Wednesday, September 30, 2015

How do I settle my Redding Work Comp Claim?

Have you received a settlement offer in your Redding Workers' Compensation Claim? Are you wanting to settle your claim? Or maybe, you just want to know your options with regard to your claim. The following are a guideline, but the best option is to contact a Work Comp Lawyer for assistance in settling your claim.

There are three options in terms of how a workers’ compensation case can be resolved in California. They are as follows:

1. Trial

In a workers’ compensation trial, it is necessary for you to testify as to the injuries you have sustained, as well as the nature and extent to your disability and medical treatment. Thereafter, the judge would issue a Findings and Award indicating the nature and extent of you disability, with a permanent disability award and in all likelihood, an award of lifetime medical treatment, for the  body parts the judge finds you have sustained injuries to while on the job. Then, that Findings and Award will be paid out bi-weekly until the gross amount of the permanent disability has been exhausted. You would thereafter have an award of lifetime medical treatment with no premium and no deductible, pertaining to the body parts injured. There is no lump-sum settlement when the matter proceeds to trial.

While you do have an award of lifetime future medical, this falls under the current laws regarding medical treatment. Thus, the carrier is likely to submit to utilization review  based on their denials to independent medical review.  (See our prior article addressing Medical determinations) This is not carte blanche medical treatment it is only for the body parts which were found industrial. There is no guarantee that five years into the future or ten years into the future the carrier will continue to pay for the medical treatment to that body part. While the award is given there is no guarantee to uphold the award;



2. Stipulations and Request for Award

This type of resolution is very similar to the trial; except you do not have to testify. In this manner, the defendants agree to the permanent disability be found by the judge, as well as lifetime medical treatment, and the parties prepare a Stipulation and forward it to the court for approval. When the court approves the Stipulation, the effect of the approval results in a Stipulation and Award, then the permanent disability and medical treatment are the same as is outlined above and discussed in the Trial section. In addition, you will have five years from the date of injury to reopen your claim in a Stipulation or Trial should your condition or injury get worse;

3. Compromise and Release

This type of settlement is a lump-sum settlement. A lump-sum settlement results as a result of determining the value of your permanent disability, after apportionment, and the value of your lifetime medical treatment. There is also consideration for additional compensation to close the matter by way of Compromise and Release.

There is an advantage to this because rather than waiting on a carrier to possibly approve medical treatment in the future, you can direct your own medical treatment. Thus, becoming the master of your own destiny.

In giving consideration to the type of settlement, you will need to be concerned with the following:

• In order for the defense to consider settlement by way of a Compromise and Release you will likely have to execute a letter of resignation; and be aware not all cases are approved to be settled by way of Compromise and Release it is done on a case by case basis.  There is no way for us to force the defendant to settle by way of Compromise and Release.

• Medicare Set Aside: if you are going to seek medical treatment through Medicare or Medicaid in the near future, a certain portion of each settlement has to be set aside and exhausted before Medicare will take over treatment for any industrial injury. If you are going to be applying for Medicaid or Medicare within the next 36 months please advise our office so that we can get the proper documentation to find out about a Medicare Set Aside. (It  appears  the Affordable Care Act, a.k.a. ObamaCare,  may allow for all  pre-existing conditions as of January 1, 2014)

Should you wish to resolve your California Workers' Compensation claim through one of these methods, we would be happy to discuss additional details regarding your claim.  Should you have additional questions about how to settle your Workers Compensation claim, please contact one our offices for a FREE consultation! 

Tuesday, May 12, 2015

Medical Travel and Out-Of-Pocket Reimbursement in California Workers' Compensation Claims




As part of a California Workers Compensation claim, you are entitled to reimbursement for travel mileage for medical appointments, prescriptions, and depositions.  

To be paid, you need to keep records of how many miles you traveled for these trips.  

You can obtain mileage information on MapQuest by searching your point of departure and the location you traveled to.  You may want to attach a MapQuest printout to your mileage form when you submit it to the claims adjuster.


In addition to mileage, you also may receive reasonable expenses of transportation, meals and lodging when traveling to medical appointments under LC 4600(e)(1) and (e)(2).


If you travel to a doctor’s office that is located a significant distance from your home, you also may receive reimbursement for meals.  These meals must be reasonable.  A reasonable value is essentially what the Judge receives for their per diem on travel, which is $7.00 for breakfast, $11.00 for lunch and $23.00 for dinner.  You will need to keep your receipts.

If a doctor indicates you cannot travel the required distance to your appointment and need a driver, you may get meals reimbursed for your driver.  You will need to have a clearly written document from the doctor indicating a driver is needed and the reason a driver is needed.  Otherwise, only your meals will be reimbursed.  


In some instances overnight lodging may be merited.  This usually occurs if the doctor’s office is some distance from your home and the appointment is scheduled early in the morning or late in the afternoon. The reimbursement for lodging varies depending upon location but usually runs between $83 to $128 per night.

It is your responsibility to fill out the request for reimbursement on the forms for the mileage you travel.  Please make sure to use the correct form for the year in which travel occurred.  The reimbursement rate will vary depending upon the year.

The mileage rates for 2008 to 2015 are also available at the above address and are as follows:


Date __________ ¢ Per Mile
On or after 1/1/2015 $.575
On or after 1/1/2014 $.56
On or after 1/1/2013 $.565
On or after 7/1/2011 $.555
1/1/2011 - 7/1/2011 $.51


When you send in the completed signed and dated reimbursement form, be sure to retain a copy for your records. If you have not received your reimbursement after the passage of 45 days you should contact your attorney. If you have not received reimbursement and need to speak to a Work Comp Attorney, please contact us for a FREE consultation. 


Often an issue arises with regard to the date the document was sent to the carrier.  Sometimes they lose it in their system and deny receipt of the same.  This can be avoided by sending the completed, signed and dated form to them with all pertinent receipts attached, by certified mail, return receipt requested.  


Other common issues which arise are failing to put the correct claim number(s) on the top of the mileage expense form, failing to sign and date the form, or failing to total the reimbursement requested.  Any inaccuracies or failure to provide information may result in delays in processing and receiving payment.


If you have more than one date of injury, please note the correct claim number must be used for the date of injury the services are being provided for.  Failure to do so may result in a denial in your mileage reimbursement request.


If you have out of pocket expenses, e.g. payment of prescriptions, bridge tolls or parking, you need to reference the same on the reimbursement form.  You also need to attach the receipts.

For your convenience our website offers the mileage reimbursement form. Should you have additional questions about mileage reimbursement, or about your work comp claim please contact one of our attorney offices in Redding, Susanville, Eureka, and Crescent City.

Thursday, April 9, 2015

Redding Workers Compensation Claim: The Process


Often, many struggle to understand the complex nature that is a California Worker's Compensation claim. Part of the struggle is the many paths and avenues a claim may take before its ultimate conclusion.

After filing an application for adjudication the California Worker's Compensation appeals board, a claim can be accepted, denied, or delayed. Each one of these has their own distinct path to conclusion.

Beginning with delayed claims, a workers compensation insurance carrier has 90 days from the date of notice to make a determination as to whether to accept or deny a claim. This 90 day waiting period is often known as delay. During delay, carrier is liable for the first $10,000 of medical expenses. Thus during this time the carrier will only pay for medical expenses and treatment. Should your treatment exceed the $10,000 during delay carrier has no obligation to pay. At the end of the 90 days the carrier can either accept or deny the claim. During the delay you will not receive any temporary disability benefits. To receive income during this period of delay you will need to apply for state disability income or SDI through the EDD, a department of state of California.

When a claim has been accepted you we entitled to the four main benefits of a work comp claim. Immediately, you will begin receiving medical treatment to cure or relieve symptoms of your injury. Should you be unable to work during this time, the doctor has taken off work, you’d be entitled to receive temporary disability. Eventually, after receiving medical treatment your primary treating physician will find you have reached maximum medical improvement (MMI). At this time, it’s appropriate for you to be seen by med legal evaluation.  Once you’ve been found MMI, you’d also be entitled to permanent disability benefits. Should you be unable to return to work, you may be entitled to a work retraining voucher.

The most complex of these is the denied claim. A claim can be denied for various reasons. Once a claim is been denied, you will receive no benefits until such time as the claim has become accepted. After your claim has been denied, if you haven’t already, you should immediately contact a workers compensation attorney. Once claim has been denied, the only recourse is to have a med legal evaluation from either a QME or an AME. No, there is no other way. Once evaluations happen, there’s a possibility the claim could in fact be moved to an accepted claim. This is why it’s so key to have an attorney involved. They will explain to you the intricacies of moving your claim to accept claim. Once your claim has been deemed accepted, you would be entitled to the benefits above.

The thing to remember in a workers’ compensation claim is each claim must follow its own process. This process may be slower or faster depending on your claim. Generally, represented individuals claims progress at a faster pace. A faster pace, does not mean fast. Workers compensation is a system mired in bureaucracy, and often times the pace is quite gruelingly slow. Worker’s Compensation law center offers competent attorneys help you better understand the process and to help speed up the pace for your claim. We have offices in Redding, Eureka, Susanville, and Crescent city to better serve you. Contact us for a free consultation.

Friday, February 6, 2015



A client calls our office stating his work comp doctor has request medical treatment and he hasn't heard from the insurance company. "Why hasn't it been approved," he asks, "It has been several weeks and I have heard nothing."

In order for medical treatment to be approved in California Workers' Compensation, the treating doctor must submit the request for the treatment on the proper form. Specifically, the doctor must fill out a DWC FORM RFA, also known as a "Request For Authorization." Without this form, it is as if the doctor never even requested the treatment. The carrier is under no obligation to authorize the treatment.

In order for the insurance carrier to even consider requested treatment, the medical doctor must submit a request for authorization. Once the insurance carrier has received proper request for authorization on the proper form, they then have between five and 14 days to either authorize or deny the treatment. If they failed to authorize or deny the treatment within the 14 days the treatment is deemed authorized.

In order to better help your attorney, have your treating physician sent a copy of the request for authorization not only to the insurance company but also a second copy to your attorney. This allows your attorney to track the time frame and file for
an expedited hearing should the medical treatment not be authorize a timely fashion.

Should the treatment be authorized, a letter will be sent but both your doctor and yourself know the treatment has been authorized. At this point you can move forward with the treatment.

Should the treatment be denied, a separate letter is also sent outlining the reasons for making a adverse decision. You have 30 days following the denial to appeal the decision of the carrier. Appeals are conducted by the independent medical review also known as IMR.

IMR can make a decision whether to uphold the carrier's denial or to overturn the denial. Should they overturn the denial, the medical treatment will be deemed authorized. However, should IMR uphold the denial of the insurance carrier the treatment is deemed denied for one year or until the applicant's medical condition has had a change of circumstance.

Should you be having any difficulty with getting medical treatment approved, please feel free to contact one of Worker's Compensation law centers offices were one of our attorneys will be more than happy to assist you. We offer a free consultation which we can discuss issues such as medical treatment.

Thursday, October 2, 2014

Case Update from City of Sacramento v. WCAB(Cannon)

City of Sacramento v. WCAB(Cannon)(Court of appeal unpublished) ADJ7238353 

Applicant police officer sustained an admitted injury to his left foot that resulted in plantar
fasciitis. The AME found 0% WPI because the AMA guides did not provide a schedule to
moderate plantar fasciitis. In a supplemental report the AME using an alternative rating found a
7% WPI by analogy to gate arrangement in the guides.

The WCJ found no PD based on the initial AME report.

Applicant filed a petition for reconsideration. The WCAB granted reconsideration and indicated
that WPI should have been 7% rather than 0%. The Board returned the matter to the trial level
for a new decision consistent with the AME’s revised opinion.

The defendants in this case argued that an alternative rating under the guides could only be
applied to the situation in which the case is complex or extraordinary. They argued in this case
the plantar fasciitis was neither complex nor extraordinary.

The WCAB rejected this argument. The WCAB indicated that the language of Guzman indicates
that a physician has the ability to rate an impairment by analogy, within the four corners of the
guides, where a strict application of the guides does not accurately reflect the impairment being
assessed. The WCAB indicated they rejected the argument that the case must be complex or
extraordinary.

The WCAB ruled in this case that the test is whether the 7% WPI more accurately reflected
applicant’s impairment and thus the medical report is substantial evidence.

As to the second issue in this case when a rating is unscheduled in the guides the WCAB
indicated the guides were not all-inclusive. For impairments that were not listed the evaluating
physician was then mandated to use his clinical judgment and expertise to determine a WPI
utilizing the four corners of the guides. When the rating is available the physician must rate by
analogy. The WCAB found the AME’s opinion to be substantial evidence and remanded the
decision to the trial court for a decision consistent with the board’s opinion.

The board concluded in this case that if an impairment is not listed in the guides the physician
can use an alternative rating based on analogy within the four corners of the guides.

In rebutting the rating the physician must show that an alternative rating more accurately reflects
applicant’s disability and the alternative rating must within the four corners of the guides. If the
medical report adequately explains the basis for the rating and how and why the rating more
accurately reflects applicant’s disability the report will be found to be substantial evidence
rebutting the guides.

Defendants filed a petition for writ of review which was granted by the appellate court and an
unpublished opinion was issued upholding the board’s decision.

Wednesday, August 20, 2014

REDDING LAW OFFICES name is changing to WORKERS' COMPENSATION LAW CENTER

As of August 1, 2014, all your Northern California needs will can be taken care of by the newly formed Workers' Compensation Law Center. With Offices in Redding, Crescent City, Eureka, and Susanville.

Workers' Compensation Law Center Logo- Representing injured workers in Del Norte, Glenn, Humboldt, Lassen, Modoc, Plumas, Shasta, Siskiyou, Tehama and Trinity Counties.

   All our offices offer a FREE consultation. Workers' Compensation Law Center has offices which can assist clients throughout Northern California, including; Del Norte, Glenn, Humboldt, Lassen, Modoc, Plumas, Shasta, Siskiyou, Tehama and Trinity Counties. So no matter where you are at in Northern California we have an office near you.  


   Whether you have a concern or issues regarding your temporary disability, permanent disability, medical treatment, or rehabilitation, Work Comp Law Center will be here to help. Our dedication to clients and professional knowledge will be of great benefit to both you and your loved ones.

   We encourage you to contact Workers' Compensation Law Center today to discuss the circumstances of your case. Again, the initial consultation is FREE. We look forward to working on your behalf.

   For additional information, you can visit www.reddinglawoffices.com or coming soon www.workcomplc.com for more information of work comp claims.

Friday, February 28, 2014

Redding Work Comp Attorney- What is a panel/ list of 3 doctors??

At some point in your claim, the insurance company is going to request/ require you to get a QME. (For more on QME appointments.What information do I provide to the QME.) Once you fill out the request for a QME panel form, titled State of California DIVISION OF WORKERS' COMPENSATION - MEDICAL UNIT REQUEST FOR QME PANEL UNDER LABOR CODE § 4062.1UNREPRESENTED, you will receive a list from the Director of the Medical Unit with 3 doctors listed on it. The doctor you, or your attorney select will become the med-legal evaluator for your claim.

FILLING OUT THE PANEL REQUEST

When filling out the panel request make sure you select a specialty. While it seems obvious to just select the specialty you were injured for, this may not always be the best case. For example, orthopedic specialties are often the most conservative specialty, meaning they favor the insurance company. It may be better to request a chiropractic or pain medicine specialty instead. This will depend on if you are looking for a more natural medicine approach or looking to use a more modern medicine approach. If you have questions about which specialty to choose, please contact a local Redding Workers' Compensation Attorney.

ONCE YOU RECEIVE THE PANEL

The panel will include 3 doctors. You have 10 days to choose the doctor you wish from the panel. If you do not choose within 3 days, the insurance company will. Insurance companies will choose the one most favorable to them. If you have questions about which doctor to use, feel free to contact my office, or another Redding Work Comp lawyer and ask who they would recommend. I am happy to help you choose the doctor most favorable.

Please see our other articles on what to say to the QME during your visit.Should you have questions or concerns about choosing the right doctor, what you should do before or after the QME, or are upset with the reporting of the QME, please contact my office to set up your free consultation. (We cover Shasta, Lassen, Trinity, Siskiyou, Humboldt, Tehama, Butte, & Del Norte Counties.)

Call for your FREE consult today. 530.222.9700