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  1. #1
    Join Date
    Aug 2010

    Default What Are the Steps of a Workers Comp Case

    Hey guys. I'm a newbie here and a newbie to injury as well

    I'm trying to figure out the steps I should take.

    I had my car accident in April. My employer never sent me a claim form and I haven't filled one out yet (I moved to Ohio to stay w/ my sis while getting rehab and figuring out my situation).

    My employer sent me a form last month saying: we'll give u 1800 dollars -- fill out this form so we won't be liable. My injuries are pretty bad and this is nowhere near the $$ it will cost me.

    So here are the steps I'm taking right now.

    1. Fill out a claim form and send it to my employer and insurance company
    2. Fill out an adjudication of claim & send it to employer and court (the worker's comp office said to do this just to get myself in the system and in case I have to go to court later on-- it looks like my employer is going to cause me trouble). Plus they said this shows I'm serious about the claim.
    3. Wait

    So here are my questions (if anyone can help )
    1. Do these steps make sense ? Are there other steps I need to take ?
    2. Do u think I'm going to have problems bcs my late filing of my claim?
    3. When do I send them info about medical costs ? And when should I send the P&S report ? Should I send a letter saying "the 1800 can't cover my costs. These are my costs and this is what I want you to pay." If so, when should I send it ?

    Any advice would be much appreciated ? Thank in advance

    One more question: When do you usually begin settlement negotiations? I've noticed a lot of sample letters online to send to employers proposing a settlement amount. Should I send the claim form and wait ? Or should I send a letter right away ?

  2. #2
    Join Date
    Oct 2006

    Default Re: Figuring Out the Timeline and Steps (Your Help Needed)

    yes the claim form starts the claim and the application opens a file at the comp court.
    does your employer have comp insurance?
    his tactics are often used by employers without coverage.
    you can't sign away your legal comp rights - the agreement is not enforceable.
    we don't know anything thing about a late filing as you posted no dates.
    what medical costs? you never posted any information.
    when did you get your P&S report?
    you don't deal with the employer you deal with the carrier or the administrator if they are self-insured.

  3. #3
    Join Date
    Aug 2010

    Default Re: Figuring Out the Timeline and Steps (Your Help Needed)

    Hi .SH,

    Thank you so much for the reply.

    Yep. They have insurance. But I learned they have a new carrier from the one they had when my accident occurred. I guess I should deal with the one they had in April when my accident occurred? I had my accident on April 28th, 2010. They sent me the letter in July and they got their new carrier in June.

    about injuries: I had a spinal injury. And I've been undergoing rehabilitation upon my doctor's suggestion. I don't have health insurance so my sister has been paying. It's been upwards of 9,000.

    I did not get a p&s report. I went to the emergency room, after which I moved to Ohio where I've been seeing a doctor. He gave me a letter detailing all my injuries. I just learned about the p&s report. And I'm trying to figure out if I should see a California doctor or if my doctor in ohio can file one.

    I called the work comp office and they said the p&s report comes later in the process. Do u think I should get it done right now and send it to the insurance company ?

    So you suggest I file the claim form and application at the comp court ? What usually happens after ? Just wait and see what they say ? I should discontinue all contact with my employer and just deal w/ the insurance ? You don't suggest I give them a counter offer (to the 1800 they offered ?)

    Sorry to flood you with all the questions. I appreciate your advice.

  4. #4
    Join Date
    Oct 2006

    Default Re: Figuring Out the Timeline and Steps (Your Help Needed)

    yes, the carrier on the date of injury has liability.
    the claim form is filed with the employer; the application with the court.
    getting a P&S report may be a bit premature.
    you gave no dates but it sounds like the filing will be very late and likely have to be litigated.

    if you are going to get an atty search here

    the carrier will file an answer to your application and you'll have an idea of what they want to dispute and what the issues will be
    they'll probably want your deposition and will likely arrange a california medical exam.

    if you believe it's a comp claim, you don't want to negotiate a non-work comp settlement; one would think you're not convinced it happened on the job....
    if he has insurance, leave the employer out of it.
    more info on california comp here

    you can't hurry the legal process; it'll take many months.
    Last edited by .SH; 08-25-2010 at 12:06 PM.

  5. #5
    Join Date
    Feb 2007

    Default Re: Figuring Out the Timeline and Steps (Your Help Needed)

    As the ER has knowledge of the MVA, and your injury, the ''claim'' has been filed... you just need the first report of injury/DWC-1 Form.

    I would not file a Application for Adjudication of the claim at this point. There is no need.
    The carrier is liable for up to 10K in medical during the first 90 days of the claim. If they dispute the claim... you go to PQME, at their cost even though you are in Ohio now. If the PQME says 'yes' to compensability, they must begin paying benefits/treatment, OR, they file the application for adjudication of the claim, and THEY pay the atty fees. Which puts you in an excellent position for legal representation.

    All you've done here is screw up the process by not filing a formal claim at the time, seeking self procured treatment, out of state no less, and actually the move itself.

    It's difficult for an out of state Dr to treat to Calif standards, let alone agree to the reporting requirements of Calif comp, and the legal process here.
    While no one can comple you to remain in Calif, it does have a tendency to skew the process.

    You are likely to be brought back to Calif for a deposition... you should NOT attend the depo without an AA/Applicant Atty. The carrier would have to file a App for depo only, but they would be liable for the AA fees there too.

    You are WAAAAY ahead of yourself on MMI/P&S issues, and settlement thought process. Awards in WC are predetermined by statute. Different in every state. You'll have to have a Calif Dr rate you, if there is dispute, a PQME would rated. Whole process once you are determined MMI. That too is subject to dispute.

    You need to be aware too, in Calif a provider cannot bill the IW for treatment, it must be provided on a lien basis. When the lien is addressed, the provider/lien claimant must show medical necessity for there to be reimbursement. Not all medical is reimbursed... you may not see those out of pocket costs. That will be subject to a Calif WC judge. Nothing in OH will have any jurisdiction over your claim.

    You will also be expected to ligitate the MVA/3rd party claim, or be willing to cooperate as the WC carrier is entitled to subrogation of benefits paid to you.
    Last edited by BvIA; 08-25-2010 at 02:12 PM.

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