How do I get total disability in workers' comp? What does it take for 100% permanent disability?
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- Опубликовано: 9 сен 2024
- This video reviews some of the more common ways that a case can result in 100% total disability. If you are an injured worker with a California injury, and don’t have an attorney, this video is intended to help provide an overview of workers’ compensation topics so you can better represent yourself.
Jeremy Lusk is a certified specialist in workers’ compensation with about two decades of experience, and previously served as a Judge at the Fresno District Office of the WCAB. He has worked out of Fresno, but appeared at numerous Boards to represent both injured workers and employers/carriers.
No attorney/client relationship is created or implied by this video. This video is not offering legal advice as to what you should, or should not, do in your workers’ compensation case, but rather offers education/information as to the California workers’ compensation system for unrepresented workers so they can better represent themselves and make more informed decisions.
If you have any questions, let us know at questions@mywcguide.com
Thank
Happy to help inform.
I am fed up with not getting the treatment I need(L5-S1 going on over 3 years of worker's comp). Being in the worker's comp system limits me to ONLY see doctors in the MPN. My question is, in California, once I settle my case, will private insurance(I.E.H.P.) treat me for what was a worker's comp injury? If it is up to the private insurance company, does it matter whether I settle my case with Stipulations or whether I settle my case with a C&R? I want to escape being limited to only being treated by WC MPN doctors for my back injury. But I have heard that In CA, no private insurance will treat my back... even after my case has been settled.
Frustration with treatment authorization is very common in California's workers' comp system. I spend much of my time on treatment disputes. If you settle with Stipulations, most likely your personal health insurance will not cover treatment because there is other insurance (workers' comp) to pay. From what I have seen, many insurance companies will cover treatment after a case settles with a C&R, but I cannot say that happens in every case.
@@myworkerscompguide Okay ill consider that. Thank you for helping me.
@@CriscOnSmootHBest of luck to you.
I know somebody that the Qme doctor found to be unable to participate in the open labour market on Qme report and even the rating is 100 percent.
Does that mean that person will get payment for life at 66%. Is a vocational expert needed to agree on the same statement?
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.
How about spine? Guy degenerated multiple spots..I can't walk 2 hours without being home later unable to walk..and sitting for long periods is extremely painful.waiting on mri but I feel multiple hernias and sciatica on top of it....should I hire a lawyer?
The system is designed for injured workers to not need an attorney. But I feel that most workers get a much better outcome with an experienced attorney. There are key steps, such as which specialty of QME to select, which QME from the panel to select, and settlement talks, that attorneys just have much more experience with. I cannot say what you should do. But especially if your case is not accepted yet or if you don't have a QME yet, I would recommend that you talk to a local attorney. I generally recommend starting with a search for certified specialists in workers' comp in your area by searching the State Bar website and doing an advanced search for attorneys.
@@myworkerscompguide ya it's been 3 weeks..I have a xray diagnosis slip in front me that I know they have.i don't think my boss fought it our last text was me saying I messed up my back I'm going to the hospital. I talked to a lawyer this morning...thank you for your time
@@chriscallahan5699 Best of luck to you.
Ok i have PTSD from CT and the qme found it 53% industrial if that matters. My case should be done but what is happening is the defense stops communicating totally then my attorney files a DOR and on the day if the status conference they suddenly agree and say they will pay then when it's taken off calendar they just stop communicating again until my attorney files another DOR and it just starts again. Cant my attorney do something about this and it's SCIF if it helps. This is the most mind bogglingly screwed up system we have. If anyone wants to know how dirty the state government is I can show you.
The system is certainly frustrating, and SCIF can be especially so at times. If your attorney is filing DOR's to keep the case moving, he or she is likely doing the right thing. Since you have an attorney you would have to ask him or her about strategy going forward. Best of luck to you.
@@myworkerscompguide So they can do what they want more or less?
@@nosir5585 No, any action or inaction taken by State Fund has to be lawful, and if they take unlawful actions then your attorney can hold them accountable either through hearings, penalties, sanctions, etc. It's just that this is a frustrating and slow system. Your attorney will know best what strategy to take in your case to hold them accountable.
If your doctor has you off on total temporary disability and your employer is aware of this should he be calling you to get you to come into work.
Generally, no. If an injured worker is on TTD, then the doctor is saying that the injured worker should not be doing any work and should be resting and recovering. It could be that the employer doesn't yet know about the TTD status.
@@myworkerscompguide I've been off work for now about 2 months . And everybody knows I am on TTD . The thing that got me thinking is an hour before my boss reached out to me to sales representatives from my job that have nothing to do with me or my department pull up to my residence. Get off the car attempt to open my work van so I made my way outside quickly being injured that was a hard thing for me to do but anyways and ask them what they were doing they said oh they just wanted to know who owned the van I told him I did they said they were just driving by saw the van and wanted to see what was going on. Could this be some kind of harassment
@@Mr-ov9wl I couldn't say as to your situation. You would need to reach out to a local attorney for a consultation. I will say that in my past cases when my client is on TTD and has a work truck, the employer often has the work truck picked up. There is no reason for the employee to have it as he or she is not working.
I have my right foot amputated, permanent drop foot on my left foot with a knee that won't bend past 60° due to crushed tibia and dislocated knee cap, sheared off anus requiring a permanent colostomy bag, big chunk of the buttocks is missing, right hand deformed due to the accident. Would this qualify me for permanent lifetime benefits?
It would not qualify for automatic 100% disability, such as a loss of both eyes or loss of both hands. But it certainly sounds like a very significant injury that may well be 100% in the end. If you do not have an attorney, I'd strongly recommend reaching out to one.
Since my left hip replacement surgery under workers comp, my right hip is now causing pain and problems and going to more than likely require replacement as well. Since I'm still having complications with my left hip and my doctor said nothing can be done with my right hip until the left hip issues are resolved, will this delay my case being settled before or after my right hip replacement? In other words, will my case have to wait to be settled until my current right hip issues are resolved?
A workers' comp case can be settled at any time. However, it is much easier to come to a figure and get a judge's approval once the injured worker is P&S. Then the QME can issue a ratable report. If the injured worker has a compensable consequence (such as a right hip injury as a compensable consequence of the left hip injury) then both conditions would need to reach P&S status.
What if SSA finds that I can’t do any jobs in the open labor market?
Social Security and workers' comp are completely different systems with different reporting requirements and different standards. The reports generated in the Social Security proceeding may be relevant to the examining doctors in workers' comp. However, a finding of inability to work in the Social Security system does not automatically mean the same thing in California's workers' comp.
What does it mean when a request for a treatment or procedure has been withdrawn due to imr uphold? Also how true is it that there are companies out there that help with loans for workers comp cases?
If IMR upholds a utilization review denial, then the denial stands and the adjuster does not have to authorize the treatment. However, I've not seen a provider withdraw a request after an IMR uphold, as there would be no point. The treatment was denied and IMR upheld the denial. As to companies that provide loans, I have no experience with them.
@@myworkerscompguide it also states the word "deferred" is that the same thing?
@@jaliscomx328 Generally I see utilization review use term deferred when there is some other issue than medical necessity. UR is designed to determine if a requested treatment is reasonable and necessary. If there is some other issue (awaiting reporting from that doctor, no narrative report, that body part is denied, etc.) then UR may be deferred.
@@myworkerscompguide thank you! Great info, is there a phone number you can provide where i can reach you/ your office?
@@jaliscomx328 Thanks, but I just don't have time in my schedule to talk to people on the phone about issues like this. I'm just too busy with my clients, and then I try to hop on here from time to time to answer questions.
My attorney told me they couldn't do anything and sometimes this happens. This shit is a fucking joke
Hey i settled my work comp with a C&R and in a month i was supposed to recive my payment i got half but in 3 day the month will be over what happenes if adjuster dosent pay all within the month period? Do you recive anytging exstra like what happens ?
If an Order is not paid within thirty days, then the unpaid balance must be paid along with interest at 10% and sometimes a self-imposed 10% penalty. Plus, if it's not paid timely, and the adjuster is made aware and still delays payments, then they may be liable for a 25% unreasonable delay penalty. It's generally best to call the adjuster and ask why full payment hasn't been made yet. It may be that it's about to issue, or the adjuster forgot and will issue it immediately.
I have a case going on right now for 2 years plus, I received an offer the first year in but I counteroffer, I did a QME a couple months back and it has already been reviewed by my attorneys and now they requested a Phycological QME, they said they filed an MSC hearing to get assistance on it, but I thought this meant the case would come to its end. my question is, can I have a say on if I want to close my case in this time period, and if I do would there be any negative
if you could reply I’d really appreciate it
i just don’t want to wait another year or so for a settlement
@@alexisvazquez9078 The decision of whether to settle is really the client's decision to make. However, it is not always that easy, as the defense may not be offering a settlement at the time. In your case you would have to talk to your attorney about whether settling now is best, what your desires are, and what your attorney recommends.
@@myworkerscompguideThank you I’ll be doing that, any recommendations on how I can bring that up to my attorney ? I don’t want to sound greedy since I know they’re working hard on my case
@@alexisvazquez9078 Attorneys understand. Every case is unique. Just call up your attorney and tell them you'd like to settle sooner rather than later, and see what they say.
@@myworkerscompguideyou’re the goat thank you sir !
I'm currently receiving long term disability payments from workers comp that apparently are being deducted from any final settlement amount since my case is still open. When do these payments stop or end if at all? How long can I receive them from WC?
It sounds like you are likely receiving PDA's, and those are deducted from any settlement since they are advances paid on the estimated final PD level. They will stop once a reasonable estimate of PD has been advanced, so that could mean very soon or in several years. I could not say how long those will continue. Each case is unique. You may want to reach out to a local attorney for a consultation, or to the I&A Officer at your local WCAB office to go over your options.
@@myworkerscompguide thank you very much for your prompt response.
@@Decades-pl2kl Best of luck to you.
Can degenerative disc disease be considered permanently disabled?
I would have to say no. There is no rating for degenerative disc disease in the AMA Guides. Total disability would come from the disability caused by the industrial injury, and that would be based on impairment found in the AMA Guides. That impairment is usually along the lines of loss of range of motion, or a diagnosis related estimate such as the type of surgery that took place, or where an amputation took place, atrophy, radiculopathy, fracture, etc.
I had two knee surgeries for an injury at work, still having pain and not getting better. In my claim I also have synovitis, depression and panic attack disorder. I am worried that I won’t get better specially from my mental issues. Do I have any chance to get permanent total?
I cannot speak to the facts of your case. You would need to consult an attorney to review your file in detail. I will say that in general it is very difficult to get 100% disability in California's workers' comp system, and it generally requires a complete inability to compete in the labor market. So essentially unable to perform most any job due to the injury. In addition, the legislature changed the law about ten years ago or so to eliminate any disability due to psychiatric injury as a compensable consequence to a physical injury. So in most cases, if it is a physical injury (such as a knee injury), then there is no additional disability paid if the injured worker has psychiatric injury or PTSD due to the injury, effects of the injury, etc.
@@myworkerscompguide Thanks so much for taking the time to answer.
@@rouguy1972 Happy to help inform. Best of luck to you.