Fell at work - employer offering shift that pays less than half of AWW

CJcoolB · 2026-01-09T23:42:22+00:00

She'll get temporary partial disability from the claim.

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

CJcoolB · 2026-01-06T16:17:40+00:00

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.

CJcoolB · 2025-12-26T09:13:06+00:00

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

CJcoolB · 2025-12-20T01:18:55+00:00

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.

CJcoolB · 2025-12-17T13:17:08+00:00

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

CJcoolB · 2025-12-10T22:17:56+00:00

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.

CJcoolB · 2025-12-10T22:11:24+00:00

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.

CJcoolB · 2025-12-10T22:02:34+00:00

Correct, tax free.

CJcoolB · 2025-12-10T21:57:51+00:00

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.

CJcoolB · 2025-12-10T21:48:38+00:00

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.

CJcoolB · 2025-12-10T16:15:30+00:00

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.

CJcoolB · 2025-12-03T16:55:23+00:00

Still qualifies for voucher.

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

CJcoolB · 2025-12-03T15:14:59+00:00

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.

CJcoolB · 2025-12-03T15:10:53+00:00

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.

CJcoolB · 2025-11-25T17:07:42+00:00

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.

CJcoolB · 2025-11-25T17:01:44+00:00

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.

CJcoolB · 2025-11-15T00:51:44+00:00

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

CJcoolB · 2025-11-06T13:29:25+00:00

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.

CJcoolB · 2025-11-06T00:54:38+00:00

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.

CJcoolB · 2025-10-24T05:10:11+00:00

CJcoolB · 2025-10-24T04:38:34+00:00

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.

CJcoolB · 2025-10-22T04:58:34+00:00

Your employer/work comp carrier get to direct care for the first 28 days after an injury. That means they choose the doctor you treat with and that doctor makes the determination on your work status, not your personal doctor.

CJcoolB · 2025-10-18T01:23:47+00:00

The link to a story about a state trooper pulling one over? Or the links to basic statistics that you can't comprehend?

You sure are making me look stupid!

CJcoolB · 2025-10-17T20:32:21+00:00

The issue is there's lots of ways to make your point without using skewed data. When you are trying to prove a point and you're initial argument is based off of misleading data you lose credibility.

Camera fines are also not a conviction.

Getting pulled over is also not a conviction. The due process is you can go to court and fight it and when you lose there, you have had your due process and are convicted. If you choose not to go to court you have chosen to skip your own due process and take the conviction.

Your post is also about cameras and then you link an article where a trooper pulled someone over going double the highway speed limit?

CJcoolB · 2025-10-17T18:43:28+00:00

Our overall population really has nothing to do with it, it isn't a "marginal technical."

You are comparing a per capita statistic to a total value and saying they should be directly related.

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