Fremont, CA asked in Workers' Compensation for California

Q: How do I get the insurance carrier to pay ttd benefits?

My workers comp claim was denied but after seeing two qme’s, the insurance carrier has accepted all medical and all doctors reports with dates of ttd period. They just won’t pay ttd benefits. I’ve alread had an expedited hearing for ttd and they judge didn’t want to make a ruling because I had an appointment with the qme the following week. He wanted to see his opinion. Do I have to wait for next hearing and have the judge decide? Does the 14 day to pay benefits apply now that they have the report? They’ve known it’s a compensable claim for one year but just refuse to pay benefits. What steps do I need to take to have the insurance carrier begin benefits?

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2 Lawyer Answers

Ronald Mahurin

Answered
  • Workers' Compensation Lawyer
  • Point Arena, CA
  • Licensed in California

A: Yhe only eay to insure the payments are made is to return to court. If the medical reports are favorable and support TTD i suggest you file a penalty petition for unreasonable delay and ask for a 25% increase in TTD for the late payment. As for 14 days, when the claim was accepted the benefits were due, but the penalty should go back to the first day you missed work.

Nancy J. Wallace

Answered
  • Workers' Compensation Lawyer
  • Grand Terrace, CA
  • Licensed in California

A: The only way to get an insurer to pay is to insist the judge issue the order. IF YOU REALLY had a report upon which the judge could make a ruling, you needed to insist you could not wait for the QME findings. It sounds like you did not have a report sufficient as 'substantial evidence' so the judge said she needed the QME report upon for that 'substantial evidence' to support an order of TTD. The insurer is only going to be ordered to pay TTD when you get a report from a physician on that insurer's Medical Provider Network, so get into treatment with an MPN physician physician immediately...THAT will take about 15 faxes, 25 phone calls and 7 letters to the adjuster and the adjuster's supervisor. when you get the MPN physician's report indicating you are TTD still, then the adjuster will start paying the date of that report.

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