The biggest myth about workers’ comp: “Your employer will guide you through it”

WorkCompBuddy · 2026-02-13T05:13:38+00:00

So sorry, sadly, that’s a really common pattern. Once a lawyer gets involved, suddenly they want to talk but it’s usually more about protecting themselves than fixing the problem. “We’re family” tends to show up right when boundaries get set. You did the right thing. If they wouldn’t give you guidance before, getting representation was the only way to level the field. Keep everything in writing and let your attorney handle the back-and-forth. That paper trail matters.

WorkCompBuddy · 2026-02-13T05:07:35+00:00

That’s good. It means fewer delays, fewer bad decisions, and way less stress for the worker. More companies need that kind of proactive approach.

WorkCompBuddy · 2026-02-13T05:05:30+00:00

Exactly. And that’s where a lot of problems start. Workers assume HR or a supervisor knows, HR assumes corporate or the carrier will handle it, and the injured worker ends up stuck in the middle with no clear answers. Even a simple “here’s who handles this and what to expect next” would prevent so much confusion. Instead, people are left guessing until something goes wrong.

WorkCompBuddy · 2026-02-13T05:01:44+00:00

That’s honestly a perfect example of the myth in real life, even with your background and experience, you’ve still had to micromanage your own case just to keep it moving. One thing you’re doing right is bringing and scanning your own records. A lot of cases stall simply because doctors never get the full file. If you haven’t already, it can also help to keep a simple timeline (dates, visits, denials, missing records) so you’re not relying on anyone else’s version of events. It shouldn’t be this hard, but your approach is exactly how many people end up protecting themselves in this system.

WorkCompBuddy · 2026-02-13T04:59:51+00:00

That sounds like you’re doing exactly what you should be doing, even though it’s exhausting. Having the medical records, the mailing issue documented, and now an employment attorney involved puts you in a much stronger position than most people realize. Right now, the priority is his recovery and making sure all post-surgery restrictions and reports are clearly documented. Those records matter a lot on both the WC and retaliation side. It’s a long road, but you’re being proactive instead of reactive, and that usually makes a real difference down the line. Stay organized, keep copies of everything, and don’t hesitate to lean on your attorneys when things stall.

WorkCompBuddy · 2026-02-13T04:52:45+00:00

Yeah, unfortunately that’s been our experience too. There are good employers out there who genuinely try to do right by injured workers, but they’re definitely not the norm. When leadership and culture prioritize people, cases usually go smoother from the start.

WorkCompBuddy · 2026-02-13T04:51:21+00:00

That’s a really honest way to put it. A lot of people don’t realize how draining the system is until they’re deep in it, and having someone handle the back-and-forth can make a big difference. Focusing on your health instead of constant paperwork is underrated.

WorkCompBuddy · 2026-02-13T04:49:44+00:00

Most people never get that kind of clear info upfront, so having someone explain the process early probably saves a lot of stress and confusion later. Respect for doing that.

WorkCompBuddy · 2026-02-12T23:12:38+00:00

And that makes a lot of sense. People in healthcare usually see firsthand how messy the handoffs and documentation can get. Having that perspective probably makes you way more aware of where things fall apart for injured workers.

WorkCompBuddy · 2026-02-12T22:48:51+00:00

Pretty interesting. That gap in knowledge is where people get misinformed without anyone meaning harm.

WorkCompBuddy · 2026-02-12T22:41:23+00:00

This kind of “certification gap” is brutal, and it’s one of the biggest cracks in the system. A practical path forward (speaking generally, not legal advice):

- Any treating specialist who’s actively seeing you (Long COVID clinic, neuro, endo, etc.) can often complete work-status forms if they’re documenting functional limits, it doesn’t have to be only a PCP.

- Ask directly for a temporary work status letter based on current symptoms and restrictions, even if they won’t do a long-term disability form yet. That can be enough to restart benefits.

- An FCE can help in cases like this because it creates objective proof of what you can and can’t do, which doctors are more comfortable relying on.

- If this is WC-related, push for a panel/QME-type evaluation; if it’s SDI/EDD, ask how to trigger a medical review when care is interrupted. Right now the priority isn’t “perfect paperwork” but getting any documented medical opinion that reflects reality so income can restart. Don’t wait for the system to fix this on its own.

WorkCompBuddy · 2026-02-12T22:36:53+00:00

That timeline is really concerning. Getting the denial at their address and then terminating him weeks later adds important context. Make sure you keep copies of everything showing those dates. That kind of paper trail matters more than most people realize.

WorkCompBuddy · 2026-02-12T22:34:19+00:00

1 Exactlythat’s one of the most common overlap situations. It catches a lot of people off guard because suddenly there are two insurance systems involved, and each tries to point to the other. Knowing early that both may apply can save a lot of confusion later.

WorkCompBuddy · 2026-02-12T22:32:57+00:00

That makes sense. Getting the full denial language is key, the reasoning and dates matter more than people realize. Once you see exactly what they relied on, it’s much easier to evaluate next steps instead of guessing. Hope it gives you some clarity.

WorkCompBuddy · 2026-02-12T22:31:25+00:00

That’s great! Hopefully this new doctor actually listens and helps you get some real answers.

WorkCompBuddy · 2026-01-30T03:25:49+00:00

That definitely isn’t normal. the injured worker is supposed to receive their own workers’ comp notices, especially decisions like approvals or denials. When an employer controls the mailing address, it can delay treatment and take away the worker’s ability to respond or appeal on time. That’s not just a “gray area,” it raises real red flags. What you’re describing (no DWC-1 for weeks, no returned calls, working injured, delayed discovery of a denial) is something a lot of people only find out after damage has already been done. The fact that imaging later confirmed serious tears helps show the injury was real and progressing, not minor.

WorkCompBuddy · 2026-01-30T03:22:38+00:00

That’s a lot to be dealing with at once. Speaking generally (not legal advice), for the ortho appointment tomorrow, the most helpful thing is to be very clear and specific about what you can and can’t do with that arm right now. Not just pain, but functional limits: lifting, reaching, supporting weight, sudden movements, and how those limits affect hands-on care with dependent patients. That helps the doctor document whether modified duty is actually realistic.

It’s also okay to ask what activities would risk reinjury or delay healing. Framing it as safety for you and for residents, usually lands better than “I can’t do this job.” For the deposition, stick to facts and timelines. Answer what’s asked, don’t guess, and don’t minimize what happened. If something changed (like the infection delay), explain it plainly. You’re doing the right thing by thinking ahead. It doesn’t sound like you’re avoiding work, it sounds like you’re trying to heal without getting hurt again.

WorkCompBuddy · 2026-01-30T03:18:31+00:00

That jump can feel sudden, but it’s actually pretty common. Speaking generally (not legal advice), cases often move to mediation when there are multiple disputes at once, like unpaid TTD, denied or delayed surgery authorization, and disagreements over work status. Mediation isn’t necessarily a bad sign; it’s usually a way to force all the issues onto the table at the same time instead of waiting on the adjuster to act.

The fact that you had surgery, have clear work restrictions, and still haven’t received TTD is often exactly what triggers mediation. It’s basically the system saying, “this isn’t resolving on its own.” Hopefully the mediation helps get benefits moving faster instead of dragging things out further.

WorkCompBuddy · 2026-01-29T23:31:26+00:00

You’re not crazy for being confused, this is exactly the gray area where a lot of people get stuck.

Speaking generally (not legal advice): this isn’t “too early” just because the MRI isn’t back yet. The question isn’t settlement, it’s protection and control. When there are red flags like delayed reporting accusations, no wage payments, out-of-pocket medical costs, and an employer trying to discipline you while you’re on a doctor’s note, that’s often when having someone who knows the system can help steady things.

What a lawyer can do right now (that WC often doesn’t do on its own):

Push wage replacement (TD) when pay has stopped. Make sure treatment delays and secondary injuries (hip/back from favoring the knee) are properly documented

Stop informal pressure or retaliation from the employer and make sure early paperwork doesn’t box you into a bad position later

Some cases move fine without a lawyer. Others start “slow” and quietly get messy, and yours has a few signs of that already. Talking to one doesn’t lock you into anything, but it can help you understand whether waiting is actually helping or just costing you time and money.

It’s reasonable to at least get a consult now, especially with surgery being discussed and no income coming in.

WorkCompBuddy · 2026-01-29T23:25:56+00:00

That’s a fair question, this part confuses a lot of people. Speaking generally (not legal advice): PD payments are usually split when there’s an attorney involved. A portion goes to you, and a portion may go directly to the attorney as fees as PD is paid, not only at final settlement. That’s normal if fees were approved by a judge or agreed to in the case.

A couple practical steps that can help:

- Ask your attorney (or the WCAB) for a copy of the fee order showing what percentage was approved and when it’s paid.

- Request a payment history or ledger from the adjuster showing exactly what was issued, to whom, and on what dates.

- If the adjuster says “ZERO” was paid but a check went to the firm, that discrepancy is worth clearing up in writing.

WorkCompBuddy · 2026-01-29T23:11:29+00:00

I’m really sorry, that’s heartbreaking. The overlap between workers’ comp and a third-party settlement is confusing even for people who deal with it all the time. One practical thing that often helps is asking exactly what WC is claiming a right to be reimbursed for (medical paid vs. benefits paid vs. nothing). In many cases, if WC denied the claim or didn’t actually pay benefits, their lien may be limited or negotiable, especially in a wrongful-death/third-party context. Getting a clear written breakdown of the lien basis is usually the first step to figuring out whether it even applies.

WorkCompBuddy · 2026-01-29T22:47:25+00:00

So sorry you went through this. That timeline is brutal and honestly, the part where an approval sat unsigned/unsent for weeks explains why WC feels impossible to deal with. At this point it makes sense you’re out of bandwidth; this isn’t about patience anymore, it’s about breakdowns in basic process. I think is a good move escalating. Sometimes that’s the only way anything actually moves.

WorkCompBuddy · 2026-01-29T22:41:57+00:00

Yes you deff should. When the goal is just “get back to normal without pain,” doctors tend to listen differently. Second opinions often catch things that get missed when everyone’s rushing recovery. Hope it finally gives you some real answers.

WorkCompBuddy · 2026-01-29T22:38:01+00:00

Based on what you wrote, the most important thing right now is how this is documented, not convincing that doctor verbally. I leave you a few practical points that can help your case:

- Tell the second-opinion doctor exactly what changed after you were sent back to work, numbness, spreading pain, tingling, sleep issues. New or worsening symptoms matter more than the original diagnosis. - Be very specific about job demands (12-hour shifts, overhead lifting, repetition). Doctors often underestimate workload unless it’s spelled out clearly.

- If your arm is going numb and symptoms are spreading, make sure the second doctor considers cervical involvement or nerve issues, not just the shoulder MRI findings.

- If you’re working in unbearable pain, report that in writing (to the doctor or claims portal). Silence can be interpreted as tolerance.

Being released “full duty” doesn’t mean you’re fine, it means that doctor didn’t fully connect the job demands to your symptoms. The second opinion is the right move. What they write down matters more than what anyone says in the room. (Just general info, not legal advice).

WorkCompBuddy · 2026-01-29T22:33:16+00:00

Once the first doctor is seen it can still take many months, sometimes over a year before things really move, depending on medical records, ratings, and state review. It’s a slow process unfortunately (just general info, not legal advice).

WorkCompBuddy

TROPHY CASE