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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 Usually it just needs to get cleared up with the EDD rep and the lien is withdrawn.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.

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 - ruclips.net/video/gxsPrAJK4Cg/видео.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.

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.

Sorry to hear that. If you don't have an attorney, I'd recommend reaching out to a local attorney for a consultation as it sounds like your case is quite complicated.

I think most injured workers are generally better off with an attorney, rather than going it alone. It's just such a strange and confusing system. As to the deposition, it depends. The filing of a Petition to Reopen is good cause for the defense to be able to take the deposition of the injured worker a second time. But they are not required to do so. Each case is different, and it will depend on how the adjuster and defense attorney look at the file.

Thank you Jeremy i appreciate you

@@BearPapa49 Happy to help educate how the system works.

How do you know if you have permanent disability advances? Is that once you agree to a settlement but haven’t signed paperwork yet or is that once you sign papers? I’m supposed to sign paperwork this week but we came to agreement on settlement June 17. After that the claim specialist ignored my emails for almost 5 weeks I’m just curious if that cost part of my settlement? I haven’t received anything from EDD (side note)

Defense attorneys often appear in front of judges, and after doing the job for a number of years can get a good feeling of what local judges will and will not approve. So it's not unheard of. The C&R does need to be signed either by two witnesses, or you can sign it with a notary public who notarizes your signature. Either works. As to a family member, the Labor Code says, "Every release or compromise agreement shall be in writing and duly executed, and the signature of the employee or other beneficiary shall be attested by two disinterested witnesses or acknowledged before a notary public." So a family member could sign, but it would need to be someone disinterested. So, not a spouse or child.

@@Analysemarie The defense attorney or adjuster can confirm if there are PDA's. They will also be listed on the C&R. A typical C&R is a set sum of money, less any PDA's listed specifically on the C&R at the time of drafting, and less any additional PDA's made after the drafting but subject to proof (so the defense has to show that they actually paid them).

@@myworkerscompguide OK great thank you so much.. to clarify if papers haven’t been drafted yet I wouldn’t have any PD advances?

@@myworkerscompguide thank you the defense attorney stated that he felt the judge would say it wasn’t an adequate settlement amount and more settlement. He stated that he’s going to reach out to the claim specialist and ask for a better settlement offer. He says that the judge works above him and he’s close friends outside of work with her yet she follows rules to the T.

I like that idea. I'll try to get that out soon.

It will really depend on what the QME and/or PTP finds. If there were no prior injuries or accidents, potentially there may be some congenital defect or other non-industrial cause/condition that caused part of the permanent disability. The insurance company can argue many things, but it really boils down to a doctor's opinion, and that doctor's opinion must be substantial medical evidence, so it must be based on an accurate medical history, a complete exam, a correct application of the law, etc.

@@myworkerscompguide thsnk you sir! Always very helpful

@@jaliscomx328 Doin' my best!

It would often depend on whether the employer can accommodate any temporary light duty work restrictions. If yes, then no TD. If not, then TD would likely resume. But each case is unique.

@myworkerscompguide So bck in may.. I was laid-off and or terminated... but the Workmans Compensation Claim is still Active... I received ttd at home for several months, as at the time, the employer could not accommodate.. then, recently..they stopped ttd.. it's been nearly 2months without ttd.. I'm suffering.. I saw the second qme for the primary injury recently, he has declared not permanent stationary, but will need further medical treatment.. Will ttd resume during this time??.. of further medical treatment??

@@7clovers007 Generally if an injured worker is not yet P&S, and is either completely off work or on light duty temporary restrictions that the employer cannot accommodate, and two years of TD have not been paid out, and it is within five years of the date of injury, and there are not other disputes such as treatment outside the MPN, then TD would be paid. You may want to reach out to the I&A Officer at your local WCAB office to discuss your options, or talk to a local attorney for a consultation.

@@myworkerscompguide Thank you for this information.. I appreciate it.

@@7clovers007 Best of luck to you.

OTOC means Order Taking Off Calendar, which means (often times) that the dispute was resolved, and the parties requested that the judge take the hearing off calendar as it was no longer needed. It may be that your hearing was over the surgery authorization, and since that was approved, the hearing was taken off calendar. If it was taken off calendar without your knowledge, then I would guess you have an attorney. If that's the case, you would need to ask him or her as your attorney knows your case best.

@@myworkerscompguide thank you for your answered

Apportionment is not very scientific. The Labor Code says, "The employer shall only be liable for the percentage of permanent disability directly caused by the injury arising out of and occurring in the course of employment" so the QME must determine what percentage of the disability was directly caused by the injury, and what percentage was caused by other injuries or causes both before and after the injury. Fighting apportionment determinations by a QME can be complicated. I'd recommend either talking to the I&A Officer at your WCAB office or to a local attorney for a consultation.

Thanks. Happy to help inform.

What the attorney or claims adjuster said is correct. It's not impossible to settle a case without a ratable report, but it is more difficult. If the PTP writes a P&S report, they usually do it on a PR-4 form as that has all the areas that need to be completed. Many treating doctors don't like to do that type of report, and they just defer to a QME. It is difficult to settle a case without a P&S report because the judge must determine adequacy, and the easiest way to do that is to review the WPI analysis, the final PD rating, and anticipated future medical care. To settle without that information the C&R needs to have a very good explanation of why the parties are settling without a QME report, how the parties determined the settlement amount, and why the parties feel that amount is a fair and reasonable settlement. Even with that the judge may still set it for a Status Conference so the judge can talk to the injured worker to ensure he or she understands the options available and what the settlement means.

@myworkerscompguide thank you so much. I appreciate all your help. I did have report from a pain management specialist. Is that something that could be taken into consideration?

@@Analysemarie Certainly. The more explanation that goes into the C&R, and the more medical reports that it refers to (and are filed for the judge), then the easier it is for the judge to determine if the settlement is adequate.

@myworkerscompguide wonderful thank you so much! I have MRI, x-rays physical therapy, orthopedic surgeon and pain management specialist reports. I’m hoping all those help .. 🤞🏼 I have an over the phone meeting on Monday with the attorney.

@@Analysemarie Best of luck to you. You can also always call the I&A Officer at your local WCAB office to go over your options.

Maybe. The defense generally has the right to take the injured worker's deposition when there is a new injury or when there is a significant change in facts. If the defense took a deposition after injury one, and then injury number two is pled, then the defense has the option to take the injured worker's deposition again. They do not have to, but they can.

Mr Lusk how do I contact you regarding my serious WC claim?

There are many factors. If the settlement was just regarding the level of PD and settling with Stipulations, then that dispute could be taken to trial. But if the defense attorney offered a C&R, and then changed the offer before everything was finalized, then going to trial would not serve much purpose as the judge cannot order or award a C&R. You may want to call your I&A Officer at the local WCAB office and talk to them about your options.

@@myworkerscompguideomg i cant believe you actually responded thank you! can i go to trial to make my case and get more money or is the judge only going to look at my Injury rating and go from there ?? My attorney told me if we go to trial the judge is only going to give me a settlement that does not include the buy out for future medical care but instead i will have open medical for the rest of my life and give me an ammount for the rating given by the QME doctor

@@julioarias5827 First, you have an attorney, so he or she knows your case best. I can only answer general questions about how the system works. What your attorney told you about the judge only being able to award the PD, and not a buyout of future medical, is correct. So a case can go to Trial if there is a dispute, but a judge cannot order a C&R. A judge can only award what is basically the equivalent of Stipulations with Request for Award. So if the parties want a C&R, it needs to be negotiated between the parties.

A. Everything is negotiable. B. Judges in workers' comp really don't like those general releases, as the WCAB only wants to see workers' comp issues, and often times those general releases pertain to many other issues that are not workers' comp. C. There is no way that I could offer you any advice on that type of issue. I'd strongly recommend reaching out to your I&A Officer at your local WCAB office, or talking to a local attorney for a consultation. There can be real significant impacts from the terms of those agreements.

@@myworkerscompguide thank you very much for your quick response. So judges not liking those general releases is that mean good or bad for my case? Thanks 🙏

@@rawtruthisahardpilltoswall6180 It's neither good nor bad. But the general rule in workers' comp is that a settlement can only settle that date of injury. So if the injured worker was hurt on May 19, 2023, and then the settlement says that it settles "any and all injuries whether known or unknown to any parts of the body" it likely won't get approved by a judge because the other injuries are not specified and a judge cannot determine adequacy.

@@myworkerscompguide dang! So it is a possibility mine won’t be approved! I’ve been waiting for this for so long already and I just signed cause I thought I had to.

@@myworkerscompguide I am working with an attorney and he said to sign it. But I did think it was a little weird but then again I didn’t know anything about it till I decided to look into it and came up on your videos. Thank you for the info either way. I appreciate it

I'm not sure what you mean. Every case is so different. Are you still employed with the employer at which you were injured? Did the QME impose permanent work restrictions? Did the PTP? Do those two doctors disagree with one another? Have you been working light duty? Are you interested in returning to that employer? Workers' comp cases in California really are unique every single time.

@@myworkerscompguide I am still employed. QME did impose permanent restrictions. The PTP has not yet. I do not think they disagree but PTP still might want to do one more procedure. No light duty available so I’ve been home since November. Work will not allow me to return with restrictions for my job. They have been downsizing so don’t see them finding me something else. QME placed P&S with restrictions in May but HR has not reached out to me.

@@Cheezmo Every situation is unique, so to discuss your options I would recommend calling the I&A Officer at the WCAB or talking to a local attorney. Generally, it is legal in California that if an injured worker has permanent work restrictions, then the employer can let the employee go after going through the interactive process and not finding either modified or alternative work. I often tell my clients that if their condition is P&S, and they don't expect to return to the same employer, that they should start looking for another job wherever they can find one as they'll need income. You can't survive on the $290 a week for the PD rate.

I really couldn't say. Every case is so unique. I've had cases with very significant injuries and significant medical expenses paid by insurance, but the recovery goes very well so the final settlement is small. Plus, it depends on whether you settle with open future medical care or close it out. As you have an attorney, he or she would know your case best, and what it is potentially worth. Best of luck to you.

I'm not familiar with a form 1020. Maybe it's for a state other than California?

No. If the defense attorney moves too slowly an injured worker can file a DOR for a hearing.

Usually the defense attorneys move fairly quickly on getting those submitted because the claims adjuster (his or her client) wants that file closed. It could be that they are trying to get EDD clearance to confirm either no benefits paid or that there's no outstanding lien. That can take weeks, and unfortunately I've even seen it take months. But ideally the defense attorney would communicate the reason for the delay to the injured worker.

There is no limit to the number of workers' comp cases you can file as an injured employee in California. That said, most California employees likely never file a claim, while if someone else has filed ten or more cases over the years that will likely raise red flags at the insurance company. It seems fairly rare that someone files double-digit numbers of workers' compensation injuries.

Generally no money is paid out for personal injury claims until they settle, while workers' comp will start paying money to the injured worker and doctors as soon as the case is accepted. Since you have an attorney, he or she would know your case best, and I'd recommend talking to your attorney about your case.