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Our Workers' Compensation Q & A

 
Arm Injury — Worker's Compensation Lawyers in San Bernardino, CA
 
Back Pain — Worker's Compensation Lawyers in San Bernardino, CA
 
Q. I just got hurt, how do I get medical care?
When an injury occurs, you must fill out a claim form and demand medical care immediately. Your claims administrator is required by law to authorize medical treatment within one working day. While your claim is being investigated, you are entitled to receive up to $10,000 of medical care.

Unfortunately, many insurance companies deny authorization for medical care while a claim is being investigated, and many doctors will not treat you without authorization because of the recent changes in the law. This results in significant delays in medical treatment. We can get your case in front of a judge to get the care you need.

Trust in over 24 years of experience when you come to our law office. We provide personalized services to ensure your needs are met. You can also get a FREE case evaluation, and you don't have to pay anything unless you win.
Q. Can I predesignate a personal doctor to treat my industrial injury?
Yes, you may, and it is a good idea to do so. You can predesignate your personal doctor if your employer offers group health coverage; the doctor has treated you in the past; the doctor has your medical records; and the doctor agrees to treat you for work injuries. The predesignation form is available through your employer or at the DWC website.
Q. Is the medical care recommended by my doctor limited?
Insurance companies are now armed with the Occupational and Environmental Medicine's (ACOEM) Practice Guidelines and Utilization Review (UR). The process, in theory, should enable a doctor to treat most injuries according to accepted practices in a cost effective way. In practice, however, this medical delivery system is unchecked and permits great abuse by denying needed medical care.

The process to overcome these denials varies in different situations. We appeal Utilization Review to get the medical care that you are entitled to have.
Q. My claims adjuster will only authorize treatment for some parts of the body and not others. How do I get medical treatment?
All too often, the claims adjuster will notify your treating physician that he/she may only treat certain parts of the body. Depending on the doctor, this may cause him/her to refuse treatment for all affected parts of your body. This is a part of the medical delivery system that is left unchecked and subject to great abuse. We get the medical evidence you need and prepare for trial.
Q. What are the temporary disability benefits?
Temporary Disability (TD) is paid biweekly when you are completely unable to work due to a work injury. This is also known as Temporary Total Disability (TTD). Subject to minimum and maximum caps, you should receive 2/3 of your average weekly wage while you are unable to work. Your doctor will determine your need for TD.
Be aware that the recent changes in the law have limited the amount of time that you can receive TD for injuries after 4/19/04. Currently, you are limited to 104 weeks of TD. There are a few exceptions to this rule.
Q. My claims adjuster denied my claim. Can I receive TD?
You may not collect TD for a denied claim. You can, however, claim State Disability. Your doctor will need to certify you for this. We work to get a judicial decision that requires your insurance company to accept your claim.
Q. Who determines my permanent disability?
Once your doctor finds your condition has reached Maximal Medical Improvement (MMI), either your treating physician or another doctor will determine whether you have any impairment. Your compensation is dependent on the level of permanent disability you are assigned.
Q. What if I don't agree with the PD assigned?
You may be able to present additional facts that the doctor may not have considered. You may also be entitled to further medical evaluations.
Q. How does my claim finally get resolved?
You can resolve your whole claim through one lump sum settlement called a Compromise and Release (C&R). A C&R is best when you want to control your own medical care. The insurance company will not be responsible for any further medical care with this type of settlement. In return, you receive a lump sum amount representing unpaid benefits that you may have been entitled to.

If you want to forgo your medical care available, you can agree to a settlement called a stipulation with request for award (stip). A stip allows your insurance company to continue the biweekly payments until your PD is paid out and leaves your future medical care open to you.

Your future medical care will remain subject to ACOEM guidelines and Utilization Review. In practice, this means that your insurance company will be able to deny and delay medical treatment whenever it chooses to do so. You will need to have a judge to enforce your award in order to get medical care.

If all else fails, you can have a Workers' Compensation Judge decide your case. The judge issues a Findings and Award (F&A). The F&A is similar to a stip. The only difference is that the judge decides all issues in your case instead of the parties coming to an agreement.
Q. Are benefits available for a work-related injury causing death?
Death benefits vary depending on the date of injury/death, types of dependents, and ages. Other issues of causation may be present.