work (which was a couple of years ago)
    Your spine surgery was 2007....and you returned to work. That claim should have had some type of resolution. With/without a rating, the CA should have had things rolling on this and had a PQME to determine your TTD/TPD or MMI status.
    The way you are explaining things now, it would appear they are providing treatment to your shoulder under the FMC/Future Medical Care from the org neck injury.
    In a new claim you'd be eligible for additional TTD...additional 104 weeks if necessary. As well as a new rating.
    Or, you could have petition for ''new and further disabililty'' due to the shoulder. And a new PD/WPI rating.

    Lot of "ifs'' here.
    There is no reason to 'trust' the CA, but you should be consulting an attorney.

  5. #5
    Join Date
    Sep 2009
    Posts
    12

    Default Re: Partial Disability Help

    This is all part of the same claim. My spine doctor told me that I'm permanent and stationary a month ago, and that he would send a report to the CA regarding my permanent disability. To date, I've not heard anything from the CA regarding PD. I know there is a 14-day time frame for the start of PD advances, but does this still apply when the IW has returned to work? If the CA disputes the drs' ratings, I assume I would need to have a QME. Is the CA required to notify me within a certain period of time? I don't like to contact the CA any more than necessary, but would like to make sure that the rules are being followed.

  6. #6
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    17,941

    Default Re: Partial Disability Help

    I don't like to contact the CA any more than necessary, but would like to make sure that the rules are being followed.
    If you have an attorney, you should not be contacting the CA...if you don't, I'd have to ask "why ?", that's where your claim is handled, that's the person who can give you the answers, and that's where you ask about why/what/where are my benefits...

    Your PTP has 5 days to get the P&S/MMI report done and to the CA. The CA has 30 days to dispute the rating. So do you. And you should be receiving ALL copies of any documents sent to the CA by your providers. If you have AA, those copies go there.

    If the CA disputes the PD/WPI rating, you must be notified, and given the opportunity to request and select a PQME from a list provided by the Medical Unit. There are strict timeframes on these disputes and process.

    As you have returned to work/RTW, your PPD indemnity may be reduced by 15%. Depends on the factors surrounding your claim.
    You should not look to be offered a lump sum payment to close the claim... when you RTW to the same ER, they don't like IW'/EE going around telling others about the ''huge settlemen'' they rec'd. You'll be paid the bi weekly indemnity, and have access to additional medical as needed. You also have the ability to petition to reopen the claim for ''new and further PD'' if your condition worsens.

    IF you are to accept a C&R, it's generally includes a voluntary termination clause.

    Since 2007... do you have an AA/Applicant Attorney handling this claim ? It's not a good idea to rely on a message board for 'legal' advice... it's not and should not be thought of as such. Contact an I&A officer at the WCAB if necessary. To know what the status of your claim is, we'd have to have the file... and there aren't any Calif AA's here that I know of.

  7. #7
    Join Date
    Sep 2009
    Posts
    12

    Default Re: Partial Disability Help

    BvIA, I can't thank you enough for answering my questions. No, I don't have an attorney. I feel fortunate that I've been able to get the medical care I need, and as I understand it, the PD ratings are taken out of a book. I would never C&R my case, as I know that I may require surgery in the future. I received a copy of the P&S report from my neck surgeon. Is it 30 work days or calendar days that CA has to dispute the report? I realize that there aren't any AA's on this board, but I really appreciate people like yourself who are willing to share their knowledge and experience with others.

  8. #8
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    17,941

    Default Re: Partial Disability Help

    PD ratings are done by your PTP, using the AMA 5th edition... they are not "taken from a book" as that statement implies. That number is then converted to a final PD/WPI %, and THEN 'taken from a book'. The indemnity weeks are pre determined by statute.

    Your PD/WPI rating is disputable, by you or the CA within the prescribed timeframes. That rating is also subject to change by a DEU rater or WCAB judge
    I realize that there aren't any AA's on this board, but I really appreciate people like yourself who are willing to share their knowledge and experience with others.
    That may be...and thank you.
    But you are looking for legal advice, and you should not rely on a message board for that. At the very least, contact an I&A officer at the WCAB for help.
    When/if you don't look to the professionals for guidance, you stand to lose valuable benefits in your claim. Not a good idea. And if there are disputes that require a hearing in front of a judge, IMHO, no IW should do that alone.

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