UCR Ext

4.15.02

WC Over

 

Suggested visiting http://www.dir.ca.gov

 

Board largely addresses permanent disability issues.

 

Average Workers’ Compensation settlement is $10,000 or less.

            Employer is limited damages by being under the umbrella of Worker’s Comp.

 

Read medical reports thoroughly to see if new injury noted i.e. could be 90 notice starting.

 

Workers’ Comp. Cases are fact driven.

 

Doctor’s pre-designation can be in writing or a note of any form… per Labor Code should be someone who applicant has treated with prior to the injury.

 

Medical treaters generally have to wait many months before receiving payment after service.

 

TD is a partial replacement of earnings.

            2/3 average weekly wages ~> $336 max.

 

AB 749 – 1/1/03 TD increase, but only for injuries occurring on or after 1/1/03

 

Temporary total disability ~> not working

Temporary partial disability ~> modified or part time work

 

TTD – lost time from work

            State disability for 1 year

            Usually if so, a lien for the amount will be filed against insurer for reimbursement

 

Workers’ Comp. Moved by medical reports… i.e. no TTD slip form doctor, no TTD payments.

 

Cannot receive money from EDD and insurer at the same time, no double recovery.

 

Labor Code § 4062.9 is the primary treating physician presumption

            Treating physician presumption overcome only when both sides go to QME

 

In some cases any necessary co-pay will be reimbursed to applicant eventually.

 

Unfortunately, lien claimants in Workers’ Comp. are often treated like second-class citizens.

 

Employer is required to send a notice to applicant anytime payment changes in anyway.

 

Applicant, unrepresented, can choose from QME panel when requested by employer.

 

AME – agreed medical examiner

AWE – throw out hi & low, and add & divide

            Then times 2/3 equals TTD

            Include weeks of paid vacation, but not if unpaid vacation i.e. 3 weeks off no pay

            “The check is suppose to go out like clockwork every 14 days.”

CIGA – suppose to pay in place of bankrupt employer

            California Insurance Guarantee Association

Cumulative trauma – overtime

            Generally limited to last year of injurious exposure; there can be variations

QME – qualified medical examiner

RRTW – release return to work

SDI – goes back 18 mons., not 1 year, when calculating benefits

            Does not include state workers because they don’t pay into it

SI – specific injury

 

Request for expedited hearing

            Usually date set within 3 weeks of filing with Board

            And judge rules within 30 days of hearing

            ~> usually used in conjunction with DOR

 

Insurer has to respond to request to change treating doctors within 5 days or applicant can choose own doctor.

 

Psyche injuries are different if from pain of the injury, compensable; or if from “litigation neurosis,” not compensable .

 

Attorney fees are generally paid at 15%.

 

Applicant may get a bumped up TD rate two years after DOI or for injuries occurring on or after 1/1/03.