a. Due to busy schedule of depositions, court appearances, and meetings, I will not always be available to personally speak when you call the office. Please explain your question to the staff member who answers your call and they will transfer you to the Legal Assistant who can best answer your question. Or, if they do not have the answer at that time, they will contact me and we will get you a response very soon (within 24- 48 hours usually).
b. Please always call the office first before stopping by to ask a question or drop off documents. This will ensure one of the staff will be available to assist you when you arrive.
DEPOSITIONS
a. In most cases, your deposition will be scheduled by the defense to ask you about history of medical treatment, prior employment, prior injuries, and how this injury occurred. This is normal. Although the notice may ask you to bring many documents, just bring yourself and a photo ID and arrive at the time instructed for preparation prior to the starting of the deposition. We will fully prepare you before the deposition starts regarding any issues specific to your case.
SOCIAL MEDIA
a. DO NOT discuss your workers’ compensation case or details of your injury on social media such as Facebook, Twitter, Instagram, etc. In some cases, the insurance company will hire investigators who search your social media accounts looking for posts that contradict what you are reporting regarding your injury.
b. ADVICE: Increase all privacy settings on your social media accounts and do not “Friend” anyone whom you have not met in person and consider to be a close friend. Delete all people who you do not know personally asap, because sometimes investigators will use a false identity to befriend you on these accounts.
TALKING TO INVESTIGATORS & VIDEO SURVEILLANCE
a. Do not give statements to investigators who are working for the insurance company. Tell them “speak to my attorney.”
b. It is possible that the insurance company will hire an investigator to take video footage of you (usually doing things like shopping at supermarket or running errands) for a couple days. It is a very rude practice, yet it is legal as long as you are in a public place. If you notice any suspicious activity and think someone may be following you, of course report it to the police.
c. The key point here is just to be honest when asked by a doctor or in a deposition what you do in your daily activities. Just emphasize that due to the work injury you cannot do things the same as before and you have increased pain. The only time these videos cause a problem is if someone is filmed doing something they have said they cannot do.
HOW LONG DO WORKERS’ COMPENSATION CASES TAKE TO FINISH?
a. The average time from date of injury to when the case is settled or adjudicated by the court is 1 ½ to 2 years. The reason for the long process is medical treatment takes time, the QME/AME process takes a long time, and this system is unfortunately full of many kinds of delay. Rest assured we will aggressively move your case forward as fast as possible.
TEMPORARY AND PERMANENT DISABILITY PAYMENTS
a. LATE CHECK: If you are receiving workers’ compensation payments every two weeks, whether temporary disability(TD) or permanent disability (PD) and your check does not arrive on the day it usually arrives, wait another day or two before calling our office. Sometimes checks are a day or two late. If more than two days goes by and your regular check does not arrive, then call our office and we will find out why.
b. NOTE: TD is supposed to be paid at 2/3 the rate of pay you were receiving prior to your injury up until you are determined to be “Permanent and Stationary (aka Maximum Medical Improvement).” Once you are found P&S/ MMI, you should receive PD advances (usually at $290/ week if your injury is after 1/1/14), unless you have been returned to work in which case your PD amount is paid to you upon settlement of the case.
EDD STATE DISABILITY BENEFITS & SOCIAL SECURITY DISABILITY
a. In many cases, if workers’ compensation is not paying you at all, or if workers’ compensation is only paying you $290/ week, you should also apply for EDD State Disability benefits. You must follow EDD’s requirements for applying.
b. AT THE END of your case, we will contact EDD to make sure they are re-paid any amounts they paid you during a time that it is determined later that workers’ compensation owed you.
c. If you have exhausted EDD State Disability payments, and you will likely not be returning to work soon, you can also apply for Social Security Disability benefits.
RECEIVING LETTERS
a. If you receive a letter in the mail regarding your case from someone besides my office (for example from the insurance company or their attorney), check to see if it has been cc’d to me or my office.
b. If my office has been cc’d, please note that we review our mail every day and if some action is needed we will contact you.
c. If my office has not been cc’d, fax or email a copy of the letter to our office and we will review to see if action is needed and contact you if necessary.
RETURNING TO WORK & MISSED TIME FROM WORK
a. A very common question is “when should I return to work?”
b. Answer: My advice is if you are physically and mentally able to work it is better to work than not work. However, if pushing yourself to return to work when you are not ready would risk you re-injuring yourself, then that is probably not smart. This decision is really up to you and your doctor. Your doctor will need to give you detailed work restrictions, which you then give to your employer. If they can accommodate those restrictions, you can return to work. If they cannot, you may be entitled to workers’ comp and/or EDD State Disability payments due to your inability to work.
c. Another common question is “if I return to work or if I get a new job will that effect” the case? Same answer as above: Always good to be working if you can. Even if you take a new job, your work comp case will continue so if you get a good new job opportunity and you can realistically perform the work, take it.
d. Keep a record of the periods of time you have missed from work due to your injury.
MEDICAL TREATMENT
a. If your claim is denied, while we fight for it to get accepted, you will seek medical treatment through your private insurance for all your health care needs. Tell the health care provider about all your health problems, but make it clear you do not have any work comp benefits at this time and work comp is denying your case, therefore you are not there for a “work comp reason.”
b. If your claim is denied, keep records of any co-pays or out of pocket costs you incur for your medical treatment (keep receipts in a folder and give to us once the claim gets accepted). ADVICE: Do not pay for any medical care out of your pocket and always make sure some insurance company pays for your health care. The most you should ever have to pay for is a co-pay.
c. IF YOU DO NOT HAVE PRIVATE HEALTH CARE: Contact your local Covered California Office ASAP and make an IN-PERSON appointment to get coverage (if you have no income you may qualify for Medi-Cal). Always make sure to have personal health coverage of some kind (other than workers’ compensation coverage), as this is required by law and is to your benefit.
d. If your claim is accepted, your Primary Treating Physician (PTP) is the “captain of the ship” for your medical treatment plan. Any questions about your treatment needs should be directed to the PTP office. If some body parts are denied in your case, see above for how to get treatment for those, and get treatment for the accepted ones with the PTP. For any denied treatment, our office will appeal denials automatically 100% of the time and you should also ask the PTP office to confirm they appeal it “doctor to doctor” directly to the Utilization Review company who denied the treatment. If treatment is denied by UR, and the appeals are not successful, see above for how to get treatment through your private health care.
e. STEPS IN OBTAINING TREATMENT: These steps must be followed to obtain treatment in the workers’ comp system (created by California’s State Legislature):
i. PTP must submit Request for Authorization (RFA) on a specific form and submit to the insurance company’s Utilization Review (UR) department for ANY TREATMENT they want to obtain for you.
ii. UR will review the RFA and accept (aka certify) or deny (non certify) the treatment.
iii. If denied: My office will fax a request for appeal to Independent Medical Review (State agency that reviews these) AND your PTP should submit a “doctor-to-doctor” appeal directly to the UR department which denied the treatment.
iv. If IMR upholds the denial (can take 30 days or more for them to even review), and the PTP cannot get the denial overturned by directly contacting UR, then the treatment will stay denied. In that event, get the treatment through your private health care and say “this is not covered by work comp because work comp denying that what I need is part of the work comp system.”
f. Whether claim is accepted or denied, DO regularly go to your doctor visits, because the reports will help to document your injuries and the progression of your treatment, work restrictions, and symptoms.
g. Whether claim is accepted or denied, DO NOT discuss legal issues or issues about the workers’ compensation system with your doctor. Please limit your discussion with the doctor to the medical issues such as describing your symptoms and discussing the medical plan to help you improve your medical condition. Doctors are not trained in legal matters so should not be offering legal advice.
MEDICAL BILLS SENT TO YOU
a. If you receive medical bills for treatment that was for your accepted workers’ compensation injury, fax or mail those bills to the claims examiner and keep a copy for your records. If you continue to receive invoices from that provider, contact my office and we will assist.
QMEs & AMEs: (Qualified Medical Examiners & Agreed Medical Examiners)
a. The QME or AME evaluations are the most important part of your case to determine the value of benefits you will receive. Please make sure to arrive early for these appointments.
b. Bring your copy of the letter sent by my office to the QME/ AME and when you arrive confirm with the doctor’s office that they received my letter with any attachments.
c. Make sure to describe to the QME and AME all body parts that you believe have been injured or worsened because of anything you experienced at work (or as a result of an injury that happened at work). For example:
i. If medications you have taken for back pain have caused stomach pain.
ii. If you now have a lot of stress, headaches, or cannot sleep because of pain.
d. Prior to the QME evaluation you will usually receive a questionnaire from the doctor’s office. Just fill out honestly and to the best of your ability and return to QME/ AME office per their instructions. You can fill this out on your own. If you don’t know how to answer a question, just write “will discuss.”
e. QME/ AME reports usually are ready 30-35 days after the evaluation takes place. Our office will contact you upon receipt to discuss the next steps with the case.
f. Do not bring copies of your own records to the QME/ AME appointment. All medical and other records given to a QME must be sent by my office and cc’d to the defense prior to sending the QME/ AME.
g. After your QME/ AME evaluation is over, contact my office ONLY IF something unusual, strange, or inappropriate occurs during the examination. Until we have the doctor’s official report (need to wait 30-35 days for that usually) we do not know what the doctor’s final opinion will be. Comments the doctor makes during the exam do not necessary reflect what they write in their report after they review all your records and complete their opinions
YOUR MEDICAL RECORDS
a. In every case we need to make sure all medical records relating to treatment you have had for your work related injuries and medical records that may contain evidence of past or prior injuries are sent to the QME/ AME to review. If you are ever asked to sign a release for your records to be obtained by one of your doctors, please promptly sign and return to my office.
b. Exception: if your case only involves a back injury (for example) and the defense is trying to obtain psychological treatment records, that would not be relevant and we can refuse to allow that.
c. Also, if you have HIV/ AIDS and do not want that information to be provided, please contact my office to discuss this issue because we can request the court keep those records under seal even if the records are necessary for the case.
MILEAGE & TRAVEL REIMBURSEMENTS
a. For accepted cases: or all authorized workers’ compensation medical treatment for the injuries that are part of your case, please regularly record your mileage on the required mileage sheets. You can fax or US Mail to the claims examiner yourself (keeping a copy for your records). If you are not reimbursed within 30 days, send a second time. If after the second time sent and you still have not been paid, contact my office for assistance.
b. For denied cases: Until the claim is accepted the insurance company will not reimburse your travel expenses; However, still keep track of when you have seen your private doctors and once the claim is accepted we can try our best to get you reimbursed at that time. The more records you have the better chance we have.
c. DO NOT wait until the end of the case to get caught up on several months of travel reimbursement because it then becomes a more complicated project.
d. MILEAGE is paid from your residence to the medical provider’s office, you also are entitled to reimbursement for BRIDGE TOLLS & PARKING.
e. You are reimbursed for depositions and QME/ AME exams travel, but NOT for travel to and from court appearances.
$6,000 VOUCHER & $5,000 RETURN TO WORK FUND MONEY
a. For injured workers who cannot return to the type of work they used to do when they were injured, you may be entitled to a job retraining voucher of $6,000 and a $5,000 check from California state AT THE END of your case. Please discuss with our office once your case is nearing the end to discuss whether your case meets the requirements for this benefit.
CURRENT CONTACT INFO
a. If your phone number and/or address changes, please notify us immediately so we can update your information with the court and other parties to your case.
CHANGE IN EMPLOYMENT STATUS
a. If your employment ends with the employer whom we have filed the work injury claim against, or you can no longer work due to worsening of your injuries, please contact my office to inform us. If you are considering resigning from your job for any reason, please contact me to discuss first.
WHAT IF A 3RD PARTY CAUSED MY INJURY?
a. Examples would be “a defective product at work injured me,” or “someone attacked me while at work.