วีดีโอ

It depends on if you are negotiating Stips or a C&R. If it's Stips, then the dollar value is based on the PD rating, and the PD rating is generally based on the reports. There's not a lot of negotiating with regards to Stips if the parties agree with the QME/PTP report. If it's a C&R, and the defense offers $110,000, but the injured worker thinks it's worth more, then the injured worker can negotiate and say that he wants more. How to negotiate, and the strategy employed to get there, is a whole nother topic entirely.

Workers' comp has always been frustratingly slow. But over the last five or ten years I swear the adjusters seem to just deny and delay everything so that injured workers get frustrated and throw in the towel just to get out of the system. But if an injured worker just quits and walks away, or settles for pennies on the dollar, its the adjuster who wins instead of the injured worker.

@@myworkerscompguide After some thought on the situation,and reading your reply.I've decided to keep pushing forward..or at least until after my deposition.I do have an attorney working on the case,but I feel like they may be part of the reason things are moving along as they are.I called them today and told them what I was thinking and they said the fact that I was injured due to the company I worked for issuing me the wrong PPE{GLOVES}and the fact that I almost had my hand ripped off..coupled with the fact they are not paying me any type of TD due to the fact they let me go..They feel like they are in hopes I give up and they wont have to payout as much as they would have had to..I haven't worked since my injury,or had any income,and my savings are gone..and I think my attorneys are trying to get some big ol payout,instead of looking out for my best intrest..I could be wrong as this isnt my field but my gut is telling me something isnt right.

Your attorney would know your case best. Best of luck to you.

It is easier to settle when there's a final QME report, because at that point the injured worker is P&S (no fight of 3 more weeks of TD versus one more year of TD), and while is there is future medical there is no imminent surgery (I think I need surgery versus I think you don't), and the PD is ratable (I think I'll rate to 40% PD versus I think you'll rate to 5% PD). There will still be negotiating over the value of future medical, and there may be disputes over the QME report, but a final ratable report is a good starting point for talks.

@myworkerscompguide thank you!

@@jaliscomx328 Happy to help inform.

Exactly.

@@myworkerscompguide . Thanks for explaining the Workman's Comp process well. Also when your attorney has numerous W/C cases it's a waiting process. Sometimes the wait is well worth it. But people want their money which is understandable because everyones situation is different.. Thanks again.

@@pauldoddy9714 Happy to help inform.

Yes, my clients tell me they want to settle, and I tell them I'll start working on it, and then a couple of days later they call wondering what's taking so long. It's a slow process. You have to work up an estimated PD level, address potential TD exposure, future medical exposure, any other issues, and then figure out a fair amount. Then the defense has to do the same. Then the negotiating starts, and it can be slooooow.

No, not directly. In California's system the PD and TD rates are determined by earnings and statutory maximus/minimums; and the disability rating is determined by whole person impairment using the AMA Guides. That said, a QME might use an FCE to help determine placement within a range or table in the AMA Guides.

It could be a typo, and he meant to say that you were credible. Or it could be that he felt you were not credible in certain areas. It's tough to say. You may want to talk to a local attorney for a consultation and to review the report to get the attorney's impression on the report itself.

@myworkerscompguide yea that's what I thought but no he double down said it again in subliminal report. IA confused to.

@@michaelarmstrong9512 It's frustrating, but sometimes I get reports from QME's on my cases and I tell my clients that the report makes no sense, or the QME must have been confused, or maybe didn't explain what he or she was thinking for some reason. Best of luck to you.

In California an attorney cannot charge for a consultation, so you can meet with an attorney in your area and discuss your case to see if you'd benefit from having representation. If the case is going to go to trial, and it's already been to mediation, you can likely assume that the insurance company will have an experienced attorney on their side with far more experience with workers' comp strategy than you likely have.

Psychiatric trials can be very complicated in California, and the burden of proof and standards that have to be shown vary depending on what type of psychiatric claim it is and what the defenses are. If your psychiatric claim is going to trial then I would strongly recommend talking to a local attorney about representation as the insurance company will almost certainly have an experienced attorney on their side. As to disputing a hip injury, a treating doctor does not usually take the lead in that dispute, but it will depend on what the dispute is such as AOE/COE, compensable consequence, or a treatment dispute. If you don't have an attorney you may want to speak to your local I&A Officer at the WCAB.

@myworkerscompguide only reason I ask is because since the QME report came out it basically means my orthopedic injuries are done with but my hip is acting up again. They already gave me partial permanent disability payments. Im waiting on a psych trial so I'm using my PPD since my TTD ran out

@@kingoftrolls19 If the ortho QME found you were P&S, but now your hip condition has changed, it may mean that your hip is no longer P&S. That would need to be addressed by the PTP and QME. As to the trial, I'd again recommend talking to an attorney if you don't have one. If you do have an attorney, then he or she would know your case best.

A third party case, such as with a personal injury lawsuit, can certainly add complexity and time as there are issues of credits and liens and potentially additional litigation.

EDD will generally pay benefits as long as the disability is certified by a doctor and there are benefits in the injured worker's account. So generally, if the EDD paid out all the benefits available to an injured worker, and then there was a new injury before either reimbursement to the EDD or new payments in due to new earnings, then there may not be additional benefits available to be paid. It really tends to depend more on what benefits are available more so than what is the date of injury or how many injuries are there. As you have an attorney, he or she would know best what benefits may be available to you. I'd say to talk to your attorney for the best information. I could only offer general info.

Thank you for the kind words. Happy Thanksgiving to you too.

A deposition of a QME is not uncommon. But in more than twenty years of practicing workers' comp, I've never seen a QME in court to testify. It was more common many decades ago. But these days the judges want discovery complete, and there's too much fear that a QME may offer new testimony, or change his or her mind, and if that occurs at trial then the entire matter may have to go off calendar for further discovery. So a deposition, which occurs in the doctor's office, or attorney's office, or these days via video/phone, is far more common than a QME going to court to testify.

You mentioned in another post that you have an attorney, so he or she would know the best strategy in your case. Generally much will depend on what the QME lays out for potential future medical care, as well as medical care expenses over the last few years. It's often not as dependent on the injury that occurred, but rather on the treatment that will likely be needed in the future. As to moving out of state, I did a video on that a while back. That's here - th-cam.com/video/RVpbQm271hY/w-d-xo.html It's really become a pain in the neck over the last couple of years trying to find doctors outside of CA.

@ thank you so much

@@crystallafrance254 Happy to help inform.

Being an attorney for injured workers in California is really tough, as the settlements tend to be small and the attorneys only get 15% of the final settlement. So the only way most applicant attorneys can make it is to have lots and lots of files, but that really eliminates time to explain things to clients. And, as the attorney, our time is best spent on developing strategy and then dealing with adjusters and defense attorneys. It doesn't leave much time for explaining the process.

@ thank you

@@crystallafrance254 Happy to help inform.

Generally closing out a case means settling with a C&R. That's one option. The other would be Stipulations with Request for Award. Those are the two main settlement options. I did a video on those generally here - th-cam.com/video/U7qy-gdSBjY/w-d-xo.html Now, does an injured worker have to settle if settlement has been offered? Not generally, if there is more discovery to do, or a QME to see, or the doctors say not P&S, etc.

It's a real pain in the neck when QME's don't respond to requests for supplemental reports. The problem is that there is no clear-cut fix for that in the Labor Code. If the QME doesn't issue a report within 30 days of an exam then a replacement panel can be requested. But there is no remedy for a late supplemental report. It's generally the type of thing that needs to go to a judge to seek an order that the Medical Unit issue a replacement panel. That may be an option for you which would be to file another DOR and explain the judge that yet again there has been no response and no compliance with the last Board order, and ask the judge to replace the QME with a new panel. You may wish to discuss your options with your local I&A Officer.

In California, when an injured worker gets treatment and reaches a P&S status, the PTP or QME will address the level of whole person impairment. That may rate out to 3% PD or 30% PD or 50% PD. But no one expects the injured worker to live on the few thousand dollars he or she gets out of the case for PD. That PD is, in theory, just supposed to compensate the injured worker for a loss of ability to compete in the open labor market. The injured worker still needs to get a job to earn enough money to pay bills, whether that be at the same employer or a new one.

You can call the I&A Officer at your local WCAB office to get answers for free, or you can reach out to a local attorney for a consultation. I generally recommend talking to a certified specialist in workers' comp, and you can start a search for those attorneys at the California State Bar website by doing an advanced search.

Happy to help inform.

Not generally. The focus from the insurance companies perspective is the level of whole person impairment, more so than whether an injured worker is P&S and can now go earn a living. No one is expected to live on the $290 a week that workers' comp pays for PD, so it's expected that once people are P&S that they'll find work one way or another.

There are a lot of variables there, and I'd recommend you talk to either I&A at your WCAB office, or to a local attorney. In general, a settlement with Stips will remain the same unless it's within five years of the date of injury as the injured worker or the insurance company could file a Petition to Reopen if there was a change in the PD level. If it was a settlement with a C&R, then it's final. Generally in California's system, each injury is separate and distinct from any other injury. There may be apportionment of PD to a prior injury, but benefits are generally all separate.

In my experience it hasn't been a noticeable difference. The TD exposure is the same, and the PD exposure is the same, and the future medical exposure is the same. The only potential difference is the employer's involvement in the case and motivation for a closed file which may sway the figures. But in my experience, most of the time it makes no noticeable difference.

That can be fairly common. The parties get together and talk and agree to more discovery, or agree to work on settlement, or agree on a settlement number and then need time to circulate documents. There are many reasons to go off calendar at a MSC, and then later new issues arise or the original issue isn't fully resolved, so another MSC is held.

Generally, once a case is being settled with a C&R then the amount of detail is only important as to getting a judge to approve the settlement. Since all issues (normally) are being settled, and an agreement has been reached on all the terms, it just doesn't matter how much detail is in the C&R as to the original injury. Generally it's more important to have a detailed discussion of parts of body, what issues are being settled or left open, etc. If you have an attorney, discuss the issue with him or her. If you don't have an attorney, you may wish to either reach out to a local attorney for a consult, or talk to the I&A Officer at your WCAB Office.

@@Analysemarie Best of luck to you.

A Compromise & Release in California, or a C&R, is a lump sum settlement. So nearly all of the time it includes a buyout of future medical. It also pays out any remaining permanent disability that is due, and closes out the right to file a Petition to Reopen for New and Further Disability within five years of the date of injury. A C&R is a common way to settle a case when the injured worker is no longer with the same employer, and both sides come to an agreement on a dollar amount and terms, and the judge finds the settlement to be adequate.

I've done a few videos on different topics surrounding a C&R, and this one might help answer a few questions - th-cam.com/video/gxsPrAJK4Cg/w-d-xo.html

@@myworkerscompguide . How long do those take on average.

Happy to help inform.

Happy to help inform.

Oh no!

If you have a good attorney on the case, then he or she would know best the strategy to employ. If you have no attorney and the defense does, and you have a 0% report, I'd strongly recommend reaching out to a local attorney for a consultation.

I'm not familiar with the term "graveman." The EDD will file a lien in the workers' comp case most any time they pay benefits. The issue of who pays them back, if anyone, can be complicated. Generally, if TD was due but the insurance company was not paying it, then insurance pays it back. If TD stopped at the two year mark, then insurance may pay back EDD but only at the PD rate. If the injured worker was getting TD and EDD at the same time, then EDD may get paid from a portion of the injured worker's part of the settlement. If EDD was paying a differential between TD that was due and PDA's that were being paid, they may not get reimbursed at all. Each case is unique. I'd recommend talking to a local attorney for a consultation, or speak to the I&A Officer at your local WCAB Office.

Happy to help inform.

OTOC is Ordered Taken Off Calendar, so that hearing is concluded and another hearing is not immediately set. Generally it means the parties resolved the dispute, or will continue working to resolve the dispute. Generally whatever pressing issue that needed to be in front of a judge, no longer needs to be in front of a judge. Another hearing may be set in the future, but that would only be after the filing of a new DOR.

@myworkerscompguide you be on point with your information the Case did settle thanks

@@badgalsheilabb2548 Congratulations!

Thank you. Happy to help inform.

In California all workers' comp settlements must be approved by a judge. So each settlement must go before a judge, but most settlements are approved without the parties being present, as the judge can review the settlement documents, medical reporting, and other documents. That said, each state has its own system, and I do not know what the requirements are in other states.

@myworkerscompguide . Ok thanks. So the judge basically has the final say in the IME report.

@@pauldoddy9714 In California we rarely have IME's. We have QME's and AME's, but fairly rare to have an IME. But it is the judge who has to determine if the medical report is substantial medical evidence.

@myworkerscompguide .Thanks. I didn't realize IME you don't have IME's. Last question! How long after your IME can a settlement be reached. It's been several months now.

@@pauldoddy9714 In California a case can really be settled at any time. So it could be settled the day after an med/legal exam even if the report isn't received yet, or the week after getting the first med/legal report, or it may be years. It just depends on when the parties can come to an agreement on a settlement, and be able to explain the basis to a judge so it will get approved.

Generally a Medical Set Aside will look at any med/legal reports (AME/QME) as well as the last few years of treatment reports. They may also review a current printout of benefits to see what has been paid in medical over the last few years.

Could they? Potentially yes, because surveillance is just obtaining video of someone in a public place. There is no law against getting film after settlement. But if the case resolves with a C&R, the insurance company has no reason to get film. The case is settled, the final check paid, and the file is closed. Insurance would not hire an investigator to get film, and spend thousands of dollars, when the film will do no good as the case is settled. Once the C&R is approved, and the check issued, I cannot envision a scenario in which insurance would hire an investigator.

@myworkerscompguide great thanks!

@@jaliscomx328 Happy to help inform.

Best of luck to you!

It may mean that they got EDD clearance, or they may be moving forward without it, or they may have confirmation that any EDD lien was paid. You would need to check with either your attorney or whoever filed the settlement.

Unfortunately it's fairly common that MPN's add and drop doctors over the course of the year. Generally, if an injured worker is with a doctor who is taken out of the MPN, then the injured worker can stay with that doctor until a new doctor is found and takes over care. That way the injured worker is not left without treatment. If there are no other pain management doctors in the MPN, and one is needed, then treatment can continue with that doctor regardless of MPN status as there are no other available doctors in the MPN.

@ I understand, but is there a limit to work comp just dropping doctors out of nowhere back to back this would be the third pain management doctor they dropped out of their MPN and I believe it’s due to the doctors being on my side instead of theirs.

@@bigdaddymex2003 There are a number of laws (the Labor Code generally) and regulations (Title 8 of the California Code of Regulations generally) that pertain to MPN's and the required standards. But I have not recently researched what the law is with regards to dropping doctors from the MPN.

The workers' comp system can be very frustrating. You may want to reach out to a local attorney for a consultation, or speak to the I&A officer at your local WCAB.

Workers' comp in California is frustratingly slow. As to the blood pressure issue, that may be what's called a compensable consequence to the original injury which may lead to insurance paying for that treatment and any PD as well. This video covers some of that issue - th-cam.com/video/e3dhQ_JVgbg/w-d-xo.html

In California the injured worker does have the right to change to another PTP within the MPN (if there is one), and if there are an insufficient number within the MPN then possibly go outside the MPN as well. But the system is slow.

Happy to help inform.

I cannot say what you should do. You may want to talk to the I&A Officer at your local WCAB office about your options. Or you may wish to speak to other attorneys to possibly take over representation. You may want to watch this video in which I discuss issues surrounding what happens if you fire your attorney to get a new one.

EDD will not pay out the permanent disability award. If an injured worker is 35% permanently partially disabled, after apportionment, and is a max wage earner for PD, then the insurance company will pay out the 35% award which is $48,140 for a recent injury. Workers' comp insurance will pay out that 35% whether the injured worker returns to work or not, or whether the injured worker finds another job in the future or not. EDD's payment of benefits is completely independent of the PD rating. EDD will pay out if the injured worker is off work due to disability and has funds available in his or her EDD account to pay.

It's tough to say as there are many possibilities. There could be an EDD lien that hasn't been resolved, or the parties need a clearance letter from the EDD. Or a new issue may have come up after signing but before submission to the Board. Or the judge may have issued an OSA because he or she wants additional documents or clarification that hasn't been provided. Or the C&R may have been submitted, but gotten lost in the WCAB system and no judge has acted on it yet. Whoever filed the DOR should have served all parties and listed in the DOR why a MSC was needed.

​@@myworkerscompguide It was filed only a few days ago. The WCAB case search really needs to expose more information. OSCAR for the federal courts has an insane wealth of useful information. However, WCAB has almost nothing. It's tough to really know what is even going on. Are MSC's required prior to a judge approving a C&R? Is there a way to find out who filed, and why? I literally cannot contact the attorney as they just ignore my calls, so I have no idea. I thought everything was resolved, but I guess it isn't. I keep getting phone calls for subpoena's and I thought this was all over, I've had like 4 phone calls asking me if I got some subpoena and then they hang up when I tell them that I have no idea what they're talking about. There was a "C&R Walk through" just prior to the DOR for the MSC being filed. But Idk who it was, was it my side, the defense, the judge? The docket says absolutely nothing.

@@decilgang EAMS provides little information unless you are a registered e-filer and you are a party to that case. I could only guess at what may be happening in your case. I suspect you will get a copy of any filing in the mail in the coming days, which will shed light on the cause. If not, you will have to keep following up with your attorney.

I only have experience with California's workers' comp system. If you're in California, I'd recommend reaching out to a local attorney for a consultation to see what options you may have available to you.

@ thank you for the response

@@ajm689 Best of luck to you.

An attorney who represents an injured worker in a California workers' comp case who is either fired by the client or dismissed by the Board, can always file a lien for fees. However, that does not mean that they will get paid. A lien just indicates to the parties and the WCAB that the attorney wants to get paid for his or her services. It is up to either the parties to negotiate at case resolution, or to be set for Trial and have a judge decide what a reasonable fee would be.

Each case is different. Sometimes drafting the C&R only takes an hour, but sometimes the defense attorney has to draft it and send it to the adjuster for approval first. Sometimes the C&R is very straightforward, but sometimes they may need to get clearance from the EDD or need to resolve the EDD lien, and that could take days, weeks, or a couple of months. It's really tough to say what is "normal" in workers' comp these days.

@@myworkerscompguide OK thank you so much. They sent me an offer back in May which I agreed to and I haven’t received any state disability. I just wish I would get a response back from an email instead of just being ignored.

@@Analysemarie Lack of communication in workers' comp is a real problem.

@@myworkerscompguide yes definitely! Thank you . I really appreciate all of your help and valuable videos!!

@@Analysemarie Happy to help inform.