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How your Workers’ Compensation Case proceeds

It’s difficult to cope up with a Workplace injury, especially when you face injustice and have to fight for your rights.

Some of you might be aware of Worker’s Compensation benefits and know that you’re eligible for Worker’s Compensation, but do not know how to claim it.

Worry not! We help you to understand your Worker’s Compensation Case and the way it proceeds.

Injury:

Does your injury arise from a job or was caused by your job? Report injury to your employer immediately.

Then, request a claim form DWC-1. You have to full the top portion while your employer has to fill out the bottom portion.

Your Employer has 24 hrs to turn form into carrier.

Medical Treatment:

If your employer has a designated medical facility or doctor that you must go to for your industrial injury, then you must see them for your initial medical examination.

If your employer has a Medical Provider Network (MPN), you may switch doctors but it must be within their approved network under most circumstances.

Disability:

If your doctor declares that you are too injured to return to your job and/ or you can return to work with restrictions but your employer cannot accommodate those restrictions and has no modified work for you, then you will be paid 2/3 or your Average Weekly Wage so long as your physician certifies you Temporary Total Disability – TTD ( up to a maximum of 104 weeks).

You must report to your worker’s comp doctor at least every 45 days or the rules say that the insurance company can stop your payments.

When you designate a doctor from the MPN list that person becomes your PTP (Primary Treating Physician) and is responsible for your medical care throughout the case and may make referrals to other doctors if needed. This will continue until you are declared Permanent and stationary.

Permanent Disability:

When your PTP declares you Permanent and Stationary ( P & S ) it simply means that you are not expected to improve or decline over the next year–you are stable.

You may not be the person you were before you were injured and have disabilities you did not have before and your doctor will issue a report called the P and S report which outlines what those disabilities are and the impairment.

When you are P and S, your disability payment will be reduced substantially. The money you receive will be subtracted from the eventual settlement of your claim. (Avg. PD $230 wk).

Once declared P and S you may go back to your former job or find a new one as the case may be.

Settlement of your claim may begin at this time depending if the carrier wants to get another medical opinion as to your level of disability.

Challenges to P and S Process:

If either your attorney or the insurance company does not agree with your PTP as to the nature and extent of your disability, they may challenge the report and request an exam with an allegedly neutral doctor called a QME. *( Qualified Medical Examiner )

The challenging party will offer the names of some doctors to act as the QME. If there is an agreement between the parties he is then called an AME.

Going to an Agreed Medical Examiner will generally eliminate the need for a later trial.

If there is no agreement on a doctor, then either side may request a State Panel QME whereby the state sends the names of 3 doctors and both attorney’s strike a name and the remaining doctor is your QME. Unfortunately, this method may lead to eventual trials because of one side objecting.

Settlement Process:

Once all the medical reports are completed one side or the other will file for a hearing called an MSC (Mandatory Settlement Conf), you will receive notice of the time and date of the hearing and you will need to attend.

Most of the time you just need to be there and wait if the attorneys are able to settle the case. You will need to sign papers.

If the attorneys can’t reach the settlement, then we generally get a trial date and send you home.

Two ways to settle your case

1) Stip and Award – Permanent disability paid out over time every 2 weeks till the full amount paid less attorney fees. Medical to remain open for your industrial injury but is usually a hassle to get.

2) Compromise and Release (C and R) 1 lump sum payment for Permanent Disability and a negotiated buy out of your anticipated future medical costs. It is never dollar for dollar otherwise there would be no incentive for the Carrier to pay upfront cash.

Settlement of your case

MSA (Medicare Set-asides) – if your settlement comes under the watchful eyes of the Social Security Admin, then your settlement needs to be approved by the gov’t before you can settle by C and R.

The insurance company must forward your medical records to an organization that calculates the anticipated medical costs over the rest of your life for your injury and how much the gov’t will require the insurance company to pay you to buy off the liability so that medicare doesn’t have to pay for your injury.

Taxes

Currently, all workers compensation payments made to injured workers are tax-free.

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Serving California

The Law Offices of Dr. Peter M. Schaeffer serves the State of California and the Riverside and San Bernadino counties, which includes the surrounding communities of Riverside, Corona, Moreno Valley, Hemet, Temecula, and Palm Springs. Our office locations are conveniently located in the cities of Riverside (main office), Temecula, and Palm Springs

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