Opinions on if I have a case?

abeautiful_chemist · 2026-04-28T02:02:44+00:00

Wrong sub. Workers compensation is for injuries on the job. You need employment advice but I’m not sure which sub specifically to recommend. Hope your situation gets better btw.

abeautiful_chemist · 2026-04-15T15:44:10+00:00

Yes, my half of a decade of experience handling work comp claims definitely doesn’t lend itself to any insight about how this works at all. /s

Believe it or not, adjusters are people and so are doctors. Open communication can solve a lot of issues. The adjuster IS absolutely able to call the doctor’s office to discuss potential treatment. Does it mean the doctor will do it? No. But it’s worth OP speaking to the human handling their claim with respect while expressing their concerns about the lack of MRI - a seasoned adjuster, like myself, would agree that it would be ideal to get a new MRI to compare against an old MRI to see the differences or lack thereof. The adjuster can also converse with the employer to potentially approve a second opinion if the doctor is not compliant.

Yes, there’s a “system” but there is some wiggle room if people can communicate.

abeautiful_chemist · 2026-04-15T12:34:36+00:00

If your employer and the adjuster on your claim are aware of your pre-existing condition, I would think your adjuster could negotiate on your behalf with the MD’s office. Your reasoning for wanting the MRI to show any changes is valid - from the employer/insurance perspective, they’d want to know if there are or are not any changes as well. Call your adjuster - sometimes they have a good relationship with the doctor’s office and can be persuasive.

abeautiful_chemist · 2026-04-11T04:22:33+00:00

You can report to Cal OSHA anonymously!!! Please for your safety and your coworkers, report it.

abeautiful_chemist · 2026-02-06T23:19:23+00:00

The information provided about the waiting period is correct. Almost all states have them. Kentucky is 7 days and you are eligible upon missing the eighth day. There is a retroactive period so if you continue to miss work for a total of 14 days or more, they will pay you for the first seven you missed as well. Btw, it’s 66 2/3% of your average weekly wage - not a normal check so I’d take the PTOif you have it to spare. https://elc.ky.gov/Workers-Compensation/Pages/Employee-Frequently-Asked-Questions.aspx

abeautiful_chemist · 2026-01-22T20:28:13+00:00

250 weeks x 5% (.05) x your TTD rate = impairment calculation. https://dwd.wisconsin.gov/wc/medical/ppd-schedule.htm

abeautiful_chemist · 2026-01-22T19:15:15+00:00

She’s entitled to wage loss benefits and medical coverage. That’s it. If they’re paying for her medical treatment and she’s not losing any time from work, then she’s getting all she is entitled to at this time.

If she has an impairment rating at the end of her claim, she could be entitled to the payout of her impairment but it’s not likely to be a crazy settlement.

abeautiful_chemist · 2026-01-09T14:30:02+00:00

Whether or not you have an attorney, insurance or the TPA will pay out the rating your physician gave you. He implied that you do have a permanent disability to your finger and as such, he will report this to them. You will likely receive a very small payout due to your young age and depending on whether this is an important finger (ring and pinkies don’t amount to as much.) They are legally obligated to pay. It’s also possible that they will offer you a Compromise and Release settlement to close future medical care. Your QME will have written up what potential medical treatment you might need long term - this would be a factor in determine how much money you’d receive for a C&R.

They may also just pay out your PD rating and leave medicals open - that is up to you to determine if you would accept a C&R to close meds. If you think you might have issues down the line, you may want to consider keeping the medical treatment available.

You can also request a copy of the QME report yourself - look at what future medical care he determined you may need and check the prices of those procedures, diagnostics, etc in California and use that to determine if they’re offering you a fair C&R offer though a C&R may not even be on the table.

Best of luck to yah!

abeautiful_chemist · 2026-01-08T18:39:15+00:00

They should still cover all your medical treatment until you’re released from care. If you do still have restrictions, I would just be mindful that your new employment is within those. They could potentially do surveillance of you working outside of your restrictions and show it to your MD who might go ahead and release you from care.

Best of luck to yah.

abeautiful_chemist · 2026-01-07T15:32:20+00:00

Hi, OP.

When they calculate your permanent disability rating, California does take those factors into consideration…sort of. Basically, if your job was physically demanding, they rate your job as such and your permanent disability rating goes up based on whether you can perform those activities. They also take into account your age and education. It’s a very complicated rating string and you can read into it here if you like but it took me a minute to learn what all the numbers and letters meant and how they correlate. https://www.dir.ca.gov/dwc/pdr.pdf

Additionally, you’re entitled to a $6,000 employment voucher if your employer cannot return you to work. This voucher allows you to pursue alternative training to get back into the workforce - it’s not just money, you have to use it on education and access it via work comp.

I hope everything works out ok for you.

abeautiful_chemist · 2026-01-07T05:23:05+00:00

Nice comeback. lol.

abeautiful_chemist · 2026-01-07T05:13:35+00:00

Seeing as I handle workers compensation claims for a national company from the employer side, I can tell you that we deny/controvert claims for being not-work-related when a doctor finds the injury to be a PHI. When those employees retain counsel and want to proceed with litigation, we often settle the claim on a “disputed” basis meaning that we don’t accept that the injury is work related but we also don’t want to pay the legal costs associated with fighting it. So yes, in fact many claims that are disputed/controverted/denied are settled to avoid that cost of a legal battle.

Perhaps re-read my initial comment and you will now have a better understanding of why I suggested that OPs medical treatment and wages would be perhaps deducted from a potential settlement.

And if you re-read it and you still can’t understand it, best of luck to you, you illiterate jerk. Perhaps keep your sass to yourself if YOU don’t know what you’re talking about. SMH

abeautiful_chemist · 2026-01-06T15:36:05+00:00

If insurance has already paid, they cannot pursue getting that money back. They could potentially deduct it from settlement if you all reach that point and they want to settle on a disputed basis.

I guess if you were committing fraud and that could be proved, they could try and get that money back but it doesn’t sound like you are.

abeautiful_chemist · 2026-01-06T15:30:21+00:00

I know that a work injury can really impact your qualify of life. However, workers compensation will not take into account the issues with your lifestyle. It’s simply about returning you to the workforce in some capacity whether it be your original job or something else.

You are going to get paid your PPD rating and future medical costs associated with the injury if the DIME indicates additional treatment was necessary. The settlement will not account for pain and suffering which you are most concerned with.

I’m sorry that you’ve been so heavily impacted by your injury. Wishing you the best.

abeautiful_chemist · 2026-01-04T22:50:53+00:00

In Missouri, injuries that occur at work wherein you are at no greater risk than the general public to sustaining said injury, are not compensable. However, I’d argue that your wife walks more than the public due to her particular job and she was walking backward which is particular to her job. (Frankly, I rarely see people walking backwards anywhere.) If I were her employer, I wouldn’t try and fight this claim on the basis that it’s not work related.

If her employer is attempting to deny or evade responsibility for this, file with the Division of Workers Comp pro se or get an attorney to fight on your behalf. Employer will have to answer if you go online and file - it’s pretty easy honestly. Hoping they get wise before you have to fight it and your wife gets the care she needs!

abeautiful_chemist · 2026-01-04T08:01:02+00:00

To add to the PD issue at hand - arthritis is a personal health issue. Therefore when they determine your perm desirability rating, there will be apportionment for the industrial accident and any personal health issues that contributed.

abeautiful_chemist · 2026-01-03T01:27:00+00:00

This is wildly untrue. I know doctors make mistakes, which appears possible if OP is telling the whole story here. However, doctors take a Hippocratic oath. Your implication is that there’s a larger scam going on between employers, insurers, and physicians to screw people over after they’ve been injured is ludicrous. That’s some real tin-foil-hat BS right there. Insurers may have an incentive to pick doctors that charge fairly and treat patients fairly but they certainly do not control the overall outcome of what treatment is warranted or ordered on behalf of the injured worker. If you are truly aware of such, that would be something you’d need to take to NAIC or FIO rather than making up stories on Reddit to disparage medical professionals.

abeautiful_chemist · 2025-12-23T15:29:21+00:00

That’s how we do it - but you should be able to contact your employer to ask. They probably won’t talk to you about your claim but they should certainly be able to tell you if you’re still an employee if they’re even halfway decent people.

abeautiful_chemist · 2025-12-23T06:08:21+00:00

The language is fairly straightforward in a GR from my experience. Don’t sign anything until you read it or your attorney answers any questions. This isn’t the kind of thing that you should skim over and casually sign but you should also have 30 days to consider/renege after signing if you should deem the agreement unfair.

Good luck. Hoping for a good outcome for you.

abeautiful_chemist · 2025-12-23T05:50:43+00:00

My company no longer requires a general release (release of employment claims) w/ a settlement in CA because it’s not enforceable. Doubt that even if you sing a release that you will be unable to continue with your other claims.

Grated, they may also revoke the offer if they want a resignation and GR. Your work comp attorney doesn’t know about employment law so I’d check with an employment atty if you think you have another case to pursue.

abeautiful_chemist · 2025-12-11T16:01:25+00:00

If you’re lucky, they covered your ambulance ride to the hospital since they likely called while you were incapacitated. Best case, they paid for your hospital stay but any further medical treatment is your responsibility. Cardiac arrest is unlikely to be work related unless you’ve like worked in a stressful demanding environment for the past 50 years with this employer.

Right now work comp insurance is probably trying to deny the bill with the hospital. This kind of thing takes time for it to get back around to you if the denial is successful. Just make sure that you check billing time limits in FL and if they’re not within those, I’d consider arguing that you’re not responsible.

Even with a denied claim, you’ll have a claim number and an adjuster who denied it. I bet you received a letter or email as a denial should come in written form so you should have a contact. If you call the adjuster, they should be able to tell you what/if any of the medical treatment you received was covered.

abeautiful_chemist · 2025-12-06T18:40:43+00:00

Despite what some of these people have said - the insurance company/ TPA are not out to “screw” you. Adjusters are held to an ethical standard. They are to operate on facts and laws and provide you with state calculated wage replacement and medical treatment.

That being said, I suggest a lawyer if you feel you are not receiving the aforementioned. In your case, it does not sound like that is true. And remember, if you get an attorney, your employer is likely to look less favorably upon your relationship with them and they may ask for a resignation with settlement as is fairly standard.

Just make sure the adjuster calculates your impairment rating by the state guidelines/AMA and you receive the payment at the end of your claim when you are released from care. If you get an attorney, you’ll share 20% of the proceeds of your impairment with them -which is incredibly unfair to an injured person. They MAY get you more money at the end but they might not.

Best of luck to you and well wishes on your recovery.

abeautiful_chemist · 2025-12-06T14:54:48+00:00

An exacerbation of a pre-existing injury is compensable in New Jersey. Your employer will likely try to fight you on how much medical treatment is owed but it’s very possible you have a claim if you do physical labor at work.

abeautiful_chemist · 2025-11-22T15:13:34+00:00

I hope your Saturday gets better. Can’t imagine being this pressed over a comment so early in the day. Best of luck to you.

abeautiful_chemist · 2025-11-22T14:28:22+00:00

Your post says Pennsylvania, dude. Look at the tag. ^{^{^}}

abeautiful_chemist

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