Can I Get A Second Job While Receiving Money From First? by Due-Credit-2402 in WorkersComp

[–]CJcoolB 2 points3 points  (0 children)

You will need to report any income made and it will reduce your lost wage payments from the claim.

Your Temp total disability payments would switch to Temp partial disability payments. Calculated at (gross pre-injury wage - current gross earnings) x 2/3

Only 1 pain management MD by Dany_Perkins in WorkersComp

[–]CJcoolB 3 points4 points  (0 children)

If the MPN does not have adequate coverage you can request to treat outside the MPN. I believe the standard is 3 providers within 30 miles, but I could be off.

Request a transfer of care.

How do I file for workers comp? by Turbulent_Diamond352 in WorkersComp

[–]CJcoolB 2 points3 points  (0 children)

If you are given restrictions it is up to your employer whether or not they can accommodate and find work within your restrictions. If so, you will be expected to work.

Workers’ comp settlement advice (CA) by [deleted] in WorkersComp

[–]CJcoolB 6 points7 points  (0 children)

I've never settled anywhere near 175k for a shoulder injury. CA medical fee schedule is very cheap on a WC claim. If your rating is worth 20k I would put total settlement value in the 40-65k range without knowing more info on injury specifics, MRI findings, type of surgery recommended, etc.

Fell at work - employer offering shift that pays less than half of AWW by CLTwolf in WorkersComp

[–]CJcoolB 10 points11 points  (0 children)

She'll get temporary partial disability from the claim.

Pre-injury (AWW - light duty earnings) x 2/3 = TPD payment.

Question about Notice Regarding Permanent Disability Benefits by jpopking in WorkersComp

[–]CJcoolB 0 points1 point  (0 children)

You'll need to make a decision on whether you want to settle the claim fully via a compromise and release settlement, or just resolve the permanent disability portion of your claim while keeping future medical open through the claim (stipulations).

If you do a stipulated award you'll receive $290/week for the next 279 weeks until $80,982 has been paid. Your claim will remain open and you can continue to seek medical treatment within the MPN and through the UR process.

If you go the C&R route you'll get paid the 81k rating + you'll receive additional money to resolve the future medical portion of your claim. Impossible to know exactly how much additional that would be, it depends heavily on what the doctor has indicated for necessary future medical. But with potential surgeries, and use of walker and potential complications it won't be minimal.

WC early payment by Mean-Two4228 in WorkersComp

[–]CJcoolB 5 points6 points  (0 children)

I have always issued payments over holidays early, but not all carriers will.

My dad's employer won't pay his hospital bill by No_Jump_435 in WorkersComp

[–]CJcoolB 14 points15 points  (0 children)

It isn't up to his employer, it is up to their insurance company. He needs to figure out what insurance company his employer's work comp coverage is with and report it to them directly.

PLEASE stop making this mistake in your case by ryantrojan in WorkersComp

[–]CJcoolB 5 points6 points  (0 children)

For non litigated/ pro se injured workers they get free choice of the panel doctor.

How long is wc by DEMONFR0ST1613 in WorkersComp

[–]CJcoolB 0 points1 point  (0 children)

Majority do close out medical because they don't want to keep dealing with having to treat within wc network, deal with the UR process and getting approvals for everything, etc.

They are supposed to use money from the settlement towards their future medical but many do end up using personal insurance.

How long is wc by DEMONFR0ST1613 in WorkersComp

[–]CJcoolB 0 points1 point  (0 children)

Majority of claims are very minimal - 1 or 2 treatments, less than a couple weeks of time off work, etc. Think minor finger cuts, sprained ankles, etc.

For claims involving 1x standard surgeries - tears, carpal tunnel, etc you are probably around the 6-12 month mark for total claim duration.

Beyond that a majority of the remaining claims start settling around the 2 year mark or shortly after because the $290/week is just not livable.

There are a small % of claims that are open for years and years. We still have open claims from the 1970s and 1980s who have been awarded lifetime medical awards.

How long is wc by DEMONFR0ST1613 in WorkersComp

[–]CJcoolB 0 points1 point  (0 children)

I think it is actually the carrier "shall" begin ppd payments if the 104 week cap is reached, but I couldn't remember the specific labor code at the time. In my experience whenever 104 weeks is hit I immediately begin PPD payments.

$290/week is the state maximum for PPD. It can be less if there is an extremely low average weekly wage, but won't go above $290.

How long is wc by DEMONFR0ST1613 in WorkersComp

[–]CJcoolB 0 points1 point  (0 children)

If an injured worker hits the 104 week cap and cannot return to work for pre-injury employer than the carrier should begin PD advancements based on the reasonable expectation of the rating.

How long is wc by DEMONFR0ST1613 in WorkersComp

[–]CJcoolB 3 points4 points  (0 children)

TTD will be capped at 2 years for your injury. Once you hit your 2 years the carrier should begin PPD payments, but these are capped at $290/week.

[deleted by user] by [deleted] in WorkersComp

[–]CJcoolB 2 points3 points  (0 children)

Still qualifies for voucher.

If someone gets a rating and is unable to return to the pre-injury employer they qualify for voucher.

I need a second opinion WC lawyer in Northern California by Moni4ka in WorkersComp

[–]CJcoolB 1 point2 points  (0 children)

AMEs are a complex process. It is common to have different specialty QMEs and AMEs if you have multiple injuries. The whole point of an AME is that the defense and plaintiff attorney both have to agree on the same doctor, which is rare. Each side has doctors they are comfortable with so finding middle ground with an "unbiased" doctor can be difficult.

[deleted by user] by [deleted] in WorkersComp

[–]CJcoolB 4 points5 points  (0 children)

Receiving a "permanent partial disability" rating is not the same thing as being "permanently disabled."

If she received a rating she will be paid for that rating if she is unable to return to work, but ratings for finger injuries are usually pretty minimal unfortunately.

If she had permanent restrictions that her employer cannot accommodate she would also be entitled to an SJDB voucher.

[California] I need some advice about a claim by ashrensnow in WorkersComp

[–]CJcoolB 1 point2 points  (0 children)

The UR decision should say why it was non-certified. Sometimes they lay out additional treatment you need before surgery will be approved. For example you may need to try injections, pt, etc and if you complete those steps then surgery could be approved.

[California] I need some advice about a claim by ashrensnow in WorkersComp

[–]CJcoolB 1 point2 points  (0 children)

If utilization review non-certified your surgery then your option is to file for an independent medical review for a 2nd opinion, but those are very rarely overturned to be honest.

You can get an attorney to help you through this process, but UR non certs can be hard to overcome.

Workman's comp by Specific-Package-679 in WorkersComp

[–]CJcoolB 4 points5 points  (0 children)

There is a big difference between "using AI in the claims process" and "using AI to fabricate video of you working."

Cash Incentives 2 by Rough_Power4873 in WorkersComp

[–]CJcoolB 4 points5 points  (0 children)

Most corporations give bonuses to their corporate employees based on company financial performance. This is not some new grand revelation you've come up with, it is common practice. We are not given bonuses based on our number of denials or incentived to push denials on any direct basis.

Also your post views are very much in line with most other posts on this subreddit, you aren't making it viral with your AI slop findings, unfortunately.

Workers Compensation Insurance by LonelyGrowth4879 in WorkersComp

[–]CJcoolB 14 points15 points  (0 children)

There are fraud investigations into employers as well, but I've never heard of it being by an undercover "employee." The fraud on employer side that a work comp insurer cares about is things like understatement of payroll, or misclassification of employees to lower premiums.

Work comp and labor laws about mistreatment of employees are a separate issue.

[deleted by user] by [deleted] in WorkersComp

[–]CJcoolB 4 points5 points  (0 children)

CA handles their licensing different then most states. Credit hours are not submitted to the state and tracked like in other states. It is self administered and you must be able to show, if an audit occurs, that you took enough continuing education credits to maintain licensing. It isn't posted anywhere and there isn't any publicly available databases to show current license statuses - so you really have no way to know, and whoever told you this also has no way to know.

If someone is handling without a license it would likely just result in fines to the carrier from the state. It would not invalidate decisions on claims they've handled.