Відео

I can only answer questions as to how the system works in general. For an assessment of your case you would need to reach out to an attorney for a consultation to go over your specific facts. Your case may not involve any wrongdoing by the employer, or there could be issues of discrimination and wrongful termination, as well as issues surrounding TD or light duty. Those can only be addressed in a consultation.

Every case is unique. Best of luck to you.

It can get complicated with regards to how temporary disability is calculated (injury at the job that pays more or less), and work restrictions imposed, and time off. I'd recommend talking to either a local attorney or the I&A Officer at your local WCAB office with regards to your specific case.

You can always speak to the I&A Officer at your local WCAB office to get answers to questions. And even during the MSC you can tell the judge that you want to discuss issues with I&A.

@@myworkerscompguideThank you so much

@@myworkerscompguide my former lawyer, said that I’m vested $10,256.34 dollars already what does that mean?But my case is worth $18,000-$25,000 at least

It means a case was opened at the WCAB. Either an Application for Adjudication was filed (perhaps if you have an attorney, he or she did this with initial paperwork you signed), or if you signed settlement documents and those were filed for approval. It's basically just the court case number.

Happy to help inform.

The general rule is that judges do have a longer time period to work on "tasks." That's what EAMS calls any incoming document for a judge. And if a judge hasn't acted within 45 days then the presiding judge is supposed to step in. But the main rule is, "A WCJ to whom a compromise and release or stipulations with request for award is assigned should initiate appropriate action within fifteen 15 days of its assignment. Pursuant to WCAB Rule 10346(c), if a compromise and release or stipulations with request for award has not been approved, disapproved, or noticed for trial on the issue of adequacy and other disputed issues within 45 days after filing, the file shall be returned to the PWCJ for review."

I couldn't say. It sounds like a real problem if the QME said that. But you would have to speak to the I&A Officer at your local WCAB about your options, or talk to a local attorney for a consultation.

In California there is no choice - an employee injured while working can get workers' comp benefits. That employee generally cannot sue their employer. It's the exclusive remedy rule. Of course there are exceptions to every rule, but that's the general rule. The advantage to the injured worker is that they immediately get temporary disability benefits and have medical treatment paid for, and and there is no requirement to go through a lawsuit first and wait a couple of years for any payment. Most injured workers could not wait a couple of years for a lawsuit to progress to either settlement or trial. It's in the injured worker's interest to get immediate payments instead.

It can be a very confusing system. As you have an attorney, he or she would know best what type of benefits you may be able to get.

Every case is different. I cannot say if that is low for your case or not. I can say that a rating like that is quite common for a low back injury with no surgery.

I can't give advice. I would recommend calling the I&A Officer at your local WCAB office, or talking to a local attorney for recommendations.

Every case is so different that I couldn't say. If it is your attorney saying you owe EDD, then you would need to ask him or her why. If it is the defense attorney saying it, you likely want to talk to either the I&A officer or a local attorney for a consult.

Thank you! So much for your time and responding. I appreciate you

@@esperanzaserrano2883 Happy to help inform.

Best of luck to you.

Probably start here - edd.ca.gov/en/disability/apply/

@@myworkerscompguide thank you so much what is the difference between state disability And Edd government

@@navarrete250 The same. The EDD is the government entity that pays state disability.

@@myworkerscompguide thank you you help so better then doctors and lawyer

@@navarrete250 Happy to help inform.

Generally, yes. For example, if an injured worker has a staph infection after an accepted knee injury and authorized surgery, then the injured worker would be entitled to TD while he or she recovers from the staph infection as well. The injury at work didn't cause the staph infection, but it was a consequence of the industrial injury.

I don't know that I've run across that question before. My gut says that for treatment the answer would likely be 'no.' For a QME, the answer might be 'maybe' but I think I'd still lean towards 'no.' But I'd have to research it to see.

@@myworkerscompguide ok thank you

@@jaliscomx328 Best of luck to you.

Happy to help inform.

That happens. I've had clients with a back injury in workers' comp take a little time off work due to a knee injury while snow skiing and collect EDD, and they file a lien. Or cases with a 2023 date of injury, and EDD notices they paid benefits back in 2005, so they file a lien even though it's completely unrelated. I've seen cases in which someone applied for EDD benefits and received them using a stolen SSN, and then a lien is filed in a case even though no benefits were ever paid to the actual injured worker. Usually it just needs to get cleared up with the EDD rep and the lien is withdrawn.

What cases**

@@TMH792 I can really only speak to California, as that is the only system with which I am familiar. As to your case, you would have to ask your attorney as he or she knows your case best. In California, and in general, I suspect the number of settled cases is around 99%. However, cases until both parties agree to terms, and that often occurs after active treatment slows down, and after a QME writes a ratable report, and after the parties agree on all the terms - and that may take six months, or two years, or five years. There is no standard time for when a case settles. I'd guess the average litigated claim in California settles at around the two year mark. Keep in mind that a "case" doesn't really go to trial, but rather a "dispute" goes to trial. So there has to be a dispute over the PD rating, or the authorization of medical treatment, or the denial of a body part. That dispute may go to trial, but even then it will only do so after both sides have completed discovery on that dispute.

@@myworkerscompguide Thank you!! I have never heard any of this from my attorney. I did ask when will they offer a settlement and he said “we are way far from that right now.” He got frustrated when I asked him, too. Appreciate you writing this out! Thanks for all the info. Oregon may be different. I’m also wondering if he’s not on top of it. I call and get things sent to him all the time and he misses my emails and have to go over it all again on the phone with me. I know he’s busy, but he’s slowly becoming less engaged. He was really on top of things in the beginning. Thanks again! Really appreciate you writing this out.

I can't speak to your case individually. I can only say how the system works in general. Many insurance companies will cut off temporary disability once the PTP says "P&S" and then the injured worker will go back to the QME for a re-exam to see if the QME agrees. If the QME agrees on P&S status, then the denial of TD will usually stand. If the QME says the injured worker is not P&S, then insurance might pick up TD, or it might need to go to a hearing over the dispute. Injured workers can generally apply for EDD benefits, but I always say to make sure that they fully explain any benefits or wages they are getting to ensure there are no duplication of benefits.

The injured worker in California can take a QME report to a treating physician and give it to him or her. There is no prohibition against that. The worker cannot give reports to the QME, but can give reports to a PTP.

@@myworkerscompguide I refer to pshyc Qme. If the insurance refuses to send Qme to treating doct, what can be done

It is not that judges do not like to have a trial, but they are a lot of work. It requires review of the PTCS with the parties, revising and amending that through discussion, the filing and review of exhibits, ensuring everything is in EAMS correctly, calling a court reporter, creation of a transcript, going on the record, the keeping track of deadlines, work for the court reporter, the possibility that a small issue was missed during trial which may necessitate the rescinding of the submission and another hearing, and then the losing party may appeal. It is much faster and easier and avoids conflicts if the parties can work out a negotiation. The percentage of cases in workers' comp that have to go to trial is very, very small.

@@myworkerscompguide it's seems that all are saying the same, and it makes sense. I think it's clear and visible when there is an injury and that medical records are showing the truth. It's a case of insanity for an insurance company to kill the judges time when they know that insurance and their attorneys are pulling the dog from the tail.

@@avarora It's nice when the handwriting is on the wall and everyone agrees to the terms. But sometimes insurance companies dig in until the very end, even though everyone seems to know what the outcome will be.

@@myworkerscompguide what is the role of a vocational expert. Can you make a video about vocational experts

@@avarora Vocational experts can be used to address ability to return to work and combat the PDRS. But it can be a very complicated area of the law, and an injured worker who was considering trying to hire a vocational expert to address the level of disability would really be best served by being represented by experienced counsel. That said, I'll see if I can do a video on that general subject soon.

I couldn't say why it is happening in your case. There are many reasons for a potential QME re-exam, including the injured worker not being P&S at the first exam, or the injured worker had surgery after the first exam, and a change in condition, or new records/conditions that need to be discussed, to name a few.

Yes. Insurance companies will often fight unfavorable QME reports by trying to get additional or replacement medical opinions. However, it can be difficult to get a QME report thrown out and a new QME assigned and that generally would require a trial and evidentiary finding by the judge.

@@myworkerscompguide in unrepresented cases, it can be even more difficult for insurance to undermine a state assigned doctor( qme), then the whole purpose of a qme / neutral doctor is invalidated, when the qme reviewed and based the decision on ptp medical records.

When a DOR is filed for a MSC, there should be a dispute that is ready to go to trial and the party filing the DOR can list the efforts they made to resolve the dispute. If an injured worker wants a vocational expert, that would be obtained before filing a DOR on the level of PD because discovery would not be complete yet. It can be very difficult to prove a 100% case as the defense will often fight that to the end. If you are trying to prove 100% PD and do not have an attorney, I'd strongly recommend reaching out to your local I&A Officer at the WCAB for answers, or reach out to a local attorney for a consultation.

@@myworkerscompguide it's seems to be a very unfair system. Why would a judge would not find 100% total disability when Qme says 100%, when ptp says the same, when the vocation expert says 100%, and all the facts are showing that the person is indeed disabled, and the insurance agreed to pay inhomecare services to a third party to care for the injured worker. I would assume that any normal judge seeing the medical condition and all supporting evidence from all doctors, multiple qme s from different area of expertise,, and vocational expert, and the need of mobility assistance and handicap transport, severe disability prescription medications and ald services to decide that that poor human can ever be employed. Seems unbelievable that any judge can humiliate and condem to slow death such an Injured worker.

A vocational expert is not required to get 100%. The injured worker will get permanent disability for life at the temporary disability rate if either the judge awards 100% or the insurance company agrees to it. Getting the QME to say 100% is just one step.

Generally yes. If the QME says the applicant is precluded from participating in the open labor market, that generally means the injured worker is 100% totally disabled. It generally comes down to all of the evidence, from the PTP to the QME to vocational experts and the applicant's testimony. There are some conditions that are presumed to be 100% disabled in California, but otherwise it depends on the facts of the case. Every case is unique.

@@myworkerscompguide is there any law that determines the individual inability to work, In SSA they say if a person loses a day or two each month because of their medical condition , is considered disability. Does the same applies to worker compensation? On what basis the Qme determines this. I assume as a judge you may have seen this in at least few cases

@@avarora There is no strict definition such as losing two days per month. With QME's it generally comes down to the QME's opinion based on his or her training, experience, and expertise. There are some statutory presumptions that someone is 100%, but most doctors will impose permanent work restrictions based on each individual case.

A doctor, either the primary treating physician or the QME, will write a report finding the injured worker to be permanent and stationary (P&S) which is essentially the same as Maximal Medical Improvement (MMI).

Thank you ​@@myworkerscompguide

Well I've had three surgeries on my right shoulder I have another tear, the qme doctor tell me that the treating doctor should have given me a shoulder replacement the second or third surgery so he set up an appointment with the treating physician the treaty physician had a negative remark to make got mad cuz I told her what t qme doctor said made a negative comment and brush me out the office she did order physical therapy for my right shoulder and neck I never received authorization or appointments I'm still in severe pain it's a lot over 5 years I've been going through this

@@aliciacolbert247 Cases like that can be frustrating, and can take some time to get to P&S status.

My pretty physician has me as permanent stationary this case has been going on over 5 years frustrating as an understatement when you still suffering and does a qme doctor restrictions out rules a treating physician restrictions when your injury already​@@myworkerscompguide

That happens regularly. The only time that I'm aware of that a case must return to the same judge (if possible) is once trial has started and the matter has gone on the record. Otherwise a case can go through multiple Status Conference or MSC judges. Quite common.

I need to do a video on that. But a judge cannot alter settlement documents that have been submitted unless all parties agree to the change. Conceivably if the judge had all the parties on the phone, and all parties agreed to a higher settlement amount, the judge could write that new amount on the documents and note who/when/where agreed. But even that is rare because the judge will want the parties to write the change, and to note that the documents are now a (for example) "First Amended C&R," and to have the parties initial or sign the change. And a judge cannot just change terms or add language because the judge feels it is needed. From the WCAB Policy & Procedure Manual, "A WCJ may refuse to approve a compromise and release agreement unless it is amended in a manner suggested by the WCJ; however, the WCJ cannot rewrite the agreement without the parties' consent. (See Burbank Studios v. WCAB (Yount) (1982) 47 Cal. Comp. Cases 832, at 836.)"

@@myworkerscompguide Thank you for your reply. My confusion comes from CA Labor code 5101 - The WCAB may recalculate the lump sum to include (lesson) Net Present Value (NPV) or Present Worth of 3% per (future) year; and CA Labor code 5102 - The WCAB may order the lump sum be paid directly to the employee OR placed in a Trust OR the State Compensation Insurance Fund, to be managed by a Trustee. I don't doubt I'm misunderstanding these codes, and will be looking forward to your future videos and expertise. Thank you.

@@inertmission4427 Those statutes don't apply to settlements. They apply to commutations. That's the "lump sum" that the statutes talk about - a commutation. That would generally take place either after a Findings and Award issues, or after Stipulations with Request for Award is approved, and the injured worker files a Petition for Commutation. A commutation often does take the present cash value into effect.

@@myworkerscompguide Thank you!

@@inertmission4427 It's a very confusing system. I'm happy to help inform.

In easy to understand language - the general rule is that PD ratings for different body parts get combined rather than added together. However, a court case (Kite) said that in the proper case, and if supported by the proper analysis from the doctor, the ratings can be added together. That was because the doctor was able to provide analysis that the synergist effect of the disabilities was more significant than the combined values chart would provide, and that the ratings should be added together to provide the most accurate rating for the injured worker. It's not seen often.

@@myworkerscompguide than you so much for explaining it to me thank you sir.

@@simorebuths7301 Happy to help inform.

Workers' comp settlements are often very low, especially if future medical care is kept open and if the insurance company has already advanced all of the permanent disability before settling. I had a case years ago where the injured worker was very upset because he was getting "nothing" in the settlement, but the insurance company had paid him close to $100,000 in temporary disability, had paid for close to $100,000 in medical bills, and had already advanced him many tens of thousands of dollars in PDA's. But we were keeping medical care open (a benefit with no dollar limit) and there was no remaining PD, so he felt like he was getting nothing. But that was because much of it was already paid out and the medical wasn't paid directly to him. As you have an attorney, you would have to ask him or her about your settlement as your attorney knows your case best.

Happy to help inform.

This can be true. Generally EDD's rate and the TD rate are fairly close to one another, but there are unique cases. Every case is different.

Eesh. When I refer to an injury in workers' comp, that's commonly known as one accident or mishap or something going wrong (like one car accident, or one fall down the stairs). There may be multiple body parts injured (broken leg, neck sprain, headaches, broken collar bone), but it was just one injury that occurred.

In the California system the injured worker is entitled to any reasonable and necessary medical treatment to cure or relieve the effects of the industrial injury. That basically means the injured worker gets medical treatment for that injury for life. Temporary total disability is generally only paid when the injured worker is off work, and unable to work, due to the injury. So the worker may heal enough to return to light duty work and keep treating, and then heal enough to return to full duty and still keep treating. The treatment frequency and intensity would likely drop, but doctor visits can continue. Also, temporary disability can stop if the two year cap is reached, or if the injured worker is released to light duty and the employer can accommodate the restrictions.

@@myworkerscompguide I been on it for 130 week an waiting on neck surgery in Oklahoma you are aloud 156 weeks of ttd

@@myworkerscompguide I been waiting for them to approve neck surgery

I've never heard that before, and my gut says 'no' that's not the case. A judge swears to faithfully perform his or her duties, and to fairly hear disputes and issue decisions. Perjury comes from a sworn statement under oath that the person knows is not true, such as deposition testimony or trial testimony. To apply that to a judge's Minutes of Hearing or Orders does not sound accurate to me. Though, I've never researched the issue.

Thank you!

@@Kim-kq8wn Happy to help inform.

To get paid out for future medical with a lump sum would mean settling by way of a Compromise and Release instead of with Stipulations with Request for Award. With a typical C&R a lump sum payment is made and the insurance company closes its file, and the injured worker is responsible for paying for future medical care. I've done a few videos on C&R issues, but this one may answer your questions - ua-cam.com/video/gxsPrAJK4Cg/v-deo.html

The Medical Unit does issue replacement QME panels. The required form is this one - www.dir.ca.gov/dwc/FORMS/QMEForms/QMEForm31_5.pdf and probably the most common reason is that the QME has reported in the case but is no longer licensed as a QME. The pertinent regulations are listed on the form.

Thank you so much for your prompt response and have a good day!

@@Kim-kq8wn Happy to help inform.

I've sure seen it a lot, but okay.

@@myworkerscompguide well in 25 years I've seen it happen maybe twice? If an applicant is in proper, there's this invention called a telephone whereby the insurance company can directly communicate with the applicant to ask questions. It's a really amazing invention. But yes tell yourself this happens frequently If it makes you feel better for content purposes.

If you have an attorney representing you, I'd recommend talking to your attorney about strategy and expectations. If you do not, you may want to consider reaching out to a local attorney for a consultation. If body parts are still denied, and the case is nearing resolution, if a settlement cannot be reached for some sort of compromise then those denied body parts may need to be set for trial.

In the California system, there is generally a primary treating physician (who acts as the gate-keeper of sorts) who then refers out to various specialists. So it is not uncommon that there is a primary treating physician who is an occupational medicine specialist, who then refers out to an orthopedic surgeon, a neurologist, a podiatrist, and a chiropractor. As to venue, any party can file a Petition to Change Venue. There are special provisions for doing it within 30 days of filing an Application. After that, it is generally done for good cause and convenience of witnesses.

I had brain injury ( meningitis) 4850 and state rate have expired 2 years. Case still open AME found a second ( vision) and third ( hearing loss) injuries as a result of the brain injury. Do I get 4850 and state rate for the second and third injuries ? Or is that considered double dipping? Great informative videos! Thanks in advance.

@@nolifenobeisbol606 It would likely depend on whether the hearing and vision were due to the same injury, or due to a separate CT or specific injury. Labor Code 4850 pay is generally paid per injury, and not per body part. But as you saw an AME, that tells me you have an attorney, and he or she would be able to answer your question best as your attorney knows your case.

@myworkerscompguide my bilateral hearing loss and tinnitus were 100% attributed to industrial exposure, both noise and contracting meningitis at work per AME report. Thank you for your answer.

@@nolifenobeisbol606 Best of luck to you.

Thanks. Just trying to help inform.

@@myworkerscompguide . Can I ask a question about the IME Dr I saw?

@@pauldoddy9714 You can ask, but I can really only answer questions about how California's workers' comp system works in general. I can't give advice, and I'm not familiar with the workers' comp system in other states. I say that because IME's are fairly uncommon in California.

@@myworkerscompguide Ok! In NJ we have IME's. What's the difference..

@@pauldoddy9714 In California we have qualified medical examiners (QME) and agreed medical examiners (AME) and rarely independent medical examiners (IME). The rules that apply to each type of examiner vary depending on statute. It would depend on what the New Jersey statutes provide as to IME's there. I couldn't really say.