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Questions Answered by Nancy J. Wallace
3 Answers | Asked in Workers' Compensation for California on
Q: Is it legal for an insurance company to stop paying benefits without medical validation by challenging their own doctor?

The insurance company sent letter challenging their own doctor's latest diagnosis and asking for QME. They have also stopped the biweekly payments abruptly which they did not even mention in their letter. I complied with the QME procedures which might take months to fully take its course and... Read more »

Nancy J. Wallace
Nancy J. Wallace
answered on Apr 27, 2023

NO! The Labor Code DOES NOT permit the Adjuster to stop TTD payments just because she thinks you aren't totally disabled any longer. SOLUTION: (1) apply for State Disability Insurance -- SDI -- at www.edd.ca.gov immediately, as it takes at least 10 days. EDD will want to see the copy of the... Read more »

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4 Answers | Asked in Workers' Compensation, Employment Law and Employment Discrimination for California on
Q: In June of last year my attorney filed my claim for workers comp, I thought, she has been after the wrong ins. Now what?

She told me this week that they found the right insurance and just now filed a claim, I have been waiting almost a year, there was even a hearing and I was told the other party never showed up. I don't know who they filed the first claim with but it seems to me that the whole process is... Read more »

Nancy J. Wallace
Nancy J. Wallace
answered on Mar 18, 2023

You are free to get a new attorney at ANY time. It sounds like there is no actual attorney at the group you had, just an 'assistant'. If the claim were mailed to the employer, the employer would have forwarded it to their CORRECT Insurer; so it appears the claim wasn't properly... Read more »

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2 Answers | Asked in Workers' Compensation for California on
Q: My present Lawyer on my Worker Comp Case keep Neglecting to write down my Diagnosis of Cervical Myelopathy on all his Re

I have a very Serious and Severe Cervical Disc Problems. My Attorney will not Never Write this Down. Three Neck Disc Herniation. Diagnosed Cervical Myelopathy. Had Failed Neck Surgery. He keep asking Me to Settle with my Company and have Future Medical. This do Not feel Right. What shall I Do?

Nancy J. Wallace
Nancy J. Wallace
answered on Dec 18, 2022

If you're in Charlotte North Carolina, that state has entire different regulations for Workers Comp ratings. You've asked your question about CALIFORNIA Labor Code rules and regulations. In california, it makes NO DIFFERENCE if your lawyer writes 'Myelopathy' or Impingement or... Read more »

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2 Answers | Asked in Employment Law and Workers' Compensation for California on
Q: Qme does not specify restrictions are permanent. Recieved returns to work form from primary care. Employers won't accept

5% herniated disc. No bending no stooping but does not specify how long from qme. 5 months later recieve return to work form from primary doctor. Leave of absence team states my qme results say restrictions are permanent. "Permanent" is not in the language. My qme does not specify... Read more »

Nancy J. Wallace
Nancy J. Wallace
answered on Dec 1, 2022

Is 'this' retaliation for workers comp? If you can PROVE -- not just state, but actually PROVE -- that the only reason you are not being offered a lighter job is in retaliation for requesting workers compensation benefits, then yes, this is a misdemeanor crime and a violation of Labor... Read more »

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1 Answer | Asked in Workers' Compensation for California on
Q: while on workmen's comp our union negotiated a bonus and a 4% retro to July 2021, would I lose any of this or get

deducted while on workmen's comp??,I was just wondering If I will be deducted the bonus or lose any of the current 2/3 that I am being paid at the moment since I am to receive a bonus and back pay

Nancy J. Wallace
Nancy J. Wallace
answered on Nov 22, 2022

Sorry, NO. The Labor Code limits you to 2/3 of your 'Average Weekly Wage' AT THE TIME OF INJURY. But not after wage negotiations. So all the adjuster has to pay is 2/3 of what you earned at the moment of injury. IF you worked and earned wages (not TTD disability payments, just Wages)... Read more »

3 Answers | Asked in Employment Law and Workers' Compensation for California on
Q: I just got out of the hospital due to work related injuries, my boss contacted me the next day to wok .can he do that

He’s not letting me fully recover, and telling me if I don’t show up to work, he will fired me…

Nancy J. Wallace
Nancy J. Wallace
answered on Nov 1, 2022

Do you have a written OFF WORK ORDER? The boss IS entitled to see that. Do you have a Work Status Report indicating you are able to perform modified duty work? The Boss IS entitled to see that. The Boss is entitled to inform you if you remain off work without written Off-Work Orders that he... Read more »

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2 Answers | Asked in Employment Discrimination and Employment Law for California on
Q: Hello I recently got fired from Amazon due to an argument with an ex co worker who initiated an argument!!

Hello I recently got fired from Amazon due to an argument with an ex co worker who initiated everything and has gotten talked to twice about arguing with coworkers and when my first time being in trouble for the first time my 10 months of working there I got terminated after awhile Amazon appealed... Read more »

Nancy J. Wallace
Nancy J. Wallace
answered on Oct 31, 2022

This isn't Workers Comp; just so you're clear, workers comp would apply if a co-worker CUT you. But not when a co-worker argues with you. An employer can fire anybody for almost anything...or nothing at all. If they write they fired you because of your Gender, Your Sexual Orientation,... Read more »

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2 Answers | Asked in Workers' Compensation for California on
Q: I’ve recently passed out at work due safety and health reasons, that my boss put me in, boss refused to give me hr dept

If I can’t get a hold of hr dept who can I talk to

Nancy J. Wallace
Nancy J. Wallace
answered on Oct 31, 2022

Give up on 'chatting' and put the words in writing and fax them to the office; keep a copy of the fax transmission report. When you have such an unprofessional institution you really need to put everything in writing, and immediately. I'll be the company's fax number is on... Read more »

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2 Answers | Asked in Employment Law for California on
Q: Large grocery store corporation has trouble paying us(employees), are we entitled to compensation?

I work for a large grocery store corporation, and they recently switched systems that they use to pay their employees, and I've been working for 3 pay periods and haven't received my 2 direct deposit OR a physical checks. They(the store) say they don't know when they can get my... Read more »

Nancy J. Wallace
Nancy J. Wallace
answered on Oct 28, 2022

The way you collect on all of those penalties and fines is to go to www.dir.ca.gov and find the WORKERS header and go to this: https://www.dir.ca.gov/dlse/HowToFileWageClaim.htm and file with the State for a Wage Claim. And when they offer you less than the full interest and penalty to... Read more »

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1 Answer | Asked in Workers' Compensation for California on
Q: Can I still receive worker's comp if I quit my current job, and if I haven't filed my claim yet?

I have had multiple issues with my current job besides my injury and want to leave as soon as possible, but have not been able to file my claim due to falling ill during the deadline week. I just began physical therapy for my hand and am looking for new work. If I file my claim after quitting my... Read more »

Nancy J. Wallace
Nancy J. Wallace
answered on Oct 12, 2022

Post-separation claims ARE PRESUMED NON-COMPENSABLE so filing after quitting is the worst idea possible. It takes about 2 minutes to write and submit the Workers Compensation Claim Form (DWC Form 1); it's FREE on the internet and your portion is 9 lines. You just hand a copy to the boss OR... Read more »

1 Answer | Asked in Workers' Compensation for California on
Q: My primary physician assigned by my workman’s comp insurance submitted a report that I am P&S but the insurance company

Disagreed and sent me to see QME the QME said that he doesn’t see anything really wrong but I’m still in pain so he recommended epidural lower back I jections and a cortisone shot for my elbow also recommended I see a pain management Dr and chiropractor. It doesn’t make sense to me why he... Read more »

Nancy J. Wallace
Nancy J. Wallace
answered on Oct 11, 2022

Sounds like you let the Insurer pick the worst doctors in the world for you. How sad! But the damage is done. It may be that the QME found you are not at Maximum Medical Improvement until you complete a course of conservative treatment, so the adjuster will just OK the Requests For... Read more »

1 Answer | Asked in Workers' Compensation for California on
Q: Yes but my mri’s and x rays show that I have spinal stenosis and a cyst on my inner elbow from my fall at work
Nancy J. Wallace
Nancy J. Wallace
answered on Oct 11, 2022

AGAIN: if you have a friendly, very carefully-chosen physician writing the evaluation report, the report could find that the Whole Person Impairment is increased as the result of stenosis and the cyst. There is no dollar amount add-on for spinal stenosis or a cyst. THE KEY is are these... Read more »

1 Answer | Asked in Workers' Compensation for California on
Q: Is there compensation for having a cyst on your inner elbow from falling at work. My inner elbow and lower arm hurts

When picking things up even driving. Injury was caused at work. Currently receiving temporary disability payments

Nancy J. Wallace
Nancy J. Wallace
answered on Oct 11, 2022

The cyst by itself has no value. At the end of your healing, the Treating Physician SHOULD write about your WHOLE PERSON IMPAIRMENT, the total impairment you have from all the body parts injured in the fall at work. Maybe the reporting doctor will write that a cyst is a great permanent... Read more »

2 Answers | Asked in Workers' Compensation for California on
Q: My QME says he doesn’t know why my back is still hurting after physical therapy and chiropractic care. It still hurts

They took MRI’s and X-rays and said that I shouldn’t be in so much pain but I am what can I do? My MRI’s show that I have spinal stenosis and that I have a cyst on my inner elbow from the fall

Nancy J. Wallace
Nancy J. Wallace
answered on Oct 11, 2022

Maybe the MRI really DOES show why there is so much pain but you have a jerk QME. If you have a real Treating Physician (unlikely if you let the adjuster pick), have the Treating PHysician go through these diagnostics report and write whether they do show the reason for ongoing pain.

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2 Answers | Asked in Employment Law, Workers' Compensation and International Law for California on
Q: International Independent Contractor law for wage claim

I am an independent contractor from the Philippines and my employer is a US citizen who has not paid for $2500 and more than 30 days past due. I need assistance in reference to the unsettled payment and corresponding charges for damages and other fees.

Nancy J. Wallace
Nancy J. Wallace
answered on Oct 5, 2022

Workers Compensation IS NOT a remedy for Independent Contractors. Wage Claims are NOT covered by the Workers Compensation Act of the Labor Code. (It sounds like it would, but it's just for employees who get physically hurt performing their job.) If you are an Independent Contractor, you... Read more »

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2 Answers | Asked in Workers' Compensation for California on
Q: How does one find a local attorney for a class action 25+ work related, personal injury.

My coworkers and I were placed in harm and contracted the Covid-19 disease causing significant illness.(Hospitalizations) This was as a result of documented and substantiated negligence on their part. How can one find an attorney to take on a case such as this one.

Nancy J. Wallace
Nancy J. Wallace
answered on Sep 14, 2022

This attorney doesn't exist because such a claim cannot exist. Work-related injury MUST go to the Workers Compensation Appeals Board. Work-related losses filed in Superior Court as a class-action or personal injury will be dismissed for lack of jurisdiction. Superior Court judges are not... Read more »

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1 Answer | Asked in Workers' Compensation for California on
Q: QME told me that I have a cyst on my elbow caused by the fall now he is recommending cortisone shots to help with the

Pain would this injury be permanent and would I be given anything In court for this injury even if the cortisone shots released the pain temporarily?

Nancy J. Wallace
Nancy J. Wallace
answered on Sep 14, 2022

You get ZERO for 'pain' in workers comp. If a physician on the network writes tht you have WHOLE PERSON IMPAIRMENT because of actions this elbow can no longer perform, there would be an award of Permanent Partial Disability. Only the Treating Physician can decide if the condition is... Read more »

2 Answers | Asked in Workers' Compensation for California on
Q: I've been evaluated by QME twice and he keeps recommending treatment that has been denied twice.

Will I have to see the QME a third time and is this normal in a workman's comp case?

Nancy J. Wallace
Nancy J. Wallace
answered on Sep 14, 2022

Sadly, yes this is normal. The insurance companies legally deny all treatment, and then the QME writes that the insurance company should have granted the treatment and you still are not at maximum improvement. If you had an attorney, that attorney should have shown the QME Report to the... Read more »

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2 Answers | Asked in Workers' Compensation for California on
Q: I've been off of work for 10 months and I just seen the Qme for a second evaluation he mentioned further treatment why

He said i have a cyst on my elbow and spinel stenosis mentioned epidural injections and pain management and chiropractor does this mean I am not MMI or P&S

Nancy J. Wallace
Nancy J. Wallace
answered on Sep 14, 2022

Correct! You are still temporarily partially or totally disabled, not yet at Maximum Medical Improvement. GET THE TREATMENT he suggests in his report or he's going to be ticked if you come back and you didn't elect a good Pain Mgt doc from the MPN and get the epidurals (or at least have... Read more »

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2 Answers | Asked in Workers' Compensation for California on
Q: Qme recommended lower back epidural injection if I refuse that type of treatment will it effect my workman's comp case
Nancy J. Wallace
Nancy J. Wallace
answered on Sep 8, 2022

If the TREATING PHYSICIAN tells you the next step is the epidural and you refuse, he will likely just declare you are at Maximum Medical Improvement. It's nearly impossible to get any surgery approved when the treater has not first tried an injection. When a Treating PHysician writes the... Read more »

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